The nursing problem of fluid overload

Fluid overload may be the result of the abnormal retention of water and sodium. This imbalance may be a result of reduced function of homeostatic mechanisms or by simply overloading with fluids (Methany, 2000). In this assignment, the nursing problem of fluid overload will be discussed, with respect to one particular patient who was admitted to the medical ward, on which I did my recent clinical placement. The holistic impact on the patient as a result of this problem will be explored in detail along with one of the many nursing interventions which was used in an effort to curb the problem.

The advantages and disadvantages of the chosen intervention will also be further discussed. By the end of this essay, my feelings about the implementation of fluid balance charts in this situation and learning outcomes will have been known. Holism, as expressed by Basford and Slevin (2003) presumes that human beings are individuals who are greater than and should be treated more than the sum of their parts. In the onset of illness, in order to give the correct care interventions for promotion and restoration of health, it is essential that all aspects of individuals are assessed.

Volume overload may present itself in innumerable ways (Majorowicz and Hayes-Christiansen, 1989) and may cause a huge problem for the patient and their families (Wallace, 1998). Dyspnoea on exertion, increased fatigue, weight gain and oedema are all features of fluid overload. The above mentioned symptoms impacted negatively on the physical, psychological and social aspects of the patient’s life. Faulkner (2000) recognizes oedema as the main visible effect of fluid overload. Oedema is described by the Dictionary Of Medicine (2001) as “swelling of part of the body caused by the accumulation of fluid in the intercellular tissue spaces. The presence of oedema restricted his movement due to the immense swelling of his feet especially round his ankles, one of the first places for excess water to accumulate due to the effects of gravity (Kidneywise Community, 2001). The result of such an impairment included disengagement from normal activities which affected his social life. The patient was therefore branded as antisocial by family members and friends. Other sites in which swelling occurred were the wrists and face, especially round the eyes. The patient’s body image was greatly altered which had a drastic psychological effect on him.

The sudden change to way of life led to severe stress, anxiety and frustration. All the other symptoms which were present in the patient were contributing factors to further psychological and physical destruction and in turn affected the social aspects of his life. For example shortness of breath added to the patient’s anxiety and increased fatigue led to decreased mobility. The “standard man” consists of sixty percent (60%) fluid and the weight at which this is present is referred to as the “dry weight” (Wallace, 1998).

The term fluid balance describes the condition where the amount of water required by the body is present and normally proportioned among the existing compartments (Stevenson, 1998). The amount of fluid lost from the body normally, should equal the amount gained. In the case of fluid overload, the intake of fluid over a twenty-four (24) hour period significantly exceeds the amount lost resulting in over hydration (Smith, 2000). In the overloaded patient, the patient’s need for intake and output must therefore be assessed (Smith at al, 2004). As a result, a daily written record of patient’s total fluid intake and output must be established.

It is for this reason that the daily fluid balance chart (see appendix 1) was put into effect. The enforcement of the fluid balance chart, as like any other nursing intervention, had both negative and positive effects on the patient. Fluid balance charts may be used as teaching aids to help patients in the management and restriction of ingested fluids (Hemmisley, 1999). A fluid restriction was mandatory for the patient due to the underlying cause of overload, renal failure. Fluid restrictions, aid in the reduction of total body water and prevents the accumulation of excess fluid (Ulrich and Canale, 2001).

The patient was able to remain within the limits of his restriction, thereby increasing his comfort levels. The chart, once explained to the patient can be easily maintained. This enabled the patient to take an active part in his care working in collaboration with the members of staff. Tschudin (2003) acknowledges “individual freedom” as one of the ethical principles and recognizes the need for it to preserve life. By restricting the amount of fluid consumed daily, the patient was deprived of his right to freedom. Apart from measuring fluid input, fluid output measurement is of similar importance (Smith et al, 2004).

What may be considered as “little things” may have a grave effects on patients dignity (Basford and Slevin, 2003). This may entail the use of disposable bed pans and urinals. Basford and Slevin (2003) further acknowledge the fact that difficulty is faced when trying to maintain patient’s dignity in medical settings. I agreed with the implementation of the intervention for I recognized the importance of strict monitoring of fluid intake and output in the overloaded patient. Although the chart appeared to be simple, I knew some degree of difficulty would be faced with, in terms of maintenance.

Difficulty arose due to lack of calibrated drinking cups, failure to measure, omission and lack of communication amongst staff members involved in the patient’s care (Metheny, 2000). At times I felt humiliated when completing the chart as intimate questions of bowel movement, which appeared to make the patient uncomfortable, were asked. The knowledge gained throughout this experience will be useful towards future competence. I am now able to recognize the need for fluid balance charts in one area, as it’s relevance in certain areas of care are continuously criticized (Challinor and Sedgewick, 1998).

The result of fluid overload can be devastating (Alexander et al, 2000) and have detrimental effects on all aspects of the patient’s life. One of the nursing interventions which may be used in an effort to decrease fluid overload is the use of the fluid balance chart, which records daily fluid input and output. The implementation of such an intervention had both negative and positive effects on the patient. The knowledge gained from this incident will be useful and be put towards future practice in an effort to increase the accuracy of the chart.

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