A Nurse/CHO is caring for a group of patients. According to the CHO, which patient should have a higher risk of Fluid Volume Excess?

Appeared in: Uttarakhand CHO - 2021

Explanation

The patient with kidney failure is at the highest risk for Fluid Volume Excess (Hypervolemia).
Kidney failure impairs the body's ability to excrete water and sodium, leading to their abnormal retention.
This retention causes an isotonic expansion of the extracellular fluid, resulting in fluid overload, edema, and potentially life-threatening complications like pulmonary edema.
Contributing factors to hypervolemia include heart failure, cirrhosis, and kidney injury.

Option B: A patient with an ileostomy loses a large volume of liquid stool, putting them at high risk for Fluid Volume Deficit (dehydration), not excess.
Option C: Diuretics are medications used to treat fluid volume excess by increasing urination. Therefore, a patient taking diuretics is at risk for Fluid Volume Deficit, not excess.
Option D: Gastric tube (GT) suctioning removes stomach fluids and electrolytes. This leads to fluid loss and places the patient at risk for Fluid Volume Deficit and metabolic alkalosis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Fluid Balance and Imbalance to guide bedside assessment, documentation, and the next nursing action.
Accurate fluid balance monitoring is a critical nursing responsibility. It involves tracking intake (oral, IV) and output (urine, drains, stool) to detect imbalances early.
For patients with kidney failure, nurses must meticulously manage fluid restrictions, monitor for signs of overload, and prepare the patient for treatments like dialysis.
A key patient safety point is understanding that a rapid weight gain of 1 kg in 24 hours is not due to fat or muscle but indicates retention of 1 liter of fluid, requiring prompt assessment and potential intervention.

How to Approach the Question

First, identify the core concept of the question, which is 'Fluid Volume Excess'.
Analyze each option by considering the pathophysiology of the condition or the mechanism of the intervention.
For 'kidney failure', recall that the kidneys regulate fluid balance. Failure means this regulation is lost, leading to fluid retention (excess).
For 'ileostomy', 'diuretics', and 'GT suctioning', recognize that these all involve the removal or loss of fluid from the body, leading to a risk of fluid deficit.
Compare the outcomes. Three options lead to fluid deficit, while only one leads to fluid excess.
Select the option that directly aligns with the risk of fluid accumulation or excess.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 144-146

E6 Nursing Fundamentals Taylor p. 788-790

Practise the full Uttarakhand CHO - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.