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How does the nurse assess for fluid volume overload?
Asked on Nov 10, 2025
Answer
Assessing for fluid volume overload involves recognizing clinical signs and symptoms that indicate excess fluid in the body, which can affect various systems. Nurses use a combination of physical assessment, monitoring vital signs, and evaluating laboratory data to identify this condition.
Example Nursing Steps:
- Step 1 – Assess for signs of edema, particularly in the lower extremities, and listen for crackles in the lungs during auscultation.
- Step 2 – Monitor vital signs, especially blood pressure and heart rate, and check for jugular vein distention.
- Step 3 – Evaluate laboratory results such as serum electrolytes and BUN/creatinine levels, and document findings accurately.
Additional Comment:
- Fluid volume overload can lead to complications such as pulmonary edema and heart failure.
- Use the ABCs (Airway, Breathing, Circulation) to prioritize assessment findings.
- Unexpected findings like sudden weight gain or decreased urine output should be reported promptly.
- Patient education on fluid restrictions and monitoring daily weights can help manage fluid balance.
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