Overloaded Olive — Fluid Volume Overload: Crackles, Bounding Pulse & Stop the Infusion
The IV ran wide open, and now she is coughing pink froth with veins standing out in her neck
Olive's IV was left at a high rate overnight. By morning she has gained 3 kg, her neck veins bulge, and crackles fill both lung bases.
Olive received IV fluid faster than her heart and kidneys could handle, causing fluid volume overload. The picture is bounding pulse, elevated blood pressure, distended neck veins, crackles in the lungs, dyspnea, dependent edema and rapid weight gain — one kilogram equals about one liter of fluid. The nursing sequence the exam expects: slow or stop the infusion, raise the head of the bed, give oxygen, notify the provider and anticipate a diuretic. Compare with dehydration, where the pulse is weak and thready, veins are flat and urine is concentrated.
Read Overloaded Olive's full story →The story arc
The setup
Olive, 78 with heart failure, is admitted for dehydration and IV fluids are started at a generous rate.
The turn
By morning she has gained 3 kilograms, her pulse is bounding, and her blood pressure is up.
The crisis
Olive becomes short of breath, sits bolt upright, and crackles are audible in both lung bases with a moist cough.
The save
The nurse slows the infusion to keep the vein open, raises the head of the bed, applies oxygen, notifies the provider and gives the ordered furosemide, then tracks weight and output.
NCLEX study section — Fluid Volume Overload: Crackles, Bounding Pulse & Stop the Infusion
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.