Excessive fluid volume risk middle-range theory

Fernandes, Maria Isabel da Conceição Dias; Dantas, Juliane Rangel; Gabriel, Maynara Caroline Gomes; Matias, Karolayne Cabral; Lopes, Marcos Venícios de Oliveira; Lira, Ana Luisa Brandão de Carvalho

doi:10.1590/2177-9465-EAN-2021-0513en

Maria Isabel da Conceição Dias Fernandes

Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem. Natal, RN, Brasil.

http://orcid.org/0000-0003-0569-5027

Juliane Rangel Dantas

Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem. Natal, RN, Brasil.

http://orcid.org/0000-0002-1542-1559

Maynara Caroline Gomes Gabriel

Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem. Natal, RN, Brasil.

http://orcid.org/0000-0002-3245-0597

Karolayne Cabral Matias

Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem. Natal, RN, Brasil.

http://orcid.org/0000-0003-0484-8693

Marcos Venícios de Oliveira Lopes

Universidade Federal do Ceará, Departamento de Enfermagem. Fortaleza, CE, Brasil.

http://orcid.org/0000-0001-5867-8023

Ana Luisa Brandão de Carvalho Lira

Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem. Natal, RN, Brasil.

http://orcid.org/0000-0002-7255-960X

Corresponding author: Maria Isabel da Conceição Dias Fernandes. E-mail: bebel_6@hotmail.com

AUTHOR’S CONTRIBUTIONS

Study design. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Data collection or production. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Data analysis. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Interpretation of results. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Article writing and critical review. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Approval of the final version of the article. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

Responsibility for all aspects of content and integrity of published article. Maria Isabel da Conceição Dias Fernandes. Juliane Rangel Dantas^. Maynara Caroline Gomes Gabriel. Karolayne Cabral Matias. Marcos Venícios de Oliveira Lopes. Ana Luisa Brandão Carvalho Lira.

EDITOR ASSOCIADO
http://orcid.org/0000-0001-5141-289
Candida Primo Caniçali

EDITOR CIENTÍFICO
http://orcid.org/0000-0002-1522-9516
Ivone Evangelista Cabral

Essential concepts of excessive liquid volume risk	n (%)
Interdialytic weight gain above 3.5% of dry weight	14 (17.07)
Excessive hydration	14 (17.07)
Excessive fluid retention	13 (15.8)
Isotonic liquid accumulation process	04 (4.8)
Lack of body volume control	01 (1.2)
Definition: vulnerability to excessive fluid retention that occurs when interdialytic weight gain is greater than 3.5% of dry weight, due to excessive hydration, able to lose control of body volume and compromise health.

Etiological factors	n (%)
Focal stimuli
Inadequate removal of fluids during hemodialysis	10 (12.1)
Increased dialysate sodium concentration	05 (6.1)
Diet abuse	04 (4.8)
Excessive fluid intake	04 (4.8)
Decline in renal function	02 (2.4)
Decreased ultrafiltration volume	02 (2.4)
Diuresis failure	02 (2.4)
Absence in hemodialysis session	01 (1.2)
Decreased body fat	01 (1.2)
Vascular access failure	01 (1.2)
Low Kt/V index	01 (1.2)
Contextual stimuli
Comorbidities	10 (12.1)
Conventional intermittent hemodialysis	08 (9.7)
Low self-efficacy for fluid intake	05 (6.1)
Altered Body Mass Index	05 (6.1)
Excessive sodium intake	05 (6.1)
Increased experience in dialysis treatment	04 (4.8)
Thirst	03 (3.6)
Dry mouth	03 (3.6)
Low serum albumin level	02 (2.4)
Elevated serum phosphorus level	02 (2.4)
Insufficient water assessment	01 (1.2)
Poor knowledge	01 (1.2)
Inflammatory state	01 (1.2)
Daily stress	01 (1.2)
Hospitalization	01 (1.2)
Use of antihypertensive drugs	01 (1.2)
Decreased serum lymphocyte level	01 (1.2)
Residual stimuli
Young adults	04 (4.8)
Older adults	02 (2.4)
African-American	02 (2.4)

1. The state of body water balance in patients undergoing hemodialysis is related to fluid intake and excretion. Ingestion occurs through beverage and food consumption, and excretion occurs through the elimination of feces, breathing, sweat and, mainly, through urine, which is regulated by the kidneys. In these patients, renal function is impaired; therefore, ingested food and liquids are not sufficiently eliminated, a problem that triggers the ineffective behavior of excessive intracellular/extracellular water retention.

2. Focal, contextual and residual stimuli affect the physical-physiological mode of individuals undergoing hemodialysis and reach the basic need for fluids, increasing the vulnerability of chronic kidney patients undergoing hemodialysis to the occurrence of ineffective behavior of excessive water retention.

3. Depending on the type of stimulus applied to patients undergoing hemodialysis, the behavior of excessive intracellular/extracellular water retention may vary to a greater or lesser extent.

4. The fluid balance of patient undergoing hemodialysis is affected by stimuli from the patients themselves (biological-genetic, psychosocial and sociodemographic) and influenced by the actions of health professionals who work in hemodialysis.

5. Focal stimuli such as dietary abuse, absence from hemodialysis session, decline in renal function, decrease in body fat, excessive fluid intake and failure to urinate are originated from the choices made by patients undergoing hemodialysis or their own biological processes, and directly reflect the increase in vulnerability to the development of excessive water retention behaviors.

6. Focal stimuli such as increased dialysate sodium concentration, decreased ultrafiltration volume, failed vascular access, lower Kt/V and inadequate fluid removal during hemodialysis involve the actions performed by health professionals directly involved in the care of patients undergoing hemodialysis and directly reflect on the increased vulnerability to water retention behavior.

7. Contextual stimuli such as comorbidities, inflammatory status, daily stress, hospitalization, altered body mass index, excessive sodium intake, increased experience in dialysis treatment, decreased serum albumin and lymphocyte level, elevated serum phosphorus, thirst and dry mouth arise from choices made by patients undergoing hemodialysis or are caused by biological processes and can influence/potentiate the development of excessive water retention behavior.

8. Plasma sodium plays a central role in fluid balance in patients undergoing hemodialysis. The change in plasma sodium level is responsible for affecting liquid volume.

9. Low self-efficacy for fluid intake is a behavior that originates in the self-concept identity mode, but acts as a contextual stimulus that affects the physical-physiological mode of patients undergoing hemodialysis, and may influence/potentiate the development of excessive water retention behavior.

10. Contextual stimuli such as insufficient water assessment and use of antihypertensive drugs are factors resulting from the behavior of health professionals who work in hemodialysis and can influence/potentiate the development of excessive water retention behavior.

11. The occurrence of contextual stimuli such as deficient knowledge and conventional intermittent hemodialysis derive jointly from the conduct of health professionals that act in hemodialysis and the attitudes of patients undergoing hemodialysis and can influence the development of excessive water retention behavior.

12. Sociodemographic factors such as being older adult, being a young adult, and/or being African-American are residual stimuli that can influence the development of excessive water-retaining behavior in some way.

Excessive liquid volume risk
Domain 2. Nutrition
Class 5 Hydration
Definition: vulnerability to excessive fluid retention that occurs when interdialytic weight gain is greater than 3.5% of dry weight, due to excessive hydration, able to lose control of body volume and compromise health.
Risk factors
• Diet abuse	• Altered Body Mass Index
• Absence in hemodialysis session	• Excessive fluid intake
• Insufficient water assessment	• Excessive sodium intake
• Low self-efficacy for fluid intake	• Increased experience in dialysis treatment
• Poor knowledge	• Lower Kt/V index
• Decreased body fat	• Inadequate removal of fluids during hemodialysis
• Daily stress	• Thirst
• Vascular access failure	• Dry mouth
Populations at risk
• Young adults
• Older adults
• African-American or white race
Associated conditions
• Increased dialysate sodium concentration
• Comorbidities
• Decline in renal function
• Decreased ultrafiltration volume
• Inflammatory state
• Diuresis failure
• Hospitalization
• Conventional intermittent hemodialysis
• Low serum albumin level
• Elevated serum phosphorus level
• Decreased serum lymphocyte level
• Use of antihypertensive drugs

[1] Corresponding author: Maria Isabel da Conceição Dias Fernandes. E-mail: bebel_6@hotmail.com

Brasil

Brasil

Excessive fluid volume risk middle-range theory

ABSTRACT

Objective

Method

Results

Conclusion and implications for practice