Fluid and Electrolytes : 1

Question 1

Fluid volume excess/ hypervolemia: too much fluid in the ______.

Answer 1

vascular space

Question 2

What are the hormonal regulation of fluid volume?

Answer 2

aldosterone
ANP
ADH

Question 3

where is aldosterone found?

what is its normal action?

Answer 3

adrenal gland (on top of the kidneys)

when the blood volume gets low, aldosterone secretions increase.
RETAIN SODIUM AND WATER, blood volume goes up

Question 4

Diseases with too much aldosterone?

Answer 4

cushings syndrome

heperaldosteronism (conn’s syndrome)

Question 5

Diseases with too little aldosterone?

Answer 5

addison’s disease

Question 6

ANP (Atrial natriuretic peptide) is found?

What is its normal action?

Answer 6

atrium of the heart

it works the opposite of aldosterone

it causes EXCRETION OF SODIUM AND WATER

Question 7

“ADH , _____.”

Answer 7

h2O

Question 8

ADH normally makes you retain or release?

Answer 8

retain; WATER ONLY

Question 9

Too much ADH

Answer 9

SIADH (Retain water, fluid volume excess)
[TOO many letter, TOO much water]

urine is (decreased) concentrated, blood is low (dilute)

Question 10

Not enough ADH

Answer 10

Diabetes Insipidus  (lose water, fluid volume deficit)
D---Diuresis (shock)

Urine is dilute and blood is concentrated.

Question 11

Concentrated makes numbers go UP

Dilute makes numbers go DOWN

For what lab values?

Answer 11

Urine specific gravity

sodium

hemocrit

Question 12

ADH is found in the _____.

What makes you think of ADH problems?

Answer 12

pituitary gland (attached to the base of the brain)

craniotomy, head injury, sinus surgery, any condition that can lead to an increase ICP can lead to an ADH problem

Question 13

What is the name for ADH hormone medication?

Answer 13

Vasopressin (Pitressin)
or
desmopressin acetate (DDAVP)
*these may be utilized as an ADH replacement in DI.

Question 14

Lung sounds are __ with hypervolemia?

Answer 14

wet

will hear low in the bases first

Question 15

Fluid retention think ______ first!!

Answer 15

heart problems**

Question 16

Loop diuretic ?

Answer 16

furosemide (laxis)

Question 17

potassium sparing diuretic?

Answer 17

spironolactone

Question 18

Bed rest induces _____ by the release of ____ and decrease the production of ____.

Answer 18

diuresis
ANP
ADH

Question 19

bedrest patient, where do you look for edema?

Answer 19

SACRUM! (gravity)

also, think about skin breakdown

Question 20

Fluid volume deficit/ hypovolemia: ___

Answer 20

BIG TIME DEFICIT =SHOCK
loss of fluid anywhere
examples- thoracentesis, paracentesis, vomitting, diarrhea, and hemorrhage

Question 21

What is third spacing?

when can this happen?

Answer 21

when the fluid is in a space that does you NO good. which can happen with burns and ascites

Question 22

with ascites, what would you key into?

Answer 22

measure abdominal girth daily

fluid in the peritoneal cavity- think cirrhosis

Question 23

replace volume:
mild deficit, ____
severe deficit ____

Answer 23

mild- PO fluid

severe- IV fluid

Question 24

what causes fluid volume excess in heart failure?

Answer 24

heart is WEAK, cardiac output goes DOWN, DECREASED kidney perfusion, urinary output goes DOWN.

The volume stays in the VASCULAR SPACE.

Question 25

what are 3 things with alot of sodium that could cause fluid volumes excess?

Answer 25

1. effervescent sodium medications (alka seltzer) 2. canned/processed foods 3. IVF with sodium

Question 26

Aldosterone is a ______!!

Answer 26

STEROID& mineralcorticoid

Question 27

Normal CVP value?

Answer 27

2-6mmHG

Question 28

What are the s/s of fluid volume excess?

Answer 28

- distended neck veins/peripheral veins (veins are FULL) - peripheral edema/ third space (veins cant hold anymore so they start to LEAK - CVP goes UP (more volume, more pressure) - lung sounds; WET - polyuria (kidneys are trying to help you diurese) - pulse UP (your heart only want the fluid to go forward!) IF the fluid cant go forward, its going to go backwards into the lungs. can lead to heart failure, then pulmonary edema. - BP UP - weight UP

Question 29

what causes hypovolemia?

Answer 29

Loss of fluid anywhere third spacing diseases with polyuria (polyuria-oliguria-anuria)

Question 30

s/s of hypovolemia?

Answer 30

- weight goes DOWN - decreased skin turgor - dry mucous membranes - decreased urine output (kidneys either arent being perfused or they are trying to hold on to fluid. (compensate)) - BP DOWN - pulse UP (heart is trying to pump what little fluid it has) - respirations UP - CVP DOWN - peripheral veins/ neck veins VASOCONSTRICT - cool extremities - urine specfic gravity UP

Question 31

Define isotonic solution

Answer 31

"balance solution" goes into VASCULAR SPACE and stays there increases BP

Question 32

example for isotonic solution

Answer 32

NS LR D5W D51/4NS

Question 33

the uses for isotonic solution?

Answer 33

the client that has lost fluids through nausea, vomiting, burns, sweating and trauma.

Question 34

______ is the basic solution when administering blood

Answer 34

NORMAL SALINE

Question 35

DO NOT use isotonic solution in clients with ?

Answer 35

hypertension cardiac disease renal failure (stays in vascular so causes high bp)

Question 36

isotonic solutions can cause ?

Answer 36

FVE, HTN, hypernatremia ( only when the solution contains sodium)

Question 37

define hypotonic solution

Answer 37

goes into VASCULAR SPACE and then SHIFTS out into the cells to replace cellular fluid

Question 38

hypotonic solution rehydrate and DO NOT CAUSE ____.

Answer 38

hypertension

Question 39

Examples of hypotonic solution

Answer 39

d2.5w 1/2NS 0.33%NS

Question 40

the uses for hypotonic solution

Answer 40

the client who has HTN, renal or cardiac disease and needs fluid replacement bc of nausea, vomiting, burns hemorrhage, etc. also used for dilution when a client has hypernatremia and for cellular dehydration

Question 41

what should you watch for with hypotonic solution?

Answer 41

cellular edema because this fluid is moving out to the cells, which could lead to fluid volume DEFICIT and decrease bp

Question 42

Define hypertonic solutions

Answer 42

(packed with particles) | volume expanders that will draw fluid into the vascular space from the cell.

Question 43

examples of hypertonic solutions

Answer 43

``` D10W 3% NS 5% NS D5LR D51/2NS D5NS TPN Albumin ```

Question 44

the uses of hypertonic solutions

Answer 44

the client with hyponatremia or a client who has shifted large amounts of vascular volume to a third space or has severe edema, burn or ascites. -A hypertonic solution will return the fluid volume to the vascular space.

Question 45

What should you watch for with hypertonic solutions?

Answer 45

fluid volume excess. monitor in an ICU setting with frequent monitoring of BP, Pulse, and CVP, especially if they are receiving 3%NS or 5%NS watch for pulmonary edema

Question 46

stay where I put It

Answer 46

Isotonic solutions

Question 47

Enter the vessel

Answer 47

hypErtonic solutions

Question 48

gO Out Of the vessel

Answer 48

hypOtonic solutions

Question 49

fluid retention think....

Answer 49

HEART problems FIRST!!

Question 50

polyuria think...

Answer 50

SHOCK