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1

What is fluid volume excess?

What is the vascular space ?

Too much volume in the vascular space

The vascular space is arteries, veins and chambers of the heart

2

What is the first thing you should think of when you hear Fluid Retention?

Heart
Problems FIRST

3

What are some causes of fluid volume excess ?

1.)CHF: The heart is weak, cardiac output decreases, decreased kindey perfusion, Decrease urinary output

2.) RF: kidneys aren't perfusing

3.) Alka-Seltzer, Fleet enemas, IVF with Na!! (All three have a lot of sodium)



4

8 Signs and symptom of fluid volume excess

1.)Distended neck veins/peripheral veins: vessels are full

2.)Peripheral edema, third spacing: vessels can’t hold anymore so they start to
Leak.

3.)CVP: measured where right atrium; number goes up CVP Normal: 2-6 mmHg

More__ volume More_ pressure


4.)BP: increases more volume….more pressure


5.)Pulse: up your heart only wants fluid to go forward
g. If the fluid doesn’t go forward it’s going to go backward into the lungs.
Can lead to heart failure then pulmonary edema.



6.) Lungs sound wet


d.

e Polyuria: kidneys trying to help you

5

4 FLE treatment

Tx:

a. Low Na diet/ restrict fluids

b. I and O’s and Daily weights

c. Diuretics:

• Loop: Example: Lasix

Bumetanide (Bumex®) may be given when Furosemide (Lasix®) doesn’t
work.

• Hydrochlorothiazide (Thiazide®) Watch lab work with all diuretics.
Dehydration and electrolyte problems
• K+ sparing: Example: Aldactone

d. Bed rest induces diuresis by release of ANP and, ↓ production of ADH.

e. Physical assessment Meaning signs and symptoms

f. Give IVFs slowly to elderly. Very young and patients with heart and kidney disease

6

With FLD u should think of what 1st?

Shock

7

FLD causes

1.Loss Of fluids was from anywhere
Examples : thoracentesis, paracentesis, vomiting diarrhea hemorrhage

2. Third spacing( when fluid is it a place it does you no good)
. Burns
.Ascites

3. Diseases with polyuria
Example : DM

8

FLD 11 S and S

1.Weight decrease
2.Poor skin turgor
3.Dry mucous membranes
4.) urine specific gravity goes up if they any urine all
5.)decreased urinary output
6.)Decrease BP (at risk for postural hypotension)

7.) Decrease CVP
8.)Increase pulse but it's weak and ; thready
9.)Increased respiration
10.)cool and calmly skin
11.) Peripheral veins/neck veins vasoconstriction

9

FLD TREATMENT

Prevent further fluid los


Tx:
a. Prevent further __________.
b. Replace volume
• Mild Deficit: _________
• Severe Deficit: _________
c. SafetyPrecautions
• Higher risk for ________
• Monitor for overload.

10

Normal action of aldosterone

When blood volume get low( vomiting, hemorrhage,etc)- aldosterone secretion increases- to help retain Na/water which increases the BP

11

Where is aldosterone found

Adrenal glands

12

Disease with to little aldosterone

Addison

13

Diseases with too much aldosterone

1.Cushing
2.hyperaldosteronism

14

Where is atrial natriuretic peptide (ANP) found?

In the atrial of the heart

15

How does atrial natriuretic peptide (ANP) work?

It's acts the opposite of aldosterone
So it's excretes Na/water instead of retaining them

16

ADH helps u retain what?

Water

17

ADH is found in the

Pituitary

18

2 ADH problems are?

S I ADH
DI

19

the less the urine out; the higher the _________?
the more the urine out; the lower the ________?

the less the urine out; the higher the specific gravity...
the more the urine out; the lower the specific gravity

20

S I ADH is

What are they in ? And why ?

Describe the blood and urine ?

Fluid volume excess
Fluid is retained in the vascular space

The blood it is dilute urine is concentrated

21

SIADH finding

Specific gravity_____

Serum sodium_______

Serum osmolality______

Specific gravity_____high

Serum sodium_______low

Serum osmolality______low

22

DI is

What are they in ? And why ?

Describe the blood and urine ?

Fluid volume deficit

Because they diuresing

Urine is concentrated and the blood is dilute

23

DI Finding


Specific gravity_____

Serum sodium_______

Serum osmolality______

Specific gravity_____low

Serum sodium_______high

Serum osmolality______high

24

Cause of ADH problems

Things invoking the head

Things invoking the head
Craniotomy
Head injury
sinus surgery
Transsphenoidal hypophysectomy

25

4 examples of isotonic solutions

1.) 0.9% NS ( sodium chloride) ( normal saline ) (0.9%NS)

2.) LR (lactated ringers)

3.) D5W (dextrose in water 5%)


4.) D5W 1/4 NS ( 5% dextrose in 0.225% saline)

26

Isotonic solutions go where?

In the vascular space and stay there

27

When is normal saline use

The client that lost fluids through_______???.”

Normal saline is the basic solution with administrating ____?


Alert---do not use isotonic solutions in clients with ______, ____, or ______?? And why don’t we give to these client

The solutions can cause fluid volume excess, hypertension, and hypernatremia (Hypernatremia is an alert only when administrating isotonic solutions that contain sodium)

The client that lost fluids through nausea, vomiting, burns, sweating, trauma.

Normal saline is the basic solution with administrating blood


Alert---do not use isotonic solutions in clients with hypertension, cardiac disease, or renal disease

The solutions can cause fluid volume excess, hypertension, and hypernatremia (Hypernatremia is an alert only when administrating isotonic solutions that contain sodium)

28

Hypotonic solutions go where

Into the vascular space then shift out into the cells to replace cellular fluid

They rehydrate but do not cause hypertension

29

4 hypotonic solution examples

1.) 0.45% sodium chloride (normal saline) (1/2)

2.) 0.225% sodium chloride (normal saline) 1/4 NS

3.) 0.33% sodium chloride )normal saline ) 1/3 NS

4.) Tap water

30

Hypotonic s



The client who has ____, ___ or ___ disease and needs fluid
replacement because of ___, ___, ___, ____, etc.
• Also used for dilution when a client has ____, and for ___ dehydration.
Alert:Watch for cellular edema because this fluid is moving out to the cells which could lead to fluid volume __________ and ______ blood pressure.

The client who has hypertension, renal or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage Etc

Also used for dilution when a client has hypernatremia and for cellular dehydration


ALERT-----watch for cellular edema because this fluid is moving out to the cells which can lead to fluid volume deficit and decreased blood pressure