What is Fluid Volume Excess/Hypervolemia?
Too much fluid in the vascular space (veins, capillaries, arteries)
What are the causes of FVE? Also, state 3 things with a lot of sodium.
Heart Failure (HF): Heart is WEAK, Cardiac Output (DOWN), DECREASED Kidney Perfusion, Urinary Output (DOWN). The volume stays in the vascular space.
Renal Failure: Kidneys aren't working.
Three Things with a lot of Sodium:
1. Effervescent soluble medications
2. Canned/processed foods
3. IVF with sodium
Tell me about Hormonal Regulation of fluid volume. Start with Aldosterone.
Aldosterone (steroid, mineralocorticoid) Found in ADRENAL GLANDS (right above kidney) Normal action: When blood volume gets low (vomiting, hemorrhage, etc.) --> Aldosterone secretion increases --> RETAIN sodium/water --> blood volume goes UP.
Give me 2 diseases with TOO MUCH aldosterone.
1. Cushing's Disease
2. Hyperaldosteronism (Conn's Syndrome)
Give me a disease with TOO LITTLE aldosterone.
1. Addison's Disease.
Tell me about Hormonal Regulation of fluid volume. Continuing with Atrial Natriuretic Peptide. (ANP)
ANP is found in the ATRIA of the heart. Function: Works the OPPOSITE of aldosterone. So it causes EXCRETION of SODIUM and WATER.
Continuing on with Hormonal Regulation of fluid volume. What does Anti-diuretic Hormone (ADH) do? Does it make you retain or diurese? What does it make you retain or diurese?
Normally makes you RETAIN WATER.
What are your two ADH problems?
1. Too Much ADH 2. Not Enough ADH
Tell me everything you know about TOO MUCH ADH.
1. Retain WATER 2. Fluid Volume EXCESS 3. Syndrome of Inappropriate ADH Secretion 4. SIADH 5. Too many LETTERS, too much WATER. 6. Urine DECREASE & Concetrated 7. Blood DILUTED
Tell me everything you know about NOT ENOUGH ADH.
1. Lose (diurese) WATER
2. Fluid Volume DEFICIT
3. Diabetes Insipidus --> SHOCK!!!
4. DI - DIabetes Insipidus (has nothing to do with your blood sugar) --> DIuresis.
5. Urine is DILUTED (Large amounts)
6. Blood is CONCENTRATED
Concentrated makes #'s go?
Concentrated makes #'s go up.
2. Specific Gravity
Dilute makes #'s go?
Dilute makes the #'s go DOWN.
2. Specific Gravity
Where is ADH found?
ADH (Anti-diuretic Hormone) is found in the PITUITARY. (between your eyeballs)
1. Give key words to make you think potential ADH problems.
2. Also, what's another name for ADH?
3. And, what drug can be utilized as an ADH replacement in Diabetes Insipidus?
A. KEY WORDS
2. Head Injury
3. Sinus surgery
4. Transsphenoidal Hypophysectomy
Trans - go all the way through
Sphenoid - Sinus
Hypophysis - Pituitary
Ectomy - taking something out
Or any condition that can lead to INCREASED ICP can lead to an ADH problem.
B. ANOTHER NAME:
C. DRUG utilized as ADH replacement.
Desmopressin acetate (DDAVP) Used as nasal spray.
What are signs/symptoms of fluid volume excess?
1. Distended neck veins/peripheral veins: Vessels are BIG & FULL
2. Peripheral edema/third spacing: Vessels can't hold any more, so they start to LEAK OUT.
3. Central Venous Pressure (CVP): Measured in Right Atrium so NUMBER goes UP.
MORE VOLUME, MORE PRESSURE!!!
4. Lung sounds: WET. (Bibasilar crackles)
5. Polyuria: Kidneys are trying to help you DIURESE.
6. Pulse: It goes UP. Your heart only wants fluid to go FORWARD.
7. If the fluid doesn't go forward, it's going to go BACK into the lungs. Can lead to HEART FAILURE then PULMONARY EDEMA.
8. Blood pressure goes UP. MORE VOLUME, MORE PRESSURE!!!
9. Weight INCREASES. Any acute gain or loss isn't fat, it's FLUID.
What is the treatment for Fluid Volume Excess (FVE)?
1. Low Sodium Diet/restrict fluids.
2. I & O and Daily WEIGHTS.
- A. Same TIME
- B. Same SCALE
- C. Same CLOTHES
- D. Void FIRST!
(can delegate to UAP)
- Loop: FUROSEMIDE (LASIX)
- Bumetanide (BUMEX) may be given if Furosemide (Lasix) doesn't work.
- Hydrochlorothiazide -HCTZ (THIAZIDE): Watch lab work with all diuretics for DEHYDRATION and ELECTROLYTE problems.
- Potassium Sparing: SPIRONALACTONE - Saves POTASSIUM!
4. Bed rest induces DIURESIS by the release of ANP and, DECREASED production of ADH.
5. Physical Assessment
- Focus on the pertinent signs and symptoms.
6. Give IVFs slowly to the ELDERLY and very YOUNG. (Heart and Kidney pts. @risk of FVE.)
Patient Improved Assessment after FVE:
Lung Sounds: CLEAR
What is another term for Fluid Volume Deficit?
Fluid Volume Deficit = Hypovolemia
- Big Time Deficit = SHOCK!
What are the causes of FVD (Fluid volume deficit)?
- Loss of fluids from anywhere'
- Third Spacing: When fluid is in a place that does you no good.
a. Burns: Fluid goes to tissues - BAD! Pt. is edematous.
- Ascites (Fluid in the Peritoneum): Measure Abdominal girth. Pt. may have TROUBLE BREATHING! Check BP! Often people with Liver disease have Ascites.
- Diseases with Polyuria
a. Polyuria (think shock first!) --> Oliguria --> Anuria
*PID (Particle Induced Diuresis)
*(Fluid comes from vascular space)
2. Signs/Symptoms of Fluid Volume Deficit
- Weight: DOWN - BP: DOWN - Pulse: UP
- Decreased skin turgor
- Dry mucous membranes
- Decreased urine output
a. Kidneys either aren't being perfused or they are trying to hold on to FLUID. (compensate)
LESS VOLUME, LESS PRESSURE!!!
- BP: DOWN (LESS VOLUME, LESS PRESSURE!!!)
- Pulse: WEAK, THREADY; Heart is trying to pump what little fluid is left around.
- Respirations: INCREASED
- CVP: DOWN (LESS VOLUME, LESS PRESSURE!!!)
- Peripheral veins/neck veins vasoconstrict (very tiny). Difficult to start IV.
- Cool extremities (peripheral vasoconstriction) in an effort to shunt blood to the vital organs.)
- Urine specific gravity: UP. If putting out any urine at all, it will be very CONCENTRATED.
- Prevent further LOSSES
- Replace volume:
a. Mild Deficit: PO FLUIDS
b. Severe Deficit: IV FLUIDS
- Safety Precautions
a. Higher risk for FALLS r/t CHANGES in VITAL and MENTAL STATUS
b. Monitor for overload.