Flashcards in Fluids & Electrolytes I Deck (26):
Fluid Volume Excess (FVE) is also know as what?
Hypervolemia: Which means there is to much volume in the vascular space.
Vascular space includes what? (V.A.C.C)
Chambers in heart
What are the 3 main causes of FVE (hypervolemia)
High Sodium Intake
What happens when someone is in heart failure?
Heart is WEAK!
Cardiac output decreases
Kidney perfusion decreases
Urinary output decreases
What happens when kidney failure occurs?
KIDNEYS STOP WORKING!
Therefore: fluid remains in the vascular space.
List 3 things that contain a lot of sodium that cause FVE
1. Effervescent Soluble Meds
2. IV with sodium
3. Canned processed foods
* All 3 things contain sodium which makes you retain water in the vascular space.
Hormonal Regulation of Fluid Volume:
What is the name of the hormone that regulates fluid volume?
AKA: Steroid- Mineral Corticoid
Where is Aldosterone found and what is its normal action?
FOUND: ADRENAL GLANDS - On top of the kidneys.
ACTION: When blood volume gets to low i.e. vomiting, hemorrhage, diarrhea etc. then aldosterone secretion increases by retaining sodium/water, which causes blood volume to go up.
Name 2 diseases with too much Aldosterone.
1. Cushings Disease
2. Hyperaldosteronism AKA: CONNS SYNDROME
Name a disease with not enough Aldosterone
Arterial Natriuretic Peptide (ANP): Where is it located and how does it work?
FOUND: in the atria of the heart
ACTION: Works the opposite of aldosterone. So instead of retaining sodium/water it EXCRETES Sodium/water . Therefore it decreases blood volume and fixes FVE.
What does Anti-diuretic Hormone (ADH) do?
Name 2 ADH problems?
Makes you retain water!
1. Too much ADH
2. Not enough ADH
Urine specific gravity, Sodium, Hematocrit numbers do what when they are concentrate and Dilute?
Concentrate #'s GO UP
Diluted #'s GO DOWN
What happens when you have to much ADH?
Retain Water: FVE
AKA: Syndrome of Inappropriate ADH secreation (SIADH)
Note: To many letters = to much water.
Urine Concentrated #'s increase
Blood Diluted #'s decrease
What happens when you don't have enough ADH?
Lose Water (Diarese)
AKA: FVD = SHOCK
DIabeties Insipidus- nothing to do with blood sugars. Its an imbalance of water in the body that causes intense thirst even after drinking fluids (polydipsia), and excretion of large amounts of urine (polyuria).
Urine Diluted #'s decrease
Blood Concentrated #'s increase
NOTE: PT going into shock still have urine output!
ADH is found where?
Pituitary Gland (behind your eyes)
Note: ADH probs usually secondary to another problem.
Therefore anything that upsets your Pituitary Gland can lead to an ADH problem.
i.e. Craniotomy, head injury, pituitary tumor, sinus surgery, transphenoidhypophyisectomy, or any condition that leads to ICP!
What are some key words that make you think ADH problem?
Any condition that leads to ICP!
TRANS: All the way thru something
ECTOMY: Take something out.
Therefore: its sinus surgery where they are going thru the pituatary to take something out.
What is another name for anti-diuretic hormone (ADH)
Desmopressin Acetate (DDAVP) - nasal spray
May be used as a ADH replacement in diabeties insipidius.
9 Signs and Symptoms: FVE
1. Distended neck/peripheral veins.
2. Peripheral Edema/3rd spacing
3. CVP: measured in Rt atrium #'s increase, more vol. = more pressure.
4. Lung sounds: wet sounds low in bases, bivascular crackling, SOB, examine both posterior and exterior
5. Polyuria: kidneys are trying to help you diaresis
6. Pulse: increases heart only wants fluid to move fwrd.
7. If fluid goes back into lungs = heart fail, pul edema.
8. BP: increases b/c more vol = more pressure.
9. Weight: increases any acute can or loss is not fat its FLUIDS! With fluid retention THINK heart problem first.
6 Treatments: FVE
1. Low Sodium
2. I/O and Daily weights - same time, scale, clothes; void first.
- LOOP i.e furosemide or bumetamide (BUMEX) may be given when furmosimide (LASIX) dosnt work!
-HYDROCHLOROTHIAZIDE (Thiazide); watch lab wrk with all diaretics for dehydration and electrolyte problems.
-POTTASIUM SPARING: i.e. Spironolactone.
4. Bed Rest induces diaresis by the release of ANP and decrease production of ADH.
5. Physical Assessment: focus on the pertinent S/S.
6. Give IVF's SLOWLY to elderly and very young.
Note: Heart and Kidney PT are at risk for FVE!
Big time fluid deficit = SHOCK!
Supply and demand, not enough O2 going to the body for cellular metabolism.
3 Causes FVD:
1. Loss of fluids from anywhere. i.e thorancentesis paracentesis, vomiting, diarrhea and hemorrhage.
2. Third Spacing: when fluid is in a space that does you no good! i.e burn ascities - fluid in abdm, measure abdom daily for increase girth b/c can lead to breathing difficulty.
3. Diseases with polyuria: i.e. diabetes- poluria-olguria-anururia
Note: with Polyuria THINK SHOCK FIRST! Decrease in Vas. Vol., decrease in urine o/p = RENAL FAILURE!
FVD Hypovolemia: 10 Signs and Symptoms
1. Weight decrease
2. Skin turgor decrease
3. Dry mucous membranes
4. Urine output decrease b/c kidneys are not being perfused or trying to hold onto fluid (compensate).
5. BP decreased-less vol, less pressure.
6. PULSE: increase b/c heart is trying to pump what little fluid is left around.
7. RESP: increase to improve hypoxia
8. CVP decrease less vol, less pressure
9. Peripheral/neck veins vasoconstrict to stunt blood vital organs.
10. Urine specific gravity increases if putting out any urine at all, it will be very concentrated.
3 Treatment: FVD
1. Prevent further losses of fluid
2. Replace volume
Mild Deficit = PO Fluid
Severe Deficit = IV Fluid
3. Safety Precautions: higher risk for falls due to changes in v.signs. Monitor for overload.