Fluid and Electrolytes : 1 Flashcards
Fluid volume excess/ hypervolemia: too much fluid in the ______.
vascular space
What are the hormonal regulation of fluid volume?
aldosterone
ANP
ADH
where is aldosterone found?
what is its normal action?
adrenal gland (on top of the kidneys)
when the blood volume gets low, aldosterone secretions increase.
RETAIN SODIUM AND WATER, blood volume goes up
Diseases with too much aldosterone?
cushings syndrome
heperaldosteronism (conn’s syndrome)
Diseases with too little aldosterone?
addison’s disease
ANP (Atrial natriuretic peptide) is found?
What is its normal action?
atrium of the heart
it works the opposite of aldosterone
it causes EXCRETION OF SODIUM AND WATER
“ADH , _____.”
h2O
ADH normally makes you retain or release?
retain; WATER ONLY
Too much ADH
SIADH (Retain water, fluid volume excess)
[TOO many letter, TOO much water]
urine is (decreased) concentrated, blood is low (dilute)
Not enough ADH
Diabetes Insipidus (lose water, fluid volume deficit) D---Diuresis (shock)
Urine is dilute and blood is concentrated.
Concentrated makes numbers go UP
Dilute makes numbers go DOWN
For what lab values?
Urine specific gravity
sodium
hemocrit
ADH is found in the _____.
What makes you think of ADH problems?
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
What is the name for ADH hormone medication?
Vasopressin (Pitressin)
or
desmopressin acetate (DDAVP)
*these may be utilized as an ADH replacement in DI.
Lung sounds are __ with hypervolemia?
wet
will hear low in the bases first
Fluid retention think ______ first!!
heart problems**
Loop diuretic ?
furosemide (laxis)
potassium sparing diuretic?
spironolactone
Bed rest induces _____ by the release of ____ and decrease the production of ____.
diuresis
ANP
ADH
bedrest patient, where do you look for edema?
SACRUM! (gravity)
also, think about skin breakdown
Fluid volume deficit/ hypovolemia: ___
BIG TIME DEFICIT =SHOCK
loss of fluid anywhere
examples- thoracentesis, paracentesis, vomitting, diarrhea, and hemorrhage
What is third spacing?
when can this happen?
when the fluid is in a space that does you NO good. which can happen with burns and ascites
with ascites, what would you key into?
measure abdominal girth daily
fluid in the peritoneal cavity- think cirrhosis
replace volume:
mild deficit, ____
severe deficit ____
mild- PO fluid
severe- IV fluid
what causes fluid volume excess in heart failure?
heart is WEAK, cardiac output goes DOWN, DECREASED kidney perfusion, urinary output goes DOWN.
The volume stays in the VASCULAR SPACE.
what are 3 things with alot of sodium that could cause fluid volumes excess?
- effervescent sodium medications (alka seltzer)
- canned/processed foods
- IVF with sodium
Aldosterone is a ______!!
STEROID& mineralcorticoid
Normal CVP value?
2-6mmHG
What are the s/s of fluid volume excess?
- 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
what causes hypovolemia?
Loss of fluid anywhere
third spacing
diseases with polyuria (polyuria-oliguria-anuria)
s/s of hypovolemia?
- 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
Define isotonic solution
“balance solution”
goes into VASCULAR SPACE and stays there
increases BP
example for isotonic solution
NS
LR
D5W
D51/4NS
the uses for isotonic solution?
the client that has lost fluids through nausea, vomiting, burns, sweating and trauma.
______ is the basic solution when administering blood
NORMAL SALINE
DO NOT use isotonic solution in clients with ?
hypertension
cardiac disease
renal failure
(stays in vascular so causes high bp)
isotonic solutions can cause ?
FVE, HTN, hypernatremia ( only when the solution contains sodium)
define hypotonic solution
goes into VASCULAR SPACE and then SHIFTS out into the cells to replace cellular fluid
hypotonic solution rehydrate and DO NOT CAUSE ____.
hypertension
Examples of hypotonic solution
d2.5w
1/2NS
0.33%NS
the uses for hypotonic solution
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
what should you watch for with hypotonic solution?
cellular edema because this fluid is moving out to the cells, which could lead to fluid volume DEFICIT and decrease bp
Define hypertonic solutions
(packed with particles)
volume expanders that will draw fluid into the vascular space from the cell.
examples of hypertonic solutions
D10W 3% NS 5% NS D5LR D51/2NS D5NS TPN Albumin
the uses of hypertonic solutions
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.
What should you watch for with hypertonic solutions?
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
stay where I put It
Isotonic solutions
Enter the vessel
hypErtonic solutions
gO Out Of the vessel
hypOtonic solutions
fluid retention think….
HEART problems FIRST!!
polyuria think…
SHOCK
