Fluid & Electrolytes- Hypervolemia/ Fluid Volume Excess Flashcards
What is hypervolemia?
Fluid volume excess
too much fluid in the vascular space
What is a vascular space?
Any vessel in your body (artery, veins, capillary)
as well as the chambers of the heart (since it is the “cardio-vascular system”)
Because when the vessels/vascular space is filling up with fluid getting bigger and bigger, so are the chambers of the heart.
When their’s too much fluid in the vascular space, where does it start leaking into?
the interstitial space (the tissues)
one cause of fluid volume excess is congestive heart failure (C.H.F)… what happens?
-what happens with
.cardiac output
.kidney perfusion
.urine output
Where does the volume stay?
Your heart is too weak to pump out the blood, so it backs up in the chambers.
as a result, your organs will not be perfused properly.
so, you get decreased C.O
Decreased kidney perfusion which results in deceased urine output.
How does a decreased cardiac output impact the kidneys and fluid volume?
less blood being pumped to the kidney= less perfusion= less cardiac output= increased fluid in the vascular space.
-the extra fluid is not going anywhere. it just stays in the vascular space because you’re not peeing it out.
Another cause of fluid volume excess is kidney failure… how does it cause you to go into fluid overload?
No urinary output= water stays in the vascular space.
Alkaseltzer
Fleet enemas
&
I.V Fluids with sodium
- All have what in common?
- Why can they potentially be bad?
- Sodium
- Makes you retain fluid; which can make you hypervolemic
What is aldosterone?
Where does it come from?
A natural mineralocorticoid in the body
from the adrenal glands which live on top of the kidneys
What is the normal action of aldosterone?
When blood volume gets too low, aldosterone secretion increases to help you retain SODIUM & WATER, so your blood volume is increase.
Increases your blood volume by making you retain sodium & water
Name 2 diseases that are products of making too much aldosterone:
- Hyperaldosteronism (Conn’s disease)
- Cushings
Cushings is when you’re making too____ of all of your steroids. including aldosterone.
Too many
What is a disease where we’re not making enough aldosterone?
Addisson’s disease (You need to “add” steroids)
ADH makes you retain what?
Water only…. ADH aka H2O
Disease where too much ADH is being produced:
SIADH (too many letters, too much water)
T OR F?
Normally, blood and urine like to do the same thing.
ex) dilute urine= dilute blood
T
In SIADH,
The blood is____
the urine is______
blood= dilute (because with ADH, you retain water in the vascular space)
urine= concentrated (the ADH is making you retain the extra water in your kidneys, so all of that water removal= urine concentration)
Your urine output will decrease, and the little bit of urine you will have will be very concentrated
Specific gravity, sodium, & hematocrit
when:
concentrated will make these numbers go___
dilute will make these numbers go___
up
down
Signs & Symptoms of fluid volume excess
____ Veins
_____ Edema caused by____.
Bulging veins (distended neck veins & peripheral veins)
peripheral edema caused by 3rd spacing (because the vascular space in the vessels are so full, the vessels start to leak to the interstitial space)
When a patient has been on bed rest for a while, where do you start seeing edema?
What are they at risk for?
Sacrum…. NOT peripheral
Skin breakdown will occur
Where is CVP measured?
In fluid volume excess, CVP number will___ because?
Right atrium
-increase because of the increased pressure in the vascular space.
More volume in the vascular space= more____
more pressure in the vessel/ vascular space
What are the lungs gonna sound like?
will they experience shortness of breath?
When people start to have fluid in their lungs, where will you hear it first?
Wet
yes
in the bases
if the kidneys are working properly, what’s gonna happen when a patient experiences hypervolemia?
- patient will pee alot / diurese
In fluid volume excess, the pulses will____.
How will they feel?
Increase
- Bounding (how hard your heart is beating trying to push the fluid forward)
& full (big artery/ full of fluid)
Your heart only wants fluid to go in which direction?
Forward (we have valves inside of our hearts to prevent back-flow…we only want the blood to flow forward)
If we have back flow of blood in the heart, then it will go into the lungs, causing_____
Pulmonary edema
t or f?
Veins pulsate
F! Only arteries pulsate
What’s gonna happen to the blood pressure? why?
increase because … More volume= more pressure
What’s gonna happen to your weight?
Any acute gain or loss of weight= ___
ex) patient gains 5 Lbs over night
Increased
Fluid gain or loss
When you start having fluid retention, think_____ problems first.
heart problems
Daily weight rules
- Same time
- same scale
- same clothes
- have patient pee first
Treatment:
- Low__
- meds? worried about?
- low sodium
- diuretics (lasix, bumex, thiazides)
- Hypokalemia
Why is bedrest good for a person who has fluid volume excess? how?
it induces diuresis/ makes u pee (when you’re supine, you perfuse your kidneys more)
How does bedrest play a role in blood clots?
How does it play a role in pneumonia?
how does it play a role in constipation?
How does it play a role in kidney stones?
So, the lesson is, when you have someone in bedrest, YOU MUST_____
Bedrest induces diuresis, which decreases fluid in the vascular space which causes increased blood concentration.
increased blood concentration= higher risk for blood clot.
- due to increased fluid loss, pulmonary secretions thicken & then you cannot mobilize them anymore and so it pools in your lungs
- Bowels don’t move as much, and bowel secretions thicken
- increased blood concentration= increased specific gravity
- PUSH FLUIDS
When you see the words ASSESSMENT or EVALUATION, always think____
Signs & symptoms
In the evaluation phase of fluid volume excess, we look for improvement in signs & symptoms, so
CVP, PULSE, BP, WEIGHT all will____
Lungs sounds=___
decreased
clear
Why must we give IV fluids SLOWLY to the elderly?
this also goes for the very young, & ANY PATIENT with a history of HEART & KIDNEY disease
Because their hearts and kidneys are aged, they don’t work as fast.
if you give them fast fluid, the heart won’t be able to push it forward fast enough, so they can go into pulmonary edema.
They also cannot excrete it as fast, so they can go into fluid volume excess.
The RN always has to the admission history. If it’s ok for LPNs to get the admission history, the RN must ALWAYS_____.
Validate the data first & then sign off on it.
