Fluid & Electrolytes- Hypervolemia/ Fluid Volume Excess

Question 1

What is hypervolemia?

Answer 1

Fluid volume excess

too much fluid in the vascular space

Question 2

What is a vascular space?

Answer 2

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.

Question 3

When their’s too much fluid in the vascular space, where does it start leaking into?

Answer 3

the interstitial space (the tissues)

Question 4

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?

Answer 4

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.

Question 5

How does a decreased cardiac output impact the kidneys and fluid volume?

Answer 5

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.

Question 6

Another cause of fluid volume excess is kidney failure… how does it cause you to go into fluid overload?

Answer 6

No urinary output= water stays in the vascular space.

Question 7

Alkaseltzer

Fleet enemas
&
I.V Fluids with sodium

• All have what in common?
• Why can they potentially be bad?

Answer 7

• Sodium

- Makes you retain fluid; which can make you hypervolemic

Question 8

What is aldosterone?

Where does it come from?

Answer 8

A natural mineralocorticoid in the body

from the adrenal glands which live on top of the kidneys

Question 9

What is the normal action of aldosterone?

Answer 9

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

Question 10

Name 2 diseases that are products of making too much aldosterone:

Answer 10

• Hyperaldosteronism (Conn’s disease)

- Cushings

Question 11

Cushings is when you’re making too____ of all of your steroids. including aldosterone.

Answer 11

Too many

Question 12

What is a disease where we’re not making enough aldosterone?

Answer 12

Addisson’s disease (You need to “add” steroids)

Question 13

ADH makes you retain what?

Answer 13

Water only…. ADH aka H2O

Question 14

Disease where too much ADH is being produced:

Answer 14

SIADH (too many letters, too much water)

Question 15

T OR F?

Normally, blood and urine like to do the same thing.
ex) dilute urine= dilute blood

Answer 15

T

Question 16

In SIADH,

The blood is____

the urine is______

Answer 16

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

Question 17

Specific gravity, sodium, & hematocrit

when:

concentrated will make these numbers go___

dilute will make these numbers go___

Answer 17

up

down

Question 18

Signs & Symptoms of fluid volume excess

____ Veins
_____ Edema caused by____.

Answer 18

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)

Question 19

When a patient has been on bed rest for a while, where do you start seeing edema?

What are they at risk for?

Answer 19

Sacrum…. NOT peripheral

Skin breakdown will occur

Question 20

Where is CVP measured?

In fluid volume excess, CVP number will___ because?

Answer 20

Right atrium

-increase because of the increased pressure in the vascular space.

Question 21

More volume in the vascular space= more____

Answer 21

more pressure in the vessel/ vascular space

Question 22

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?

Answer 22

Wet

yes

in the bases

Question 23

if the kidneys are working properly, what’s gonna happen when a patient experiences hypervolemia?

Answer 23

• patient will pee alot / diurese

Question 24

In fluid volume excess, the pulses will____.

How will they feel?

Answer 24

Increase

• Bounding (how hard your heart is beating trying to push the fluid forward)
  & full (big artery/ full of fluid)

Question 25

Your heart only wants fluid to go in which direction?

Answer 25

Forward (we have valves inside of our hearts to prevent back-flow…we only want the blood to flow forward)

Question 26

If we have back flow of blood in the heart, then it will go into the lungs, causing_____

Answer 26

Pulmonary edema

Question 27

t or f?

Veins pulsate

Answer 27

F! Only arteries pulsate

Question 28

What’s gonna happen to the blood pressure? why?

Answer 28

increase because … More volume= more pressure

Question 29

What’s gonna happen to your weight?

Any acute gain or loss of weight= ___

ex) patient gains 5 Lbs over night

Answer 29

Increased

Fluid gain or loss

Question 30

When you start having fluid retention, think_____ problems first.

Answer 30

heart problems

Question 31

Daily weight rules

Answer 31

• Same time
• same scale
• same clothes
• have patient pee first

Question 32

Treatment:

• Low__
• meds? worried about?

Answer 32

• low sodium
• diuretics (lasix, bumex, thiazides)
• Hypokalemia

Question 33

Why is bedrest good for a person who has fluid volume excess? how?

Answer 33

it induces diuresis/ makes u pee (when you’re supine, you perfuse your kidneys more)

Question 34

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_____

Answer 34

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

Question 35

When you see the words ASSESSMENT or EVALUATION, always think____

Answer 35

Signs & symptoms

Question 36

In the evaluation phase of fluid volume excess, we look for improvement in signs & symptoms, so

CVP, PULSE, BP, WEIGHT all will____

Lungs sounds=___

Answer 36

decreased

clear

Question 37

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

Answer 37

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.

Question 38

The RN always has to the admission history. If it’s ok for LPNs to get the admission history, the RN must ALWAYS_____.

Answer 38

Validate the data first & then sign off on it.