Fluid & Electrolytes I Flashcards
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:
- Effervescent soluble medications
- Canned/processed foods
- 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.
- 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?
- Too Much ADH 2. Not Enough ADH
Tell me everything you know about TOO MUCH ADH.
- 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.
- Lose (diurese) WATER
- Fluid Volume DEFICIT
- Diabetes Insipidus –> SHOCK!!!
- DI - DIabetes Insipidus (has nothing to do with your blood sugar) –> DIuresis.
- Urine is DILUTED (Large amounts)
- Blood is CONCENTRATED
Concentrated makes #’s go?
Concentrated makes #’s go up.
- Urine
- Specific Gravity
- Sodium
- Hematocrit
Dilute makes #’s go?
Dilute makes the #’s go DOWN.
- Urine
- Specific Gravity
- Sodium
- Hematocrit
Where is ADH found?
ADH (Anti-diuretic Hormone) is found in the PITUITARY. (between your eyeballs)
- Give key words to make you think potential ADH problems.
- Also, what’s another name for ADH?
- And, what drug can be utilized as an ADH replacement in Diabetes Insipidus?
A. KEY WORDS
1. Craniotomy
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:
Vasopressin (Pitressin)
C. DRUG utilized as ADH replacement.
Desmopressin acetate (DDAVP) Used as nasal spray.
What are signs/symptoms of fluid volume excess?
- Distended neck veins/peripheral veins: Vessels are BIG & FULL
- Peripheral edema/third spacing: Vessels can’t hold any more, so they start to LEAK OUT.
- Central Venous Pressure (CVP): Measured in Right Atrium so NUMBER goes UP.
MORE VOLUME, MORE PRESSURE!!!
- Lung sounds: WET. (Bibasilar crackles)
- Polyuria: Kidneys are trying to help you DIURESE.
- Pulse: It goes UP. Your heart only wants fluid to go FORWARD.
- If the fluid doesn’t go forward, it’s going to go BACK into the lungs. Can lead to HEART FAILURE then PULMONARY EDEMA.
- Blood pressure goes UP. MORE VOLUME, MORE PRESSURE!!!
- Weight INCREASES. Any acute gain or loss isn’t fat, it’s FLUID.
What is the treatment for Fluid Volume Excess (FVE)?
- Low Sodium Diet/restrict fluids.
- I & O and Daily WEIGHTS.
DAILY WEIGHTS:
- A. Same TIME
- B. Same SCALE
- C. Same CLOTHES
- D. Void FIRST!
(can delegate to UAP)
- Diuretics:
- 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!
- Bed rest induces DIURESIS by the release of ANP and, DECREASED production of ADH.
-
Physical Assessment
* Focus on the pertinent signs and symptoms. - Give IVFs slowly to the ELDERLY and very YOUNG. (Heart and Kidney pts. @risk of FVE.)
Patient Improved Assessment after FVE:
CVP: DOWN
BP: DOWN
Pulse: DOWN
Weight: DOWN
Lung Sounds: CLEAR
What are the causes of FVD (Fluid volume deficit)?
- Causes
* Loss of fluids from anywhere’
a. Thoracentesis
b. Paracentesis
c. Vomiting
d. Diarrhea
e. Hemorrhage
* 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)
- 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.
- Treatment
- 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.
