Fluid Volume Excess/Hypervolemia Flashcards
Definition of Hypervolemia ?
Too much fluid in the vascular space
(Vascular space - aka: cardiovascular system (veins, arteries, capillaries) )
Think of –> Increasing a garden hose without spraying it. The pressure increases and then causes 3rd spacing into the tissues
Causes of Hypervolemia ?
- Heart failure (HF)
- Renal failure (RF)
- Three 3 things with lots of sodium
1. Effervescent soluble medications
2. Canned/processed foods
3. IVF with sodium
In Heart Failure the heart is weak, thus causing CO to be what ?
Decreased
In Heart Failure
Cardiac Output is \_\_\_\_\_\_\_\_\_\_ ? Kidney perfusion is \_\_\_\_\_\_\_\_\_ ? Urinary Output is \_\_\_\_\_\_\_\_\_\_\_ ?
Cardiac Output = Decreased
Kidney Perfusion = Decreased
urinary Output = Decreased
In Hypervolemia, the volume stays where ?
Vascular space
What is Kidney Failure ?
Kidney’s aren’t working
Aside from the causes of Hypervolemia, what else has an affect on Fluid Volume ?
Hormonal Regulation
What hormonal regulators have an affect on Fluid Volume (excess) ?
- Aldosterone (steroid, specifically a mineralocorticoid)
- Anti-diuretic Hormone (ADH) (retain H2O?)
Where is Aldosterone found ?
Adrenal glands (above kidneys)
What is the normal action of Aldosterone when blood volume gets low (vomiting, hemorrhage, etc) ?
- Aldosterone secretion increases, causing a retention of sodium and water in the vascular space
- Thus, blood volume goes up
What are diseases with too much Aldosterone ?
- Cushing’s disease (too much of ALL steroids)
- Hyperaldosteronism
What are diseases with too little Aldosterone ?
- Addison’s Disease
Anti-diuretic Hormone makes you retain what ?
H2O
What are Two ADH problems ?
- Too much ADH
- Not enough ADH
Too much ADH causes you to retain what ? causing ?
Retain water Causing Fluid Volume Excess
Having too much ADH is known as what ?
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
Think: TOO many letters = TOO much water
SIADH (too much ADH) causes the…
Urine to be ? Blood to be ?
Urine = Concentrated (lack of H2O) Blood = Dilute (too much H2O)
Not enough ADH is known as what ?
Diabetes Insipidious
Not having enough ADH (aka: DI) can cause what ?
Shock (which can cause death)
Diabetes Insipidious (not enough ADH) causes what type of fluid volume status ?
Fluid Volume Deficit
Diabetes Insipidius causes you to do what ?
Lose (diurese) water
Diabetes Insipidus causes the…
Urine to be what ? Blood to be what ?
Urine = Dilute Blood = Concentrated
Where is ADH found ?
In the pituitary
Where is the pituitary located ?
In the brain & behind eyes
Key words that make you think potential ADH problem ?
- Craniotomy
- Head injury
- Sinus Surgery
- Transphenoidal hypophysectomy
- OR any condition that can lead to an increased ICP can lead to an ADH problem
What is another name for ADH (Anti-Diuretic Hormone)?
Vasopressin
The drug Vasopressin or Desmopressin acetate (DDAVP) may be utilized how ?
As an ADH replacement in Diabetes Insipidus
What are the signs & symptoms of Hypervolemia/FVE ?
- Distended neck/peripheral veins (vessels are FULL)
- Peripheral edema/third spacing (vessels can’t hold anymore so they start to leak) (For someone on bed rest we would see more dependent edema, Ex: Sacrum. –> *Reposition!)
- Increase in Central Venous Pressure (CVP) (more volume = more pressure)
- Wet lung sounds (on lung assessment want to listen at the bases & posteriorly)
- Polyuria (kidneys are trying to help and get rid of excess fluid)
- HR goes up
- BP increases
- Weight increases
Where is the Central Venous Pressure (CVP) measured ?
Right Atrium
Why do the lungs sound wet in Hypervolemia/FVE ?
B/c fluid first settles in the lungs
What is a normal CVP range ?
2-6mmHg
5-10cmH2O
*Depending on the measuring device being used
Why does the Pulse go up in client’s with Hypervolemia/FVE ?
B/c your heart only wants fluid to go Forward (causing an increased HR?)
(if the fluid doesn’t go forward, it goes backwards into the lungs which can lead to HF or pulmonary edema)
When assessing a pulse in a client with Hypervolemia/FVE, do you palpate a vein or artery ? and what would it feel like ?
Palpate an Artery
Would feel bounding and full
Why does the BP increase in Hypervolemia/FVE ?
More volume = more pressure
With Hypervolemia, any acute weight gain or loss isn’t ? it is ?
Isn’t fat
It’s fluid
When getting a clients weight who has Hypervolemia, how and when should you weight them ?
- have pt. void before getting weight
- same time
- same clothes
- same scale
What are the Treatments for Hypervolemia/FVE ?
- Low sodium diet/restrict fluids
- I & O and daily weight
- Diuretics
- Bed rest (indices ANP)
- Physical assessment
- Give IV fluids slowly to the very old and very young and clients with a Hx of heart and kidney disease)
What is an example of a Loop Diuretic ?
Furosemide
- Administer Furosemide SLOWLY; b/c rapid admin can cause Ototoxicity
What is a loop diuretic that may given when Furosemide (lasix) doesn’t work ?
Bumetanide (Bumex)
What two types of Diuretics are K+ wasting ?
- Loop diuretics
- Hydrochlorothiazide (Thiazide)
Which Diuretic spares K+ ?
Spirnolactone
With ALL diuretics you want to lab work for what ?
Dehydration & Electrolyte problems
TESTING STRATEGY
What should you think of first when you hear Fluid Retention ?
Heart problems
Bed rest induces what ?
What should you do ?
Diuresis
Push fluids
Why does Bed rest induce Diuresis ?
By the release of ANP, and decreased production of ANP
What does ANP stand for ?
Atrial Natriuretic Peptide
With a physical assessment on a client with FVE, what do you want to focus on ?
Focus on pertinent signs and symptoms
* Signs of successful fluid reduction =
Decreased CVP
Decreased BP , HR
Decreased weight
Clear lung sounds
