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2013-09-06 14:50:17

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  1. FVE: Hypervolemia
    too much fluid in the vascular space
  2. Causes of FVE
    • HF: heart is weak, CO dec, Kidney perfusion dec, UO down. *The volume stays in the vascular space.
    • Renal Failure
    • Alka-seltzer, fleet enema, IVF with Na: all 3 have a lot of Na.
  3. Hormonal Regulation of Fluid Volume
    • ALDOSTERONE: found in adrenal glands
    • **when blood volume dec, aldo is released. Retains Na/water-->blood volume goes up
    • **too much aldo: con's & cushing's syndrome
    • **little aldo: addison's disease
    • **found in the atria of the heart (blood inc, ANP inc so Na & H2O dec)
    • **works opposite of aldo--> causes excretion of Na & H2O
    • **retain H2O
  4. Too much ADH: SIADH=FVE
    **too much letters=too much ADH
    • urine concentrated
    • blood dilute
    • SG inc
    • blood dec
  5. Note enough ADH: DI=FVD
    • urine dilute
    • blood concentrated
    • SG dec
    • blood inc
    • TX: vasopressin, acetate, DDAVP
  6. SG, Na, & Hct labs
    • concentrated makes the¬†#'s go up
    • dilute makes the #'s go down
  7. ADH
    • found in pituitary
    • potential ADH problem: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy or any condition that could l/t inc ICP.
  8. FVE s/s
    • distended neck/peripheral veins: vessels are distended
    • peripheral edema, thrid spacing: vessels can't hold anymoreso they start to leak
    • CVP inc (measured at r atrium): more volume=more pressure (normal=2-6mmHg)
    • wet lung sounds
    • polyuria
    • pulse inc(heart wants to move fluid forward)
    • BP inc
    • wt gain
  9. FVE tx
    • low Na diet/restrict fluids
    • I&O + daily wt
    • diuretics: Lasix(Bumex if lasix doesnt work), thiazide, K+ sparing=aldactone
    • bed rest=induces diuresing by release of ANP & production of ADH
  10. FVD: Hypovolemia
    • big time deficit=shock
    • **polyuria think SHOCK first
  11. FVD causes
    • loss of fluids from anywhere: thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
    • third spacing: burns, ascites
    • disease with polyuria: DM
  12. FVD s/s
    • wt dec
    • dec skin turgor
    • dry mucous membrane
    • dec UO
    • BP dec
    • P inc
    • R inc (body thinks its hypoxia)
    • CVP dec
    • peripheral veins/neck veins vasocontrict
    • cool extremities (peripheral vasoconstriction in an effort to shunt blood to vital organs)
    • SG inc
  13. FVD tx
    • prevent further loss
    • replace volume
    • safety precautions: r/f falls, monitor for overload
  14. Isotonic Solution: go into vascular space & stays there
    • 0.9% NS, LR, D5W, D5 1/4 NS
    • USES: client that has lost fluids through nausea, vomiting, burns, sweating, trauma
    • ALERT: do not use in clients with HTN, cardiac disease or renal disease
  15. Hypotonic Solution: go into the vascular space then shift out into the cells to replace cellular fluid
    • **they rehydrate but do not cause HTN
    • 0.45%NS, 0.33%NS, D2.5W
    • USES: HTN, renal or cardiac disease & needs fluid replacement b/c of nausea, vomiting, burns, hemorrhage
    • **also used for dilution when a client has hypernatremia, & for cellular dehydration
    • ALERT: watch for cellular edema b/c this fluid is moving out to the cell which could l/t FVD & dec BP
  16. Hypertonic Solutions: volume expanders that will draw fluids into the vascular space from the cell
    • d10W, 3%NS, 5%NS, D5LR, D5 1/2NS, D5NS, TPN, Albumin
    • Uses: hypoNa or has shifted large amounts of vascular volume to a 3rd space or has severe edema, burns, ascites
    • **hypertonic sltn--> return the fluid volume to the vascular space
    • ALERT: watch for FVE. Monitor in an ICU setting with frequent BP, P, CVP ¬†monitoring
  17. Quick Tips
    • Isotonic="Stay where I put it!" (vessel)
    • Hypotonic="Go OUT of the vessel" (vessel to cell)
    • Hypertonic="ENTER the vessel" (cell to vessel)