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Too much fluid in the vascular space (veins, arteries, capillaries, heart)
Hypervolemia
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Causes of Hypervolemia
- Heart Failure
- Renal Failure
- Pharm (alka-seltzer, fleet enema, IVF with Na)
-
Patho of Heart Failure:
- Weak Heart
- Decreased Cardiac Output
- Decreased Kidney Perfusion
- Decreased Urinary Output
- (volume stays IN VASCULAR SPACE)
-
Hormonal Regulation of Fluid Volume
- Aldosterone
- ANP (atrial natriuretic peptide)
- ADH (antidiuretic hormone)
-
What is aldosterone?
steroid/mineralcorticoid
-
Where is aldosterone found?
Adrenal Glands (above kidneys)
-
Normal action of aldosterone:
When blood volume gets LOW (from hemorrhage, vomiting, etc...) aldosterone secretion INCREASES.
Retains Na/Water
Increases Blood Volume
-
Diseases with too much aldosterone:
- Cushing's
- Conn's (hyperaldosteronism)
(VOLUME EXCESS)
-
Diseases with too little aldosterone:
Addison's Disease
(VOLUME DEFICIT)
(loss of Na/H20)
-
Where is ANP found?
Atria of the heart
-
How does ANP work?
Excretion of Na/Water
(opposite of Aldosterone)
-
ADH is _____ diuresis
against
-
ADH makes you ____ fluid
Retain
-
Two ADH problems:
SIADH (too much)
DI (not enough)
-
When there is too much ADH...
- Retain water
- Fluid volume excess
(SIADH)
- Urine will decrease and will be concentrated
- Blood will be diluted and serum sodium will be low
-
In SIADH, Urine is:
Concentrated
-
In SIADH, Blood is:
- Diluted
- (serum sodium will be low)
-
When there is not enough ADH:
- Diruesis (loss) of Water
- Fluid Volume Deficit (SHOCK!!!!)
Diabetes Insipidus
- Urine will be diluted
- Blood will be concentrated
-
When there is fluid deficit, always worry about:
SHOCK!
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Concentrated makes specific gravity, sodium and hematocrit numbers _____
INCREASE
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Dilute makes specific gravity, sodium and hematocrit numbers ____
DECREASE
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ADH is found in the ____
pituitary
-
ADH issues are always ____
- secondary
- (ie: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy, increased ICP)
-
Another name for anti-diuretic hormone (ADH)
- Vasopressin (Pitressin)
- Desmopressin acetate (DDAVP)
-
___ may be used as an ADH replacement in Diabetes Insipidus
Vasopressin (pitressin) or Desmopressin Acetate (DDAVP)
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S/S of Hypervolemia
Distended Neck Veins
- Peripheral Edema, Third Spacing (because vessels can't hold any more fluid and start to leak....leading to sacral skin breakdown)
- CVP is increased
Wet Lung Sounds
Polyuria (kidneys are trying to get you to diurese)
Bounding pulse
Increased BP
Weight Gain (quickly!)
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Treatment for Hypervolemia:
- Low Na diet
- Restriction of fluids
- I/O
- Daily Weights
- Diuretics
- Bed Rest (induces diuresis)
- Physical Assessment (focused)
- Give IVFs SLOWLY to elderly, young, kidney and heart pts
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Fluid volume defecit
Hypovolemia
-
Hypovolemia can lead to:
Big Time SHOCK!
-
Causes of Hypovolemia
Loss of fluid from anywhere (thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage, suctions, etc)
Third Spacing (burns, ascites)
Diseases with Polyuria (poly--oli--anuria)
-
S/S of Hypovolemia
Weight Loss
Decreased skin turgor
Dry mucous membranes
Decreased urine output (kidneys aren't being perfused OR they are trying to hold fluid)
Decreased BP (less fluid, less pressure)
Increased weak, thready pulse
Increased respirations
Decreased CVP
VERY TINY peripheral veins
Cool Extremities
Increased Urine Specific Gravity
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Tx for Hypovolemia
Prevent Further Loss!
Replace Volume (mild = PO, severe= IV)
Safety Precautions (falls, overload)
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Isotonic Solutions:
- "Stay where I put them"
- Go into vascular space and STAY
-
Examples of Iso Solutions
- NS (for blood)
- LR (for shock)
- D5W
- D5 1/4 NS
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Uses for Isotonic solutions
For the pt that has lost fluids through nausea, vomiting, burns, sweating, and trauma
NOT used for HTN pts, Cardiac Disease, Renal Disease
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Hypotonic Solutions:
- "Go OUT of vessel"
- Into vascular space and shift OUT into the cells to replace cellular fluid
-
Examples of Hypotonic Solutions
-
Uses for Hypotonic Solutions:
Pt that has HTN, Renal or Cardiac Disease (needing fluid because of nausea, vomiting, burns, hemorrhage, etc)
-
ALERT for Hypotonic Solutions
Watch for cellular edema leading to fluid volume def and decreased BP
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Hypertonic Solutions:
"Packed with Particles"
"Enter the Vessel"
Volume expanders that draw fluid into vascular space from the cells
-
Examples of Hypertonic Solutions
- D10W
- 3% NS
- 5% NS
- D5LR
- D5 1/2 NS
- D5 NS
- TPN
- Albumin
-
Uses for Hypertonic Solutions
- Pt with hyponatremia or that has shifted large amounts of vascular volume to 3rd space or has severe edema, burns or ascites
- (returns fluids to the vascular space where it should be)
-
ALERT for Hypertonic Solutions
- Watch for fluid volume excess
- Monitor in ICU setting
- Frequent BP, Pulse, CVP
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Mag and Ca act like:
Sedatives!
-
When you deal with Mg and Ca, think ____ first!
Muscles
-
Magnesium is excreted by the ____
kidneys
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Causes of Hypermagnesmia:
-
Causes of Hypercalcemia
- Hyperparathyroidism (too much PTH)
- Thiazides
- Immobilization (must bear weight to keep Ca in bones)
-
S/S of Hypermagnesemia
- DTRs decreased
- Decreased Muscle Tone
- Arrhythmias
- Decreased LOC
- Decreased Pulse
- Decreased Respirations
- Flushing
- Warmth (from vasodilation)
-
S/S of Hypercalcemia
- DTRs decreased
- Decreased Muscle Tone
- Arrhythmias
- Decreased LOC
- Decreased Pulse
- Decreased Respirations
- Brittle bones
- Kidney Stones
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Tx for Hypermagnesemia
- Ventilator < 12 RR
- Dialysis
- Calcium Gluconate (antidote)
- Safety Precautions (because of sedation)
-
___ is antidote for Mag
- Calcium Gluconate
- (administered IVP very slowly at 1.5-2ml/min)
-
Tx of Hypercalcemia
- Move!!
- Fluids (prevention of kidney stones)
- Sodium Phosphate
- Steroids
- Add Phosphorus to diet
- Safety precautions
- Must have vitamin D to use
- Calcitonin
-
Calcium and ___ are inversely related
Phosphorus
-
-
-
Causes of Hypomagnesemia
- (Not ENOUGH sedative)
- Diarrhea (mg in intestines)
- Alcoholism (most common)
- Not Eating/Drinking
-
Causes of Hypocalcemia
Not Enough PTH!!!
- Hypoparathyroidism
- Radical Neck
- Thyroidectomy
-
S/S of Hypomagnesemia
- THINK MUSCLES FIRST!!!
- Tight rigid muscles
- Seizures
- Stridor/Laryngospasm
- +Chvostek's
- +Trousseau's
- Arrhythmias
- Increased DTRs
- Mind Changes
- Swallowing Probs (risk for aspiration!!!)
-
Tx for Hypomagnesemia
- Mg
- Check Kidney Function (before and after IV)
- Seizure precautions
- Eat Magnesium (spinach, mustard, squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, etc)
-
Tx for Hypocalcemia
- Vitamin D (to use Ca)
- Phosphate binders
- IV Ca (SLOWLY)
-
How to give IV Ca:
SLOWLY and put pt on heart monitor (widened QRS)
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Be watching for ___ changes as Sodium levels fluctuate
Neuro!
-
Na levels in your blood are totally dependent on:
How much water you have in your body
-
Hypernatremia =
Dehydration (not enough water!)
-
Causes of Hypernatremia
- Hyperventilation (loss of water)
- Heat Stroke
- DI (vomiting/diarrhea, etc)
-
S/S of Hypernatremia
- ***Neuro Changes!!!
- Dry mouth
- Thirsty
- Swollen Tongue
-
Tx for Hypernatremia
- Restric Na+
- Dilute client with fluids
- Daily Weights
- I/O
- Labs!
-
Feeding tube pts tend to get:
Dehydrated
-
Hyponatremia =
Dilution (too much water, not enough Na)
-
Causes of Hyponatremia
Drinking H2O for fluid replacement (vomiting, sweating...just dilutes blood more)
Psychogenic Polydipsia
D5W
SIADH (retaining water)
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S/S of Hyponatremia
- ***Neuro changes
- Headache
- Seizure
- Coma
-
Tx for Hyponatremia
- Client needs SODIUM
- Restrict Water
- If having neuro probs...hypertonic saline is needed! 3% NS or 5% NS
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Potassium is excreted by the:
Kidneys
-
-
-
Causes of Hyperkalemia
- Kidney Trouble
- Spironolactone (Aldactone) - makes you retain potassiun
-
S/S of Hyperkalemia
- ***Life Threatening Arrhythmias
- Muscle Twitching
- Muscle Weakness
- Flaccid Paralysis
-
Tx of Hyperkalemia
Dialysis
Calcium Gluconate (decreases arrhythmias)
Glucose/Insulin (insulin carries glucose and potassium into the cell)
Sodium Polystyrene Sulfonate (kayexalate)
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Sodium and ___ have an inverse relationship
INVERSE
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Causes of Hypokalemia
- Vomiting
- NG Suction
- DIuretics
- Not eating
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