Summary FLUID VOLUME EXCESS: HYPERVOLEMIA

FLUID VOLUME EXCESS: HYPERVOLEMIA Define: too much volume in the l. Causes: a. CHF: heart is , CO , decreased perfusion, UO *the volume stays in the b. RF: Kidneys aren't a. Alkaseltzer Fleets enemas All 3 have a lot of IVF with Na b. Aldosterone (steroid, mineralocorticoid) Where does aldosterone live? -Normal action: when blood volume gets low (vomiting, blood loss, etc.) —aldosterone secretion increases— retain Na/water— blood volume ** Diseases with too much aldosterone: -also seen with liver disease and heart disease 1. 2. **Disease with too little aldosterone: 1. e. ADH (anti-diuretic hormone) Normally makes you retain or diurese? Retain? 2 ADH problems Too Much Not enough Retain Lose (diuese) Fluid Volume Fluid Volume SIADH DI Syndrome of Inappropriate ADH Secretion Diabetes Insipidus Urine Urine Blood Blood *Concentrated makes #’s go up specific gravity, Na *Dilute makes #’s go down ADH lives in pituitary; key words to make you think potential ADH problem: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy *Another name for anti-diuretic hormone (ADH) is Vasopressin. The drug Vasopressin (Pitressin or DDAVP (Desmopressin acetate) may be utilized as an ADH replacement in Diabetes Insipidus. f. S/Sx of FVE: Distended neck veins/peripheral veins: vessels are Peripheral edema, third spacing: vessels can't hold anymore so they start to CVP: measured where? ; number goes More More Lung sounds: Polyuria: kidneys trying to help you Pulse: ; your heart only wants fluid to go If the fluid doesn't go forward it's going to go into the BP: move volume more Weight: any acute gain or loss isn't fat-it’s fluid g. Treatment: Low Na diet Diuretics Loop *Bumex® may be given when Lasix® doesn’t work. Thiazide (HCTZ) * Watch lab work with all diuretics *Dehydration and electrolyte problems K-sparing Bed rest induces *when you are supine you perfuse your kidneys more h. Interventions: Physical Assessment Give IVF’s slowly to elderly FLUID VOLUME DEFICIT: HYPOVOLEMIA Big Time Deficit=Shock l. Causes: Loss of fluids from anywhere Thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage Third spacing (when fluid is in a place that does you no good) *burns *ascites Polyuria- Diseases with polyuria Oliguric- Anuric- 2. Weight Decreased Skin Turgor Dry mucous membranes Decreased Urine Output kidneys either aren't being or they are trying to BP? (less , less ) Pulse? , heart is trying to pump what little is left around CVP? , less volume, less Peripheral Veins/Neck veins Cool Extremities (peripheral in an effort to shunt blood to ) Urine Specific Gravity , if putting out any urine at all it will be 2. TxandNursingInterventions:Mild Deficit: Severe Deficit: