Fluid and Electrolyte Hurst Study Guide with Complete Solution

What is another name of Hypervolemia - Fluid Volume Exceed What happen to the body fluid in Fluid Volume Exceed - Too much fluid in the body What are causes of Fluid Volume Exceed or Hypervolemia - 1. Heart failure 2. Renal failure 3. Alka-Seltzer, Fleet enema, IVF with Na How Heart failure causes Fluid Volume Exceed or Hypervolemia - Heart is weak, CO went down, decreased kidney perfusion, UO went down * the volume stays in the vascular space * How Renal failure causes Fluid Volume Exceed or Hypervolemia - Kidneys aren't working or functioning What do Alka-Seltzer, Fleet enema, IVF with sodium have a lot which result in Fluid Volume Exceed or Hypervolemia - sodium which makes you retain more water. What are 3 hormones that regulate fluid volume in the body - Aldosterone or steroid and mineralocorticoid, ANP or Atrial Natriuretic Peptide, ADH or Antidiuretic Hormone Where is the Aldosterone found - Adrenal Grand which is right above the kidney What Aldosterone does when severe diarrhea or blood loss - When blood volume gets low such as vomiting, blood loss. Aldosterone secretion will increase which causes the body retain sodium and water. Resulting in blood volume goes back up. What are diseases with too much Aldosterone which means fluid volume exceed occurs - Cushing's syndrome, Hyper-Aldosterone, Conn's syndrome Define Conn's disease - A condition in which the adrenal glands produce too much aldosterone. It is frequently caused by a benign or the non-cancerous tumor of an adrenal gland. Resulting in hypertension and hypokalemia. Diseases with too little Aldosterone which means fluid volume deficit occurs - Addison's disease Atrial Natriuretic Peptide or ANP causes - Excretion of sodium and water Where is ANP found - Atrial of heart How does ANP works - Opposite of Aldosterone which means causes excretion of sodium and water What ANP does to sodium and water - Excrete sodium and water ADH or Anti-diuretic hormone normally makes you retain or diurese ? - Retain What ADH retains - Water ADH problem in term of too much ADH - Body will retain water and fluid volume exceed occurs. Client experiences SIADH or Syndrome of Inappropriate ADH Secretion. Which resulting in low urine output. ADH problem in term of not enough ADH - Body will start to diurese and lose water which causes fluid volume deficit. Client experiences DI or Diabetes Insipidus. Define DI or Diabetes Insipidus - Is a condition in which the kidneys are unable to prevent the excretion of water. Client will extremely thirst and urinate pretty often. Where is the ADH found? - Pituitary grand What is the key word that will have ADH problem? - Increased ICP in any condition, craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy What is transphenoidal hypophysectomy? - is the surgical removal of the hypophysis or pituitary gland. It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing's syndrome due to pituitary adenoma. What should be concerned when fluid retention issue occurs? - Be aware of heart problem Signs and symptoms of fluid volume exceed - Distended neck vein, peripheral edema, increased CVP, crackle lung sounds, polyuria, full and bounding pulse, acute weight gain Treatments for fluid volume exceed - Low sodium diet and restrict fluid, Intake & Output with daily weigh, administer diuretic, bed rest Instruction for daily weigh - Same time, same clothes, same scale, and void first What are 3 types of diuretic - 1. Loop; Lasix which will switch to Burmetanide or Bumex later on once Lasix does not work. 2. Hydrochlorothiazide 3. Potassium sparing such as Aldactone What is nursing plan for client with diuretic - Watch out for lab work to prevent dehydration and electrolyte problem How bed rest induces diurese - Body will release more ANP and decrease ADH production which will results in excrete more sodium and water Fluid Volume Deficit or Hypovolemia could lead to - Hypovolemic shock What are 3 causes of Fluid Volume Deficit - 1. loss of fluid from Thoracentesis, paracentesis, vomiting, diarrhea, or hemorrhage 2. third space such as burn and Ascites se with polyuria which will ended to be Anuria Signs and symptoms of Fluid Volume Deficit - weigh loss, decreased skin tugor, dry mucous membrane, decreased urine output from kidneys aren't perfuse or trying to hold on the fluid as body compensation, decreased blood pressure as less volume, less pressure, increased pulse and respiration rate as heart is trying to pump what little is left around, peripheral vein and neck, cool extremities from peripheral construction in an effort to shunt blood to vital organs, urine specific gravity goes up Why client with Fluid Volume Deficit experiences cool extremities - Peripheral constriction occurs in afford to shunt blood to vital organ Why client with Fluid Volume Deficit experiences decreased urine output - Kidneys either aren't being perfuse or they are trying to hold on to the fluid. Treatments for Fluid Volume Deficit - 1. prevent further losses 2. replace volume; force oral fluid in mild deficit and administer IV fluid in severe deficit 3. provide safety precaution as the client will be high risk for all from weakness and also monitor for overload Types of fluid solution - Isotonic, Hypotonic solution, Hypertonic solution What are alteration names of isotonic solution - balance solution or crystalloid How isotonic solution works - Go into the vascular space and stays there. Which causes fluid volume and blood pressure go up Examples of isotonic solution - normal saline, Lactate Ringer, D5W, D5 1/4NS Uses for isotonic solution - Client with lost fluid through nausea, vomiting, burns, sweating, trauma What are the types of patient that should NOT use isotonic solution - Patient with hypertension, cardiac disease, or renal failure Complications that cause by isotonic solution - Fluid volume exceed, hypertension, hypernaturmia How hypotonic solution works - Go into the vascular space then shift out into cells to replace cellular fluid. It won't drop or increase blood pressure Uses for hypotonic solution - Good for client with hypertension, renal disease, cardiac disease, and any clients who need fluid replacement from nausea, vomiting, burns, hemorrhage Complication of hypotonic solution - Cellular edema Why hypotonic solution causes cellular edema - This fluid is moving out to cell which could lead to fluid volume deficit and decrease blood pressure How hypertonic solution works - Volume expanders that draw fluid into vascular space from cell. Examples of hypertonic solution - D10W, 3%NS, 5%NS, D5LR, D5 1/2NS, D5NS, TPN, Albumin Uses for hypertonic solution - Client with hyponatermia, severe edema, burns, or ascites How to handle fluid volume exceed in client with hypertonic solution - Monitor in an ICU setting with frequent monitoring of blood pressure, pulse, and CVP