Hurst Review(65 Pages)

fluid volume excess also another word for ? - HYPERvolemia definition of fluid volume excess - too much fluid in the vascular space ( any vessel in our body ex: vein , artery) 00:28 01:34 what are 2 causes of fluid volume excess? - heart failure - renal failure heart failure ( HF) means what? - the heart is weak - the cardiac output is DOWN - kidney perfusion is DOWN - urinary output is DOWN - the volume stays in the vascular space renal failure( RF) means what? - kidneys arent working what are three things that contain A LOT of sodium? - canned process foods - IVF with sodium - fleet enemas Aldosterone ( steroid, mineralocorticoid) is found where? - adrenal glands ( on top of the kidneys) what is the normal action of aldosterone ? When your blood volume gets low through for example vomiting or hemorrhage, the aldosterone secretion increases and makes your body retain sodium and water and therefore increases the blood volume aldosterone makes us retain what? SODIUM AND WATER when aldosterone secretion increases ---- retain sodium/water--- blood volume goes ________ ---- retain in ______________________ - up - vascular space what two diseases have too much aldosterone? - cushings ( too much steroids) - hyperaldosterosteronism ( aka: CONNS) what disease has too little aldosterone? - Addisons disease ( not enough aldosterone means you lose NA & water directly from the vascular space) 00:02 01:34 when taking a Anti-diuretic hormone ( ADH) do you retain or diurese? - retain when taking a anti-diuretic what do you retain ? - water when you have too much ADH what happens in the body ? - RETAIN water - fluid volume EXCESS - Syndrome of inappropriate ADH ( TOO MANY LETTERS TOO MUCH WATER ) - urine is CONCENTRATED ( too much ADH and NA ) - blood is DILUTED when you have not enough ADH what happens in the body ? - DIURESE water - fluid volume DEFICIT - DI ( diabetes insipidus) DIurese - urine is DILUTED - blood is CONCENTRATED when checking the urine specific gravity, sodium, and hematocrit on lets say a urine test strip if the urine is concentrated will it make the numbers go up or down? - UP when checking the urine specific gravity, sodium, and hematocrit on lets say a urine test strip if the urine is diluted will it make the numbers go up or down? - down where is ADH found ? - pituitary gland what should you think about first when you think your patient has a ADH problem? head injuries ( craniotomy, increase ICP ) transsphenoidhypophysisectomy all the way through ( across) sinus pituitary removal what are some drugs that are anti diuretic hormones ( ADH) - vasoPRESSIN *ends in PRESSINS) what are some S?S of fluid volume excess? - distended neck veins/ peripheral veins ( VESSELS ARE FULL) - third spacing - lungs are CRACKLED - polyuria - pulse INCREASED ( palpate the artery) - Blood pressure INCREASES ( more volume = more pressure ) - weight INCREASES what is the treatment for fluid volume excess? - low NA diet - restrict fluids - daily I& Os and weights what are some diuretics you can give to help FVE? - FurosemIDE ( lasix ) ( DECREASES K+) - drugs that end in IDE !!!!! what is an example of a potassium spraing drug ? - spironolactone ( retain K+) when thinking of fluid retention you should think what first? - HEART PROBLEMS bed rest induces _________ by the release of ___________- and lowers the production of ____________- - diurese - ANP - ADH what is another word for fluid volume deficit? - HYPOvolemia when you have a big time deficit you should think what first ? - SHOCK what are the three causes of Fluid volume deficit? - loss of fluid from annywhere - third spacing - diseases with polyuria what is third spacing? - when fluid is in a place that does you no good ex: burns, ascites ( measure abdominal girth daily/ worry about HYPOtension) what is an example of a disease that deals with polyuria? - diabetes mellitus when you see the word POLYURIA what should you think of first? - SHOCK what are some S/S of fluid volume deficit ? - weight DOWN - decreased skin turgor - dry mucous membranes - urine output DECREASED ( kidneys arent being profused or they are trying to hold on to fluid ( compensate)) - blood pressure is DOWN ( less volume, less pressure ) - pulse is INCREASED ( heart is trying to pump what little fluid is left ) ( weak and thready in FVD) respirations are INCREASED ( hypoxia) - veins are CONSTRICTED - urine specific gravity is INCREASED and CONCENTRATED what is the treatment for FVD ? - prevent further losses - replace volume ex: mild deficit- PO fluids severe deficit- IV fluids what are patients are higher risk for when they are dealing with FVD? - falls b/c of changes in V/S & mental status what happens in the body when you are given isotonic solutions? - goes into the vascular space and stays there what are some examples of isotonic solutions? - normal saline - lactated ringers - D5W which fluid is best for shock patients? - Lactated ringers what do you use isotonic solutions for ? - pt's that lost fluids through nausea, vomiting, burns, sweating, trauma - normal saline is the basic solution when administering blood DO NOT use isotonic solutions in clients with what? - hypertensions, cardiac disease or renal disease isotonic solutions can cause what? - FVE, hypertensions, or hypernatremia ( high concentration of sodium in the blood) hypotonic solution does what in the body? - goes into the vascular space and then shifts out into the cells to REPLACE CELLULAR FLUID hypotonic solution rehydrates but does not cause _____________ hypertension what are some examples of hypotonic solutions ? - 1/2 NS - 0.33 % NS when and on who do you use hypotonic solutions? - pt's who have hypertension, renal, or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage, etc. - also used for dilution when a client has hypernatremia and cellular dehydration what should you watch out for when adminstering HYPOtonic solutions? - watch for cellular edema because this fluid is moving out to the cells, which could lead to fluid volume DEFICET and decreased blood pressure HYPERtonic solutions does what in the body ? - volume expanders that will draw fluid into the VASCULAR SPACE from the CELL what are some examples of hypertonic solutions? - TPN, albumin what do you use hypertonic solutions for ? - clients with HYPONATREMIA or a client who has shifted large amts of vascular volume to a 3rd space or has severe edema, burns, or ascites - hypertonic solutions will return the fluid volume to the vascular space what should you watch out for when adminstering hypertonic solutions? - watch for fluid volume EXCESS - monitor ICU setting with frequent monitoring of blood pressure , pulse, and CVP, esp. if they are receiving 3% NS or 5% NS what are the top 5 joint commission high alert mediciations? - insulin - opiods/narcotics - injectable potassium chloride or phosphate concentrate - intravenous anticoagulants ( heparin) - sodium chloride solutions ABOVE 9% when thinking isotonic solutions think of what saying? - " Stay where I put It" when thinking of hypOtonic solutions think of what saying? ' go Out of the vessel" when thinking of hypErtonic solutions think of what saying? " Enter the vessel" magnesium and calcium act like a what? - sedative megnesium is excreted by the _________, but it can be lost in other ways ( GI tract) kidneys what is the antidote for magnesium toxicity? - calcium gluconate what is the normal lab value for magnesium ? - 1.3- 2.1 mEq/L what is the normal lab value for calcium ? - 9.0- 10.5 mg/dL what are the causes for hypermagnesemia? - renal failure - antacids signs and symptoms of hypermagnesemia - flushing and warmth - mg causes vasodilate what is the treatment for hypermagnesmia ? - ventilator - dialysis - calcium gluconate when calcium goes down the phosphate does what? - goes up - they have a inverse relationship which means they are opposite of each other what are the causes of hypercalcemia ? - hyperparathyroidism: too much PTH * when your serum calcium gets low, parathormone (PTH) kicks in and oulls Ca from the BONE and puts it in the BLOOD; therefore the serum, calcium goes UP - thiazides - retain CALCIUM - immobilzations- you have to bear weight to keep Ca in the BONES what are some S/S of HYPERcalcemia ? - bones are BRITTLE - KIDNEY STONES Majority or calcium what is the treatment for hypercalcemia? - MOVE!!!! - fluids prevent KIDNEY STONES - ca has an inverse relationship with phosphurus - steroids