Fluid Volume Excess (hypervolemia) - ✔✔ Too much fluid in the vascular space caused by: HF, RF, and High Na intake (meds, food, IVF with Na) and
... [Show More] Hormones (aldosterone and ADH)
How does HF cause FVE (Fluid Volume Excess)? - ✔✔ bc the weak heart cant perfuse the the kids therefore decreased Urine out put.
How does RF cause FVE? - ✔✔ the kidneys are not functioning therefore no urine out put and fluid remains in vasc space
Aldosterone - ✔✔ created in adrenal glands on Kidneys, it is a steroid and mineralocosteroid; retains water and sodium. therefore increases BP
AHD - ✔✔ anti diuretic therefore RETAINS water only. found in pituitary therefore any head trauma, surgery, or increased ICP can lead to ADH issues.
Dx name for it is Vasopressin or "Pressins"
Too much ADH - ✔✔ SIADH, therefore reatains water in vasc space. Urine is concentrated (increased serum spef) and blood is diluted (decreased Blood HCT).
Too little ADH - ✔✔ Diabetes insipidus; diuresis fluid leads to FVD (shock), Urine will be dilute (urine spef will decrease) and blood will be conc. (HCT will be increased).
the three labs that concentration (increases) and dilution (decreases) - ✔✔ Na, Hct, Urine spef
FVE SS - ✔✔ incresaed: BP, P, RR, CVP (2-6), DW, JVP
wet lungs, polyuria,
P is bounding and full
3rd spacing
FVE trx - ✔✔ low Na, fluid restriction
I&O and DW
Diuretics
bed rest
FVD (hypovolemia) - ✔✔ not enough fluid in vasc space which can lead to shock and is casued by fluid loss, 3rd space, Disease with polyuria.
FVD ss - ✔✔ wt decreases,
poor skin turg,
dry mm
decreased Urine
decrease BP & CVP,
Tachy and weak/thready,
cool clammy r/t vasocons
increase urine spef.
FVD trx - ✔✔ prevent loss,
replace fluid
safety precs (falls r/t loc),
Hypermagnesemis - ✔✔ acts like a sedative and think of muscles;
excreted by kidneys therefore:
RF and antacids can be the problem.
Hypermagnesemia ss - ✔✔ vasodil--> warm/flushing;
decreased DTRS, flaccid tone, decreased LOC/P/RR, and arrythmias (same as....hypo....)
Hypermagnesemia trx - ✔✔ ventilator, dialysis, Ca Gluc (antidote), safety precs (sedation)
Hypercalcemia - ✔✔ Sedative, think of the muscles;
caused by hyperparatyroidism too much PTH therefore pulls from bones into blood; Thiazides retains Ca, and immobility
Hypercalcemia SS - ✔✔ bones and stones
Decreased DTRs, flaccid,
decrease: P, RR< LOC
arrythmias
Hypercalcemis Trx - ✔✔ Mobility, increase fluids, inverse r/s with phos so admin phosphates and calcitonin, steroids, safety precs,
Hypomagnesemia - ✔✔ Not enough sedative; caused by diarrhea and alcoholism bc it suprresses ADH and it is a hypertonic solution and they dont eat.
Hypomagnesemia & Hypocalcemia ss - ✔✔ Convulsions. confusion (loc change)
Arrythmias
Tetany, DTRS increase,
Sstridor, swallow prob
(positive Stridor and chevotske)
Hypomagnesemia Trx - ✔✔ give Mg (IV, PO, Foods) , monitor Kidney fxn, seizure precs, stop infusion with flushing/sweating
Hypocalcemia caused by: - ✔✔ caused by hypoparathyroidism, radiac neck, thyroidectomy therefore decreased PTH=decreased Ca serum
Hypocalcemia trx - ✔✔ PO, IV Ca therefore give slow and on cardiac monitor, give Vit D, phophate binders: ca acetate, sevelamer hydrochloride
HyperNa - ✔✔ think neuro changes, dehydration too much Na not enough water, r/t hyperventialation, heat stroke and DI
HypoNa - ✔✔ think neuro changes, too much water and not enough Na r/t excessive water replacemoent for sweating, psychogenic polydipsia, D5W and SIADH
Hyper Na SS - ✔✔ dry mouth, thristy, swollen tongue, neuro changes
HypoNA ss - ✔✔ HA, seizure, coma
HyperNa trx - ✔✔ Na restriction, diulre fluids, DW, I&O, labs
hypoNa TRX - ✔✔ give NA, no water, hypertonic saline, give hypertonic saline if neuro problems occure
HyperKa - ✔✔ it is excreted by kidney so it increases think kidney problems or medications like spironalactone
HypoKa - ✔✔ excreted by kid therefore you can think of diuretics of problem or not gettingenough in diet or NG suction of vomitting
SS HyperK - ✔✔ muscle twitch leads to weak to paraplysis; brady Tall T prolonged/wide QRS, vfib
SS hypoK - ✔✔ cramps to weak to arrythmias ECG: u waves, PVCs, and Vtach
HyperKa trx - ✔✔ dialysis, ca gluc (arrythmia), gluc and insulin; sodium polystyrene sulfaonate
sodium pollystyrene sulfonate - ✔✔ Kayexalate
HypoKa trx - ✔✔ give K IV (never push and only on a monitor with a pump and will burn) , PO (med may cause GI upset), or spironolactone
Respiratory Acidosis - ✔✔ gas exchange issue (obstructive), too much CO2 r/t Hypoventilation. Think Lethargy.
increased CO2=decreased LOC=decreased o2
SS: confusion, sleepy, coma and hypoxic
TRX: fix the primary resp issue and give oxygen
Resp Alkalosis - ✔✔ Think excitable, too little CO2 r/t hyperventilation. Kidneys exrete bicarb and ratin H. Hysteria, acute ASA OD can cause this.
SS: vasoconstriction therefore lightheaded, faint, periorbital numbness, tingling toes, and fingers.
TRX: sedate, treat the cause and ABGs
Metabolic acidosis - ✔✔ too much H r/t DKA, Starvation, RF, severe diahrea. cells are starving b/c gluc not available therefore breakdown of fat creates keteone (an acid).
SS: think lethargy and hyperK (MURDER- twitch, weak, flaccid, and arrythmia) Kussmaul (increased resp r/t DM).
Metabolic alkalosis - ✔✔ Too much bicar r/t to loss of upper GI or too many antacids.
SS: hyperactive, and hypokalemia(CRAMPS and arrrythmia)
TRX: replace K
Burns - ✔✔ Cap permeability puts the client at first for 24 hours. therefore cardiac output will decrease kidney perfusion.
They will exprete EPI and NOreEPI furthur vasoconstricuting.
ADH and Aldosterone are secreted too.
Fluids are replaced within 24 hours of the burn contact and half of the fluid is given in 8 hours.
Burn Trx - ✔✔ 1. cool water for 10 min
2. Keep pt covered to promote warmth and decrease bacteria introduction
3. Remove jewlery or constricting artificats DO NOT peal away skin.
Inhalation burns - ✔✔ Carbon monozide and hydrogen cyanide. treat with 100% oxygen and think of possible intubation.
Burn Meds - ✔✔ Albumin: increases vol. therefore monitor for FVE
IV pain meds not IM b/c decreased circulation.
Immunications: active (2-4 wks) or passsive (immediate-globulins)
ABX: braods like Mycins (nephro/ototoxic).
Silvers [Show Less]