fluid volume excess also another word for ?
- HYPERvolemia
definition of fluid volume excess
- too much fluid in the vascular space ( any vessel
... [Show More] in our body ex: vein , artery)
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)
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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
what are some causes of HYPOmagnesmia ?
- diarrhea- lots of Mg in intestines
- alcoholism
- alcohol suppresses ADH & its hypertonic ( not eating or drinking)
what is the treatment of hypomagnesmia ?
- give some Mg
- check KIDNEY function ( before and during IV mg )
- seizure precautions
- eat magnesium
what are the causes of hypocalcemia ?
- hypoparathyroidism
- radical neck
- thyroidectomy
* all these = not enough PTH)
serim calcium goes DOWN
what is the treatment for hypocalcemia?
- PO calcium
- Vitamin D
- phosphate binders: sevelamer hydrochloride ( renagel) calcium acetate ( PhosLO)
what kind of S/S does hypermagnesmia and hypercalcemia have in common?
- DTRs DECREASED
- muscle tone WEAK/FLACCID
- arrhytmias INCREASED
- LOC DECREASED
- Pulse DECREASED
- respirations DECREASED
what are some S/S does hypomagnesia and hypocalcemia have in common?
- muscle tone RIGID, TIGHT
- cloud the client have a seizure? YES
- stridor/laryngospasm- airway is a SMOOTH muscle
- + chovostek sign ( tap cheek "C" is fo cheek)
- + Trousseaus ( pump up BP Cuff)
- arrhythmias heart is a MUSCLE
- DTRs- INCREASED
- mind changes
- swallowing problems- esphagus is a smooth MUSCLE
what are some foods that are high in magnesium ?
- spinach
- mustard GREENS
- squash
- pumpkin seeds
- flax seeds
the nurse is caring for a client post colonoscopy. the client reports a small amount of abdominal discomfort and there is a drop of bright red blood on the sheet. what is the priority nursing intervention?
1. reassess in 15 min
2. call the primary healthcare provider
3. call for STAT H&H
4. instruct the client to stay in bed
2. call the primary healthcare provider
intervention is required with which client ?
- a client with a HX of generalized ( tonic clonic ) seizures or a client that is 8 hr post heart cath ?
- client that is 8 hr post heart cath
TIP: no happy questions. ALWAYS BE WORRIED about hemorrhaging maybe the doc. punctured/perforated something. pick an answer that fixes the problem.
when you think of sodium in the body what should you think of first?
- neuro changes
- the brain does not like when NA + is messed up
- the sodium level in your blood is totally deoendent on how much water you have in the blood
hypernatremia also another word for ?
- dehydration
hypernatremia means what?
- too much sodium ; not enough WATER
what are the causes of hypernatremia?
- hyperventilation
- heat stroke
- diabetes insipidus ( DI)
what is the normal lab value for sodium ?
135-145 mEq/L
signs and symptoms of hypernatremia
- dry mouth
- thirsty already dehydrated by the time you're thirsty
- swollen TONGUE
- neuro changes
what is the treatment for hypernatremia
- restrict sodium
- dilute clients with fluids ( diluting makes sodium go DOWN
- daily weights
- I&O
- lab work
If you have a sodium problem you have a _______ problem?
FLUID
hyponatremia is another word for what?
- dilution
definiton of hyponatremia
too much water; not enough SODIUM
what are the causes of hyponatremia
- drinking H2O for fluid replacement ( vomiting, sweating) ( this only replaces water and dilutes the blood)
- psychogenic polydipsia; loves to drink WATER
- D5W ( sugar & water)
- SIADH; retaining WATER
what are the S/S of hyponatremia
- headache
- seizure
- coma
what is the treatment of hyponatremia ?
- client needs SODIUM
- client doesnt need WATER
case in point: feeding tube clients tend to become ___________
dehydrated
what is the normal lab values for potassium ?
- 3.5- 5.0 mEq/L
potassium is excreated by the ________
kidneys
- if the kidneys are not working well, the serum potassium will go UP!
what are the causes of hyperkalemia ?
- kidney trouble
- spironolactone ( aldactone) - makes you RETAIN potassium
what are the signs and symptoms of hyperkalemia?
- begins with muscle twitching
- then proceeds to muscle twitching/weakness
- then flaccid paralysis
when the symptoms " begins with muscle twitching" what does that alternative mean?
- life threatening arrhythmia [Show Less]