NEW NCLEX NOTES
Fluid Volume Excess = Think Heart First
▪ Causes:
o HF, RF, Too much sodium
o Too much Aldosterone or Cortisol = fluid & sodium
... [Show More] Retention
◆ Cushing’s
• Too many Steroids = sodium and water retention, lose Potassium
• Moon face, Obesity, Buffalo Hump, Weight gain (fluid volume excess)
◆ Hyperaldosteronism
o Too Much ADH/Vasopressin = fluid Retention
◆ SIADH
* Decreased urine Output = Specific Gravity ↑ (Concentrated)
▪ Signs/Symptoms:
o JVD: vessels full
o Edema: vessels are too full, leaking out
o Increased CVP: more volume = more pressure (Range = 2-6)
o Wet Lungs: full of fluid
o Polyuria: kidneys trying to get rid of fluid
o Increased Pulse: they are full and bounding
o Increased BP: more volume = more pressure
o Weight Gain: excess fluid
▪ Treatment:
o Restrict fluid and sodium
o Measure I & O, Daily weight, abdominal girth
o Bedrest: to produce ANP which causes diuresis
o Give IV fluids slowly
o Meds:
◆ Furosemide (Lasix), Hydrochlorothiazide, Spironolactone
◆ Monitor Potassium with Diuretics!!!!
Fluid Volume Deficit = Think Shock First
▪ Causes:
o Vomiting, diarrhea, Hemorrhage, Diabetes
o Burns = fluid into skin
o Ascites = fluid into abdomen
o Too Little Aldosterone or Cortisol = fluid & sodium Loss
◆ Addison’s
o Too Little ADH = fluid loss
◆ Diabetes Insipidus
* Increased Urine Output = Specific Gravity ↓(Dilute), Think “Shock”
▪ Signs/Symptoms:
o Weight loss
o Decreased skin turgor
o Dry mucous membranes
o Decreased urine output (SG ↑, Concentrated)
o Decreased blood pressure (less volume = less pressure)
o Increased Pulse (Weak & Thready)
o Increased Respirations (lungs trying to compensate)
o Decreased CVP (less volume = less pressure) (Range 2-6)
o Tiny neck veins
o Cool, clammy skin (vasoconstriction) (body pulling all blood to center)
▪ Treatment:
o Replace volume
▪ Safety Precautions:
o Risk for falls
o Monitor for Fluid volume overlo
• Diagnostic Scans
▪ CT (contrast) = Check for allergies to iodine or shellfish
▪ MRI = No jewelry, credit cards, Pacemakers
▪ PET
o Alzheimer’ [Show Less]