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Fluid Volume Excess & Fluid Volume Deficit

Terms in this set (34)

Fluid Volume Excess is also known as
Hypervolemia
With fluid volume excess there is too much fluid in the
Vascular Space
Name 3 causes of Fluid volume excess
1. Heart Failure
2. Renal Failure
3. Too much Sodium (Alkaseltzer, fleets enemas, IVF with sodium)
What is the relationship between heart failure and fluid volume excess
the heart is weak so cardiac output decreases.
if cardiac output decreases, nothing is perfusing well.
now we're worried about decreased kidney perfusion because that will decrease urinary output.
As a result, volume stays in the vascular space.
what does sodium do?
sodium makes you RETAIN water in the vascular space which then leads to fluid volume excess
Name the 3 hormones used to regulate Fluid Volume:
1. Aldosterone
2. ANP (Atrial Naturiutic Peptide)
3. ADH
What is aldosterone?
aldosterone is a steroid, specifically a mineral corticoid.
aldosterone retains sodium AND water.
Normal Action of Aldosterone
when blood volume gets low (vomiting, hemorrhage, etc), aldosterone secretion increases and then sodium and water is retained to increase blood volume.
Conditions with too much Aldosterone
Cushing syndrome: too much of ALL steroids
Hyperaldosteronism aka Conn's Syndrome

we are retaining too much sodium and water so we are in a fluid volume excess
Conditions with too little aldosterone
Addison's Disease: not enough steroids.
we are losing sodium and water so we are in a fluid volume deficit
Atrial Naturitic Peptide (ANP)
Where is it found?
How does it work?
ANP is found in the atrium of the heart
It is the opposite of aldosterone so it causes EXCRETION of sodium and water.

ANP works on the kidneys to excrete sodium and water which decreases blood volume to fix the fluid excess problem
With aldosterone think...
With ADH think...
Aldosterone think SODIUM AND WATER
ADH think JUST water, ADH had 3 letters, H2O has 3 letters
Anti-Diuretic Hormone
normally makes you RETAIN water
remember ADH is found in the pituitary
Two ADH problems?
SIADH & Diabetes Insipidus
SIADH
what are you doing with the water?
fluid volume _____
urine _____
blood _____
serum sodium _____
too much ADH
retaining water
fluid: volume excess
urine: concentrated
blood: dilute
serum: sodium low because the blood is diluted
Diabetes Inspidus (DI)
what are you doing with the water?
fluid volume _____
urine _____
blood _____
serum sodium _____
not enough ADH
losing/diuresing water
fluid volume: deficit
urine: dilute
blood: concentrated
serium: sodium high because the blood is concentrated
What is the number one think we're worried about with diabetes inspidus (DI)
SHOCK!!! You're losing fluid!
very important to monitor blood pressure!
when something is concentrated the numbers go
UP
hematocrit, specific gravity, and sodium
when something is dilute the numbers go
DOWN
hematocrit, specific gravity, and sodium
Another name for ADH is ________ and ___________ can be utilized in ADH replacement in DI
Vasopressin and Desmopressin (DDAVP)
FVE causes _____ neck veins and peripheral vessels bc they are ______
Distended
are FULL
Why do you have peripheral edema with fluid volume excess?
the vessels are so full that they cannot hold anymore fluid so they start to leak out into the interstitial tissue resulting in edema
What happens to the CVP in fluid volume excess
INCREASES!
remember, more volume means more pressure
Fluid volume excess signs and symptoms
neck veins/peripheral veins:
lung sounds:
kidneys:
distended neck veins/peripheral veins because the vessels are FULL
lung sounds will be wet, so you will have bibasilar crackles
kidneys are trying to help you diurese so you will have polyuria
Fluid volume excess signs and symptoms
pulse:
blood pressure:
weight:
pulse is BOUNDING AND FULL because your heart wants fluid to go forward. the heart needs to work faster and harder to pump the fluid so heart rate increases
Blood pressure is INCREASED, remember more volume means more pressure
weight increases so its important to monitor weight gain
testing strategy: FLUID RETENTION THINK HEART PROBLEMS FIRST
testing strategy: FLUID RETENTION THINK HEART PROBLEMS FIRST
Treatment for Fluid volume excess
Diet:
Restrict:
Important to monitor:
Medications:
Bed rest induces:
Diet: LOW sodium (they have too much sodium already)
Restrict: fluids (they have too much water already)
Important to monitor: I&Os and daily weights
Medications: Diuretics to offload fluid
Bed rest induces diureses
Anytime you see assessment or evaluation look for the presence or absence of ______ & _______
signs & symptoms
Fluid volume deficit is known as
Hypovolemia
Big time deficit = shock
patients with fluid volume deficit are at high risk for orthostatic hypotension
What causes fluid volume deficit
loss of fluids from anywhere
third spacing especially with burns and ascites
disease with polyuria like diabetes
Signs and symptoms of fluid volume deficit
weight:
hydration status:
urinary output:
blood pressure:
weight: decrease
hydration status: dehydrated; decreased skin turgor, dry mucous membranes
urinary output: decreased. why? because the kidneys are either not being perfused or the kidneys are trying to hold on to what little fluid we have
blood pressure: decreases, less volume, less pressure
Signs and symptoms of fluid volume deficit
pulse:
respirations:
CVP:
peripheral veins/neck veins:
temperature of extremities:
urine specific gratvity:
pulse: increased but WEAK AND THREADY
CVP: decreased
peripheral veins/neck veins: vasoconstricted
temperature of extremities: cool because we are shunting blood to vital organs. remember when cool and clammy were in shock
urine specific gravity: concentrated
Fluid volume deficit treatment
prevent further losses
replace volume
safety precautions with fluid volume deficit
highest risk for falls related to changes in vital signs and mental status.
high risk for orthostatic hypotension
monitor for fluid overload when giving fluids
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