Fluid Volume Excess (Overload)/Hypervolemia

Aldosterone

-Steroid, Mineralocorticoid -When blood volume gets low (vomiting, hemorrhage, etc): Aldosterone secretion increases= retain sodium/water=blood volume goes up -Diseases with too much Aldosterone: Cushings, Hyperaldosteronism (AKA Conns Syndrome) -Disease with too little Aldosterone: Addison's (decrease in retention of sodium/water=fluid volume defecit)

What are 2 important hormones in regulation of fluid volume?

1. Aldosterone -Steroid, Mineralocorticoid -Found in adrenal glands -Normal action: when blood volume gets low (vomiting, hemorrhage, etc), Aldosterone secretion increases to tell the body to retain sodium and water. Blood volume goes up. -Diseases with too much Aldosterone: 1) Cushings (too much steroids in general) and 2) Hyperadosteronism (AKA Conn's Syndrome, hyperactive adrenal gland(s)) -Disease with too little Aldosterone: Addison's (decreased sodium and water, causes a fluid volume DEFECIT) 2. Anti-Diuretic Hormone (ADH) -Normally makes you retain water -Consider differences between if you have too much or too little ADH

What are the 4 hazards of immobility due to the bedrest effect on diureses?

1. DVT 2. Pneumonia 3. Kidney stones (from dehydration) 4. Constipation

Name 3 Causes of Hypervolemia and why/how they cause it?

1. Heart Failure: Heart is weak, cardiac output goes down, kidney perfusion goes down, urinary output goes down, and volume stays in the vascular space (particularly the heart and causes hypertrophy) 2. Renal Failure: Kidneys aren't working 3. Things with lots of Sodium (Effervescent soluble meds (i.e. Alka-Seltzer), canned/processed foods, IV fluids with sodium)

Normal level: Urine Specific Gravity

1.002-1.030

Normal level: Serum Sodium

135-145 mEq/L

Vasopressin

Anti-Diuretic Hormone (ADH)Vasopressin (Pitressin) or desmopressin acetate (DDAVP) Used as ADH replacement for Diabetes Insipidus Works to maintain fluid/blood volume and therefore blood pressure

What is ANP?

Atrial Natriuetic Peptide (ANP) causes excretion of sodium and water. *In hypervolemia, fluid goes backward to heart and stretches atria. Stretched atria release ANP to diurese fluid.

What is the effect of bedrest on diuresis? How?

Bed rest induces diuresis. *Releases ANP and decreases production of ADH.* ANP: Atrial Natriuetic Peptide: Fluid goes backward to heart and stretches atria; stretched atria release ANP to diurese ADH: Anti-diuretic Hormone

Always PUSH FLUIDS for clients on bedrest. Why?

Bed rest induces diuresis. Maintain fluid balance. To avoid 4 hazards of immobility 1. DVT 2. Pneumonia 3. Kidney stones (from dehydration) 4. Constipation

Normal level: Central Venous Pressure

Central Venous Pressure (CVP) aka "RAP" Right Atrial Pressure 2-6 mmHg 5-10 cmH2O Depends on which measuring device is being used

Problems that influence ADH levels

Diabetes Insipidus (too little ADH) Any condition that can lead to increased ICP: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy

S/S of Fluid Volume Excess

Distended neck veins/peripheral veins. Vessels are full. a. Increased Jugular Vein Distention (JVD), Increased BP b. Peripheral edema/third spacing: vessels can't hold any more, so they start to leak c. Central venous pressure (CVP): measured where? right atrium: number goes up in FVE. More volume more pressure. >6 mmHg or >10 cmH2O d. Lungs sound wet; listen to bases in back = shortness of breath e. Polyuria (kidneys are trying to diurese) f. Tachycardia (to keep blood pushing forward; if it goes backward, it goes into the lungs and causes pulmonary edema. Palpate radial artery & it will feel full and bounding) g. Hypertension h. Fast weight gain: "Any acute (fast) gain or loss isn't fat, it's fluid."

Treatment for too little ADH in Diabetes Insipidus

Drug vasopressin (Pitressin) or desmospressin acetate (DDAVP) may be used as ADH replaccement in Diabetes Insipidus

S/S of Too Little ADH

Fluid Volume Defecit (Hypovolemia)=shock=death Loose (diurese) water DI (diabetes inspidus: not enough ADH; dilute urine) "Sneaky, less obvious way to die. Pee yourself to death." Urine: diluted (urine specific gravity <1.002) Blood: concentrated (increase in serum sodium >145, hematocrit >48% or 52%) Treatment? Drug vasopression (Pitressin) or desmopresson acetate (DDAVP) may be used as ADH replacement in Diabetes Insipidus

S/S of Too Much ADH

Fluid Volume Excess (Hypervolemia) Retain water SIADH (Syndrome of Inappropriate Antidiuretic Hormone) Urine: concentrated (increase in urine specific gravity >1.030) Blood: diluted (decrease in serum sodium <135, hematocrit <37%, 45%)

Fluid Retention: Think ____________ first

Fluid retention: Think heart problems first

Explain heart failure

Heart is weak Cardiac output goes down Kidney perfusion goes down Urinary output goes down Fluid builds up in heart and causes hypertrophy Heart cannot pump as effectively Right vs. Left side: Right side has systemic buildup of fluid; Left side has lung buildup of fluid

Anti-Diuretic Hormone (ADH)

Hormone that Retains Water (increases blood volume, increases blood pressure) "With ADH, think H2O" -Think of differences between too much vs. too little ADH -Found in the pituitary gland

Where is ADH found?

In the pituitary gland IN YOUR HEAD *This means that if there is a head issue, there may be a pituitary gland issue, and therefore an ADH issue. *Key words to make you think potential ADH problem (too much or too little): craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy, or any condition that leads to INCREASED ICP (intracranial pressure) can lead to an ADH problem

Normal level: Hematocrit (Hct)

Male 45-52% Female 37-48%

Right-Sided vs. Left-Sided Heart Failure

Right-sided: Fluid buildup is systemic Left-sided: Fluid buildup is in lungs; "wet lungs"

Definition of hypervolemia

Too much fluid in the vascular space *Think of a garden hose with the water turned all the way up

What is the vascular space?

Veins, arteries, capillaries, heart

Treatment for Fluid Volume Excess

a. Low sodium diet/restrict fluids b. I & O and daily weights c. Diuretics **Monitor lab work for dehydration and electrolyte problems (specifically hypokalemia) -Loop: Furosemide or Bumetanide -Hydrochlorothiazide -Potassium-sparing: Spironolactone Aldactone d. Bed rest induces diuresis by the release of ANP, and decreases produciton of ADH e. Physical assessment focused on pertinent symptoms f. Give IVFs slowly to the elderly and very young and clients with a history of heart or kidney problems (high risk for FVE on IV fluids)