hypo and hypervolemia
Normal CVP readings in mmHg
2-6
Normal CVP readings in cmH20
5-10
where is ANP found
Atria of the heart
which disease has not enough ADH
DI
what is a cheat strategy for diabetes insipidus/DI
DIurese
tx for hypervolemia: what 2 test results affect tx
I&O and daily weights
to replace volume in hypovolemia with a severe deficit fluids are given
IV
increased aldosterone causes
Na and water retention
to replace volume in hypovolemia with a mild deficit fluids are given
PO
which disease has too much ADH
SIADH
what are 2 ADH problems
SIADH, DI
DI leads to
Shock
transphynodial hypophysectomy
across sinus pituitary take out
disease with too little aldosterone
addison's
where is aldosterone found
adrenal glands located near your kidneys
What 3 hormones regulate fluid volume
aldosterone, atrial natriuretic peptide (ANP), ADH
what 3 medications cause hypervolemia
alkaselter, fleet enema, and IVF with Na
ADH
antidiuretic hormone
2nd step in assessing orthostatic hypotension
assess vitals lying down
3rd step in assessing orthostatic hypotension
assess vitals sitting up
4th step in assessing orthostatic hypotension
assess vitals standing up
ANP
atrial natriuric peptide
the ______ is concentrated in DI
blood
peripheral vasoconstriction -> cool extremities in hypovolemia b/c of
blood shunting to vital organs
hypervolemia is too much fluid in the
body/vascular space
another loop diuretic that will work when lasix/ fruosimide will not
bumetanide (bumex)
during hypovolemia 2 problems that lead to third spacing are
burns and ascites
what happens when the atria chambers stretch and get bigger
causes ANP release
in hypovolemia if the patient is putting out any urine at all it will be
concentrated
what happens to the urine in SIADH
concentrated
_____ a s/s of hypovolemia is due to peripheral vasoconstriction in an effort to shunt blood to vital organs
cool extremities
what are the key words to make you think of a potential ADH problem
craniotomy, head injury, transphynodial hypophysectomy, sinus surgery, or any condition that can lead to increased ICP
2 diseases with too much aldosterone
cushings, hyperaldoseronism (conn's)
dilute makes numbers
decrease
in hypovolemia: weight, skin turgor, urine output, BP, CVP
decreases
in SIADH urine output ____ making the serum Na ____ and the urine Na ____
decreases, low, high
in DI there is a fluid volume
deficit
when hypovolemia turns into shock there is a big time fluid volume
deficit
a cause of hypovolemia is polyuria; what is a major disease that causes this
diabetes
what happens to the blood in SIADH
dilute
what happens to the urine in DI
dilute
s/s of hypervolemia
distended neck and peripheral veins, peripheral edema and third spacing, increased CVP, wet lung sounds, polyuria, increased pulse, fluid going backward -> HF then pulmonary edema, increased BP, weight gain
a s/s of hypervolemia is full vessels what is another name
distended neck/peripheral veins
addison's
doesn't have enough Na and Water
a s/s of hypovolemia is ____ mucous membranes
dry
what 4 pt's do you give IVF's slowly to
elderly, young, cardiac, kidney
in SIADH there is a fluid volume
excess
ANP causes
excretion of Na and water
hypovolemia pt's are at higher risk for ____ due to ____
falls, orthostatic hypotension
when treating for hypovolemia you must monitor for
fluid overload
hypovolemia
fluid volume deficit
decreased aldosterone causes
fluid volume deficit (hypovolemia)
hypervolemia
fluid volume excess
any acute weight gain is ____ not ____
fluid, fat
a s/s in hypervolemia: if the fluid in the heart doesn't go ____ it's going to go ____ into the ____
forward, backward, lungs
a s/s in hypervolemia: weight ____
gain
a s/s in hypervolemia: fluid going backward into the lungs from the heart can lead to ____ then ____
heart failure, pulmonary edema
causes of hypervolemia
heart failure, renal failure, alka seltzer, fleet enema, IVF with Na
how does HF cause hypervolemia
heart is weak -> c/o decrease -> decreased kidney perfusion -> decreased urinary output = the volume stays in the vasculature
testing strategy: for fluid retention think ____ ____ first
heart problems
example of HCTZ diuretic
hydrochlorothiazide (thiazide)
concentrated makes numbers
increase
a tx for hypervolemia: is bed rest b/c it induces diuresis by
increased ANP, which causes excretion of Na and water and a decrease production of ADH, which causes decreased Na and water
a s/s in hypervolemia: bp ____
increases, (more volume; more pressure)
a s/s in hypervolemia: pulse ____; your heart only wants fluid to go ____
increases; forward
in hypervolemia what organ is trying to help you get rid of the fluid
kidneys
example of 1st line loop diuretic
lasix/ fruosimide
in hypervolemia vessels can't hold anymore so they start to
leak
what causes ascites
liver failure
tx for hypervolemia: the 3 diuretics are
loop, hctz, K sparing
what happens to water in DI
loose/ diurese
what causes hypovolemia 3 things cause
loss of fluids from anywhere, third spacing, diseases with polyuria
tx for hypervolemia: is a ____ Na diet and ____ fluids
low, restriction
what can polyuria lead to
oliguria -> anuria -> renal failure
decreased bp in hypovolemia leads to
orthostatic hypotension
a s/s in hypervolemia: what is another name for leaking vessels
peripheral edema/ third spacing
for ascites; third spacing, a cause hypovolemia, affects the
peritoneum
where is ADH found
pituitary
a s/s in hypervolemia: what is the term for when the kidneys are trying to get rid of the fluid
polyuria
tx for hypovolemia
prevent further deficit, replace volume, safety precautions
1st step in assessing orthostatic hypotension
pt lies down for 3 min
5th step in assessing orthostatic hypotension
record bp and pulse with each position change
does ADH normally make you retain or diurese?
retain
where is the CVP measured
right atrium
example of k sparing diuretic
spironalactone (aldactone)
aldosterone is a
steroid
where are the lung sounds first heard in hypervolemia
the base of the lungs
how does renal failure cause hypervolemia
the kidneys aren't working
why is there decreased urine output in hypovolemia
the kidneys either aren't being perfused or they are trying to hold onto fluid (compensation)
how does ANP work
the opposite of Aldosterone
what happens to respirations any time you have a decreased blood volume in your body
the rate increases
why does ascites lead to respiratory problems
the swelling in the peritoneum causes it to push up on the lungs making it hard to breathe
test strategie: for polyuria
think shock first
what is the term for the definition used in hypovolemia when fluid is in a place that does you no good
third spacing
examples of what it means when you say a loss of fluids from anywhere in hypovolemia
thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
for burns; third spacing, a cause hypovolemia, affects the
tissues
what is a cheat strategy for SIADH
too many letters = too much water
cushings
too much of all steroids
a s/s in hypervolemia: the CVP number goes
up (more volume; more pressure)
A drug that means ADH
vasopressin (pitressin)
which 2 drugs may be used as an ADH replacement in DI
vasopressin (pitressin), desmopressin acetate (DDAVP)
vein vasoconstriction
very tiny veins
what does ADH make you retain
water, only water
s/s of hypovolemia
weight loss, decreased skin turgor, dry mucous membranes, decreased urine output, decreased BP, pulse increased, respirations increased, CVP decreased, peripheral and neck vein vasoconstriction, cool extremities, increase in urine specific gravity
a s/s of hypervolemia: what are the lung sounds heard
wet
normal action of aldosterone
when blood volume gets low (vomiting/hemorrhage) -> aldosterone secretion increases -> retention of Na and Water -> a blood volume increase
in SIADH what happens to vascular water
you retain it
