hypo and hypervolemia

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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


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