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FVE: Hypervolemia
too much fluid in the vascular space
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Causes of FVE
- HF: heart is weak, CO dec, Kidney perfusion dec, UO down. *The volume stays in the vascular space.
- Renal Failure
- Alka-seltzer, fleet enema, IVF with Na: all 3 have a lot of Na.
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Hormonal Regulation of Fluid Volume
- ALDOSTERONE: found in adrenal glands
- **when blood volume dec, aldo is released. Retains Na/water-->blood volume goes up
- **too much aldo: con's & cushing's syndrome
- **little aldo: addison's disease
- ATRIAL NATRIURETIC PEPTIDE (ANP)
- **found in the atria of the heart (blood inc, ANP inc so Na & H2O dec)
- **works opposite of aldo--> causes excretion of Na & H2O
- ANTI-DIURETIC HORMONE(ADH)
- **retain H2O
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Too much ADH: SIADH=FVE
**too much letters=too much ADH
- urine concentrated
- blood dilute
- SG inc
- blood dec
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Note enough ADH: DI=FVD
- urine dilute
- blood concentrated
- SG dec
- blood inc
- TX: vasopressin, acetate, DDAVP
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SG, Na, & Hct labs
- concentrated makes the #'s go up
- dilute makes the #'s go down
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ADH
- found in pituitary
- potential ADH problem: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy or any condition that could l/t inc ICP.
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FVE s/s
- distended neck/peripheral veins: vessels are distended
- peripheral edema, thrid spacing: vessels can't hold anymoreso they start to leak
- CVP inc (measured at r atrium): more volume=more pressure (normal=2-6mmHg)
- wet lung sounds
- polyuria
- pulse inc(heart wants to move fluid forward)
- BP inc
- wt gain
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FVE tx
- low Na diet/restrict fluids
- I&O + daily wt
- diuretics: Lasix(Bumex if lasix doesnt work), thiazide, K+ sparing=aldactone
- bed rest=induces diuresing by release of ANP & production of ADH
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FVD: Hypovolemia
- big time deficit=shock
- **polyuria think SHOCK first
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FVD causes
- loss of fluids from anywhere: thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
- third spacing: burns, ascites
- disease with polyuria: DM
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FVD s/s
- wt dec
- dec skin turgor
- dry mucous membrane
- dec UO
- BP dec
- P inc
- R inc (body thinks its hypoxia)
- CVP dec
- peripheral veins/neck veins vasocontrict
- cool extremities (peripheral vasoconstriction in an effort to shunt blood to vital organs)
- SG inc
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FVD tx
- prevent further loss
- replace volume
- safety precautions: r/f falls, monitor for overload
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Isotonic Solution: go into vascular space & stays there
- 0.9% NS, LR, D5W, D5 1/4 NS
- USES: client that has lost fluids through nausea, vomiting, burns, sweating, trauma
- ALERT: do not use in clients with HTN, cardiac disease or renal disease
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Hypotonic Solution: go into the vascular space then shift out into the cells to replace cellular fluid
- **they rehydrate but do not cause HTN
- 0.45%NS, 0.33%NS, D2.5W
- USES: HTN, renal or cardiac disease & needs fluid replacement b/c of nausea, vomiting, burns, hemorrhage
- **also used for dilution when a client has hypernatremia, & for cellular dehydration
- ALERT: watch for cellular edema b/c this fluid is moving out to the cell which could l/t FVD & dec BP
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Hypertonic Solutions: volume expanders that will draw fluids into the vascular space from the cell
- d10W, 3%NS, 5%NS, D5LR, D5 1/2NS, D5NS, TPN, Albumin
- Uses: hypoNa or has shifted large amounts of vascular volume to a 3rd space or has severe edema, burns, ascites
- **hypertonic sltn--> return the fluid volume to the vascular space
- ALERT: watch for FVE. Monitor in an ICU setting with frequent BP, P, CVP monitoring
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Quick Tips
- Isotonic="Stay where I put it!" (vessel)
- Hypotonic="Go OUT of the vessel" (vessel to cell)
- Hypertonic="ENTER the vessel" (cell to vessel)
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