What is the:
- function of antidiuretic hormone (ADH)?
- what is it controlled by?
- what does it regulate?
ADH:
- function: to hold onto water only
- controlled by: posterior pituitary and kidneys
- regulates: blood pressure
What is the:
- function of aldosterone?
- what is it controlled by?
- what does it regulate?
Aldosterone is a steroid hormone:
- function: to hold onto sodium and water
- controlled by: adrenals (on top of kidneys)
- regulates: blood pressure
What are the cascade of hormones that go into effect with low blood pressure which then helps the body hold onto fluid and increase the blood pressure?
- renin: kidneys release this when it senses low blood pressure
- angiotensin I: then the liver releases this hormone
- angiotensin II: then the lungs release this hormone
- aldosterone: then the adrenals release this hormone, which helps the kidneys hold onto sodium and water causing an increase in blood pressure.
What are atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)?
ANP and BNP are two hormones released by the heart when the heart tissue is stretched due to fluid volume overload.
They both help the body to get rid of extra fluids.
What is the difference between intravascular, intracellular and extracellular fluid compartments?
- intravascular (or vascular): are all the fluids in the blood vessels
- intracellular: are all the fluids in the cells
- extracellular (or third space): are all the fluids outside the cells
What is third-spacing?
A type of edema. It is extracellular fluid that has leaked out of the vessels and into the tissues due to a disease or injury.
This fluid shift can cause fluid volume deficit.
What is central venous pressure and what does it indicate when it’s high and low?
CVP is blood pressure in the vena cava, which carries blood returning to the heart right near the right atrium. It is used to determine the severity of heart failure.
- increased CVP: high blood pressure and too much fluid in the body
- decreased CVP: low blood pressure and not enough fluid in the body
What is fluid volume overload (FVO) and what are 2 basic causes of it?
It’s when there is too much fluid in the vascular space. It is caused by:
- holding onto fluids or
- not getting rid of fluids
Overhydration and hypervolemia are other terms used to describe FVO.
What are the most common diseases that cause fluid volume overload from holding onto fluids?
- Heart failure: the heart can’t pump the extra fluids through
- Cirrhosis: the liver can’t make proteins, causing fluids to leak out of the vascular space and into the third space
- Cushing’s: there are too many steroids and steroids hold onto fluids
What is the most common disease that causes fluid volume overload from the body not getting rid of fluid?
Chronic kidney failure: the kidneys no longer work, so the body doesn’t get rid of the fluids.
What are two common situations of a client getting too much fluid intake that worsens fluid volume overload?
- the client eats salty food which causes thirst and fluid intake
- the client receives too much IV fluids
What are the vital signs with fluid volume overload (FVO) and why do they occur?
- ↑ blood pressure: more fluid volume causes increased pressure
- ↑ heart rate: heart works extra hard to push fluids through
- bounding pulse: more fluid volume stretches the vessels
Which way do the labs go with fluid volume overload?
- hematocrit
- BUN
- serum osmolality
- sodium
- urine specific gravity
- ↓ hematocrit: also called hemodilution
- ↓ BUN
- ↓ serum osmolality: ↓ electrolytes and sugar in the blood
- ↓ sodium
- ↓ urine specific gravity: ↓ particles in the urine
Everything is diluted in the blood or urine due to the extra fluids.
What are the signs and symptoms of fluid volume overload?
- cardiac: distended veins, dysrhythmias, ↑CVP
- respiratory: increased and shallow respirations, dyspnea, moist crackles
- renal: decreased or increased urine output (depends on cause)
- skin: edema, pale and cool skin
- gastrointestinal: increased weight
- neuro & muscular: confusion, muscle weakness
The body has too many fluids in it and electrolytes can also become imbalanced.
What are the most common interventions to treat fluid volume overload?
- Always treat the “cause” first
- fluid restrictions
- diuretics: meds that cause urination
- possible dialysis: if there is chronic kidney disease
- monitor intake and output
What is fluid volume deficit (FVD) and what are 2 basic causes of it?
It’s when there is not enough fluid in the vascular space. It is caused by:
- not enough fluid intake by mouth or IV
- getting rid of too many fluids
Dehydration and hypovolemia are other words for FVD.
What are the most common causes of fluid volume deficit?
(think of reasons of where the client would be getting rid of fluids)
- vomiting
- polyuria
- diarrhea or laxative overuse
- drainage from fistulas (abnormal openings)
- drainage from tubes
- excessive sweating
- hemorrhage
- burns
What are two ways the kidneys can cause fluid volume deficit?
- too many diuretics: the client urinates too much
- Addison’s disease: the client doesn’t have enough steroids. Without enough steroids, the client won’t be able to hold onto fluids.
What are the vital signs with fluid volume deficit and why do they occur?
- ↓ blood pressure: less fluid volume causes decreased pressure
- orthostatic hypotension
- ↑ heart rate: less fluid means less oxygen so the heart compensates to get oxygen to the vital organs
- weak and thready pulse: less fluid volume in the vessels
- ↑ temperature: due to loss of fluids cooling the body down
Which way do the following labs go with fluid volume deficit?
- hematocrit
- BUN
- serum osmolality
- sodium
- urine specific gravity
- ↑ hematocrit: also called hemoconcentration
- ↑ BUN
- ↑ serum osmolality: ↑ electrolytes and sugar in the blood
- ↑ sodium
- ↑ urine specific gravity: ↑ particles in the urine
Everything is concentrated in the blood or urine due to the decreased fluids.
What are the signs and symptoms of fluid volume deficit?
- cardiac: flat veins, dysrhythmias, ↓CVP
- respiratory: increased rate and depth of respirations, dyspnea
- renal: decreased urine output, dark-yellow urine
- skin: poor skin turgor
- gastrointestinal: decreased weight
- neuro & muscular: confusion, muscle weakness
The body doesn’t have enough fluids in it and electrolytes can also become imbalanced.
What are the most common interventions to treat fluid volume deficit?
- Always treat the “cause” first
- Increase fluid intake (especially IV fluids)
- monitor intake and output
How are intake and output monitored by the nurse?
- weighing the client daily at the same time
- measuring the urine output (client may get a Foley)
- measuring amount of fluids ingested by mouth or IV fluids
- estimating fluid loss by sweating, breathing and bowel movements
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Positions37
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Lab Values46
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Health & Physical Assessment128
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Lab Interpretation61
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Fluids23
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Electrolytes55
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Acid-Base Imbalance31
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Diagnostic Tests73
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Perioperative Nursing47
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Nutrition and Diets45
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Tubes56
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Complementary and Alternative Medicine15
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Intravenous Therapy88
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Total Parenteral Nutrition (TPN)28
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Culture & Religion27
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Growth and Developmental Theories21
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Blood Administration38
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Community Health27
