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FLUID VOLUME EXCESS
HYPERVOLEMEIA
TOO MUCH VOLUME IN VASCULAR SPACE
HYPERVOLEMIA CAUSES
1. CHF( HEART IS WEAK, CO DOWN, DECREASED KIDNEY PERFUSION, DECREASED UP)
2. RF
3. ALKASELTERS, FLEET ENEMAS, AND IV FLUIDS WITH SODIUM

(ALL THREE HAVE LOTS OF SODIUM)
4. ALDOSTERONE
5. ADH
ALDOSTERONE (STEROID, MINERALCORTICOID)
WHEN BLOOD VOLUME GOES DOWN ALDOSTERONE INCREASES
RETAIN SODIUM AND WATER
ALDOSTERONE TOO MUCH
CUSHINGS
HYPERALDOSTERONE
CONNS
ALSO SEEN IN LIVER AND HEART DISEASE
ALDOSTERONE TOO LITTLE
ADDISONS DISEASE
ADH
VASOPRESSIN ALSO CALLED
LIVES IN PITUITARY  
PROBLEMS:
CRANIOTOMY
HEAD INJURY
SINUS SURGERY
TRANSPHENOIDAL HYPOPHYSECTOMY
SIADH
ADH TOO MUCH
FLUID VOLUME EXCESS
URINE CONCENTRATED
LOW OUTPUT
BLOOD DILUTE

DI
TOO LITTLE ADH
FLUID VOLUME DEFICIT
SHOCK
URINE DILUTE
LARGE AMOUNTS
BLOOD VERY CONCENTRATED
S/S OF FVE
  • DISTENDED NECK VEINS
  • PERIFERAL EDEMA-THIRD SPACING
  • CVP IN RIGHT ATRIUM IS UP
  • CRACKLES OR WET LUNG SOUNDS
  • POLYURIA
  • INCREASE PULSE
  • INCREASE BP
TREATMENT FVE
LOW SODIUM DIET
DIURETICS
1. LOOP
2. THIAZIDES
3. POTASSIUM SPARING
BED REST
GIVE IVF'S SLOWLY TO ELDERLY
FV DEFICIT CAUSES
THORACENTESIS
PARACENTESIS
VOMITING DIARRHEA
HEMMORHAGING
THIRD SPACING FROM BURNS AND ASCITES
DISEASE WITH POLYURIA-DM
S/S FVD
  • DECREASED WEIGHT
  • DECREASED CVP
  • INCREASED PULSE
  • DECREASED BP
  • DECREASED UO
  • COOL EXTREMITITES
  • URINE SPECIFIC GRAVITY INCREASED
TX FVD
MILD DEFICIT PO FLUIDS
SEVERE IV FLUIDS
IV FLUIDS ISOTONIC
GO IN VASCULAR SPACE AND STAY THERE
NORMAL SALINE .9
LR
D5W
IV FLUIDS HYPOTONIC
HANG OUT IN VASCULAR SPACE FOR A LIL WHILE AND REHYDRATE
BUT DONT STAY THERE
WONT DRIVE PRESSURE UP
CAUSES FLUID SHIFT FROM VASCULAR SPACE INTO CELL
IV FLUIDS HYPERTONIC
VOLUME EXPANDER
SOLUTION THAT DRAWS FLUID INTO THE VASCULAR SPACE
MAGNESIUM AND CALCIUM
ACT AS SEDATIVES
MAGNESIUM
HYPER
CAUSES
CAUSES
RENAL FAILURE
ANTACIDS
HYPERMAGNESIUM
S/S
  • FLUSHING
  • WARMTH
  • VASOCONSTRICTING
  • DECREASES BP
TX HYPERMAG
VENTILATOR
DIALYSIS
CALCIUM GLUCONATE
HYPERCALCIUM  CAUSES
HYPERPARATHYROIDISM
THIAZIDES-RETAIN CA
IMMOBILIZATION
HYPERCALC
S/S
BRITTLE BONES
KIDNEY STONES
TX HYPERCALC
MOVEMENT
FLUIDS
PHOSPHOSODA WITH FLEET ENEMAS
PHOSPHORUS INVERSES CALCIUM
STEROIDS-DECREASE CA
CALCITONIN-DRIVES BACK INTO BONES
CAUSES OF HYPOMAG
DIARRHEA
ALCOHOLISM
NOT EATING AND DRINKING
CAUSES OF HYPOCALCE
HYPOPARATHYOIDISM
RADICAL NECK
THYROIDECTOMY
S/S HYPOMAGNES AND HYPOCALC
  • MUSCLE TONE RIGID AND TIGHT
  • STRIDOR
  • CHVOSTEKS-TAP CHEEK TWITCH
  • TROUSSEAUS-PUMP UP BP CUFF HAND TREMOR
  • ARRYTHMIAS
  • INCREASED DTR'S
  • PSYCOSIS
  • SWALLOWING PROBLEMS
TX HYPOMAG
CHECK KIDNEY FUNCTION DURING IV ADMIN OF MAGNESIA
SEIZURE PRECAUTIONS
TX HYPOCALCEM
AMPHOGEL-PHOSPHORUS BINDING GEL
IV CA-WATCH HEART
HYPERNATREMIA
DEHYDRATION
CAUSES
1. HYPERVENTILATION
2. HEAT STROKE
3. DI
S/S HYPERNATREMIA
DRY MOUTH
THIRSTY
SWOLLEN TONGUE
TX HYPERNATREMIA
RESTRICT NA
DILUTE WITH IV FLUIDS
DAILY WEIGHTS
I/O
HYPONATREMIA
LOW SALT TOO MUCH WATER
CAUSES HYPONATREMIA
VOMITING
SWEATING
THEN DRINKING WATER
PSYCOGENIC POLYDIPSIA
D5W
SIADH
TX HYPONATREMIA
NEEDS SODIUM NOT WATER
IF NEURO PROBS:NEED HYPERTONIC SALINE
3-5%NS
POTASSIUM FACTS
EXCRETED BY KIDNEYS
KIDNEYS NOT WORKING WELL
POTASSIUM GOES UP
HYPERKALEMIA CAUSES
KIDNET PROBLEMS
ALDACTONE-RETAIN K
S/S HYPERKALEMIA
BEGINS WITH MUSCLE TWITCHING
PROCEEDS TO WEAKNESS AND FLACCID PARALYSIS
TX HYPERKALEMIA
DIALYSIS
CALCIUM GLUCONATE-DECREASES ARRYTHMIAS
GLUCOSE AND INSULIN
INSULIN TAKES POTASSIUM AND GLUCOSE BACK INTO THE CELL
GIVE KAEXYLATE-EXCHANGES NA AND K INTO THE GI TRACT
HYPOKALEMIA CAUSES
1. VOMITING
2. NG SUCTIONING
3. DIURETICS
4. NOT EATING
THINK STOMACH
HYPOKALEMIA S/S
MUSCLE CRAMPS AND WEAKNESS
TX OF HYPOKALEMIA
GIVE K
EAT K
ALDACTONE
SODIUM AND POTASSIUM HAVE AN INVERSE RELATIONSHIP
EXTRAS POTASSIUM
ALWAYS PUT ON PUMP
NEVER GIVE PUSH
MIX WELL
WILL BURN
MAJOR PROBLEM WITH PO POTASSIUM IS STOMACH UPSET
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