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N112 Fluids

N112 - Fluid Imbalances

QuestionAnswer
How does ADH (antidiuretic hormone) work? An increase in ADH will cause the kidney to retain fluid and a decrease in ADH will cause the kidney to excrete fluid.
How does aldosterone work? Aldosterone causes the kidney to retain sodium & water.
How do fluid shifts occur? Decreased vascular colloid pressure, increased capillary hydrostatic pressure, increased capillary permeability, lymph obstruction.
What is colloid osmotic pressure? Colloid osmotic pressure is the pulling force of albumin (protein) in the intravascular space.
What would be the result of low colloid osmotic pressure? Less water would be pulled into the blood vessels from the interstitial spaces.
How would colloid osmotic pressure decrease? A decrease in serum protein (albumin), as in malnutrition, burns or liver damage result in low colloid osmotic pressure.
What would happen to the blood volume if more water stayed in the interstitial space? More water in the interstitial spaces would create a lower blood volume.
What would an increase in hydrostatic pressure cause? An increase in capillary hydrostatic pressure will cause fluid & solutes to be forced into interstitial space or prevent colloid osmotic pressure from pulling water in.
What would increased capillary permeability cause? Damage to blood vessels causes proteins to leak into the interstitial space, the result is edema since the protein in the interstitial space attracts water.
How does inflammation, burns or allergic reactions effect edema? Inflammation, burns or allergic reactions cause vasodilation and increased capillary permeability, causing both water & solutes to move into the tissues creating edema.
What is hypervolemia? Hypovolemia is sodium & water excess, occurs with heart failure. Heart failure reduces renal blood flow and causes retention of sodium & water.
What are the signs & symptoms of hypervolemia? Weight gain, peripheral edema, distended neck & peripheral veins, bounding full pulse, polyuria, pulmonary edema, moist rales. Serum sodium levels may be normal or decreased due to dilution.
What is hypovolemia? Hypovolemia is due to a loss of both water & electrolytes, especially sodium.
What are causes of hypovolemia? A reduced circulating blood volume can be caused by blood loss, reduced fluid intake, excessive fluid loss, fluid lost to interstitial space.
What is the treatment for hypovolemia? Determine renal function, isotonic electrolyte solution (lactated ringers), followed by a hypotonic solution. Continue fluids, evaluate lung sounds & BP for indications of overload.
What are clinical indications of fluid volume deficiency? Indications of fluid volume deficiency may include decreased urine, output, drop in systolic BP, weak rapid pulse, dry mucous membranes, last stages include cold, clammy skin, olguria, stupor & coma.
What is third spacing? Third spacing is a shift of fluid from the vascular bed to the interstitial space. The vascular volume is reduced, but the person will have edematous tissue.
Created by: jrb265