N112 - Fluid Imbalances
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| 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.
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| How does aldosterone work? | Aldosterone causes the kidney to retain sodium & water.
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| How do fluid shifts occur? | Decreased vascular colloid pressure, increased capillary hydrostatic pressure, increased capillary permeability, lymph obstruction.
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| What is colloid osmotic pressure? | Colloid osmotic pressure is the pulling force of albumin (protein) in the intravascular space.
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| What would be the result of low colloid osmotic pressure? | Less water would be pulled into the blood vessels from the interstitial spaces.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| What is hypervolemia? | Hypovolemia is sodium & water excess, occurs with heart failure. Heart failure reduces renal blood flow and causes retention of sodium & water.
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| 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.
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| What is hypovolemia? | Hypovolemia is due to a loss of both water & electrolytes, especially sodium.
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| 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.
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| 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.
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| 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.
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| 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.
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