NR 324 Exam 1 Study Guide/NR 324 Exam 1 Study Guide Chamberlain College of Nursing

What are possible causes of hypervolemia? ● Excessive isotonic or hypotonic IV fluids ● Heart failure ● Renal failure ● Primary polydipsia ● SIADH ( syndrome of inappropriate antidiuretic hormone secretion) ● Cushing Syndrome ● Long-term use of corticosteroids 2. What are the clinical manifestations of hypervolemia? o Elevated BP o Bounding pulse o Peripheral edema o Dyspnea, crackles, pulmonary edema o Jugular vein distention o Headache, confusion, lethargy 3. What are remarks that a patient might say if they are experiencing fluid volume overload? A patient experiencing fluid volume overload might complain of: ● Shortness of breath, especially when lying down (orthopnea) ● Feeling like they can’t catch their breath ● Swelling, especially in the lower extremities ● Headache 4. What are the vital signs changes you’ll see with hypervolemia? o Elevated BP o Bounding pulse 5. What are specific nursing assessments to assess for hypervolemia? o Lung sounds- crackles will be heard if in fluid overload o Skin assessment- especially in the lower extremities for edema o I & O o Daily weights o Vital signs o Neurologic assessment- ECF excess may result in cerebral edema 6. What is the treatment for these patients? Stop IV fluid infusions, fluid and sodium restrictions, diuretics o What are the different types of diuretics? Loop diuretics (furosemide) Thiazide diuretics Potassium sparing diuretics (Spironolactone) o How would you educate your patient with each type? All: ● Frequent laboratory tests may be indicated at the beginning of and during therapy with diuretics. These tests may include measurement of electrolytes, uric acid, and blood gases. ● Encourage patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and possible fainting (syncope). ● Forcing of fluids may be needed (if not contraindicated) to prevent dehydration and minimize constipation. Increased consumption of fiber may also help with constipation. Loop Diuretics: ● Educate the patient about the signs and symptoms of hypokalemia, such as anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. In addition, emphasize the importance of being cautious with hot climates, excessive sweating, fever, and the use of saunas or hot tubs. Heat raises core body temperature and causes further loss of potassium, sodium, and water through sweat, which may increase the risk for more problems with hypotension and fluid-electrolyte imbalances. Fluid volume and electrolyte loss may also occur with vomiting and diarrhea. ● Educate patients with diabetes who are also taking thiazide and/or loop diuretics about the need for close monitoring of blood glucose levels. ● Patients taking diuretics need to maintain proper nutritional intake and fluid volume and eat potassium-rich foods, except when contraindicated or when potassium-sparing diuretics are used. Foods high in potassium include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes. ● Potassium supplementation may be recommended by a prescriber, depending on the symptoms the patient presents and the serum levels. Normal serum potassium levels are 3.5 to 5 mEq/L. 7. What are possible causes of hypovolemia? o Increased insensible water loss (high fever, heatstroke) o Diabetes insipidus o Osmotic diuresis o Hemorrhage o GI losses: vomiting, NG suction, diarrhea, fistula drainage o Overuse of diuretics o Inadequate fluid intake o Third-space fluid shifts: burns, intestinal obstruction 8. What are the clinical manifestations of hypovolemia? · Restlessness, lethargy, drowsiness, confusion · Thirst, dry mucous membranes · Decreased skin turgor and decreased capillary refill · Postural hypotension, increased pulse, decreased central venous pressure (BP)