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    HIPERVOLEMIA

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    perkakas78
    This document discusses fluid overload (hypervolemia), defined as an excessive amount of fluid, especially intravascular fluid, in the body beyond the ability to excrete it. Fluid overload can be caused by compromised regulatory mechanisms for sodium and water or factors that cause fluid shifts into the intravascular space. Signs and symptoms include edema, shortness of breath, crackles on lung exam, and increased jugular vein pressure. Diagnostic tests may show decreased hemoglobin and increased BUN. Management involves identifying and treating the underlying cause, restricting fluid intake, using diuretics, and patient education on monitoring intake and output.

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    HIPERVOLEMIA

    Uploaded by

    perkakas78
    361 views22 pages
    This document discusses fluid overload (hypervolemia), defined as an excessive amount of fluid, especially intravascular fluid, in the body beyond the ability to excrete it. Fluid overload can be caused by compromised regulatory mechanisms for sodium and water or factors that cause fluid shifts into the intravascular space. Signs and symptoms include edema, shortness of breath, crackles on lung exam, and increased jugular vein pressure. Diagnostic tests may show decreased hemoglobin and increased BUN. Management involves identifying and treating the underlying cause, restricting fluid intake, using diuretics, and patient education on monitoring intake and output.

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    HIPERVOLEMIA[1]

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    This document discusses fluid overload (hypervolemia), defined as an excessive amount of fluid, especially intravascular fluid, in the body beyond the ability to excrete it. Fluid overload can be caused by compromised regulatory mechanisms for sodium and water or factors that cause fluid shifts into the intravascular space. Signs and symptoms include edema, shortness of breath, crackles on lung exam, and increased jugular vein pressure. Diagnostic tests may show decreased hemoglobin and increased BUN. Management involves identifying and treating the underlying cause, restricting fluid intake, using diuretics, and patient education on monitoring intake and output.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    361 views22 pages

    HIPERVOLEMIA

    Uploaded by

    perkakas78
    This document discusses fluid overload (hypervolemia), defined as an excessive amount of fluid, especially intravascular fluid, in the body beyond the ability to excrete it. Fluid overload can be caused by compromised regulatory mechanisms for sodium and water or factors that cause fluid shifts into the intravascular space. Signs and symptoms include edema, shortness of breath, crackles on lung exam, and increased jugular vein pressure. Diagnostic tests may show decreased hemoglobin and increased BUN. Management involves identifying and treating the underlying cause, restricting fluid intake, using diuretics, and patient education on monitoring intake and output.

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    of 22

    ASKEP KLIEN DENGAN OVERLOAD CAIRAN

    Lestari Sukmarini, MNS 2010


    Page 1

    Definisi
    OVERLOAD=HIPERVOLEMIA=FLUID EXCESS NANDA: peningkatan retensi cairan isotonik, meningkatnya jumlah total sodium

    tubuh dan cairan total tubuh.


    Suatu keadaan dimana terjadi peningkatan volume cairan ekstrasel terutama Intravaskular melebihi kemampuan tubuh mengeluarkan air melalui ginjal, saluran cerna dan kulit.

    Compromised regulatory mechanisms for sodium and water (CHF, CKD, Liver
    failure), Hypervolemia (or "Fluid overload") is the medical condition where there is too much fluid in the blood. The fluid can either be intravascular or extravascular

    and result in edema.


    An expansion of extracellular volume involving interstitial or vascular space.

    Page 2

    Intake cairan

    Intake Na+

    Hipervolemia

    Retensi garam: Heart failure Liver cirrhosis Nephrotic syndrome Corticosteroid therapy Hyperaldosteronism Intake rendah protein

    Fluid shift into intravascular: Remobilisasi cairan setelah penanganan luka bakar Pemberian cairan hipertonik mis: mannitol atau hypertonic saline Pemberian plasma proteins, mis albumin

    Page 3

    Page 4

    G e j a l

    Weight gain Edema Bounding pulses Shortness of breath; orthopnea Pulmonary congestion on x-ray Abnormal breath sounds: crackles (rales) Change in respiratory pattern Third heart sound (S3) Intake greater than output
    Page 5

    Decreased hemoglobin or hematocrit Increased blood pressure Increased central venous pressure (CVP) Increased pulmonary artery pressure (PAP) Jugular vein distension Change in mental status (lethargy or confusion) Oliguria Specific gravity changes Azotemia Change in electrolytes Restlessness and anxiety
    Page 6

    Edema
    Lokal edema = tangan/kaki General edema = anasarka Mekanisme: Tekanan hidrostatik kapiler Tek onkotik kapiler = hipoalbumin Tek onkotik interstisial
    Page 7

    Lung edema

    Page 8

    Fluid dynamics at the capillary

    CHP = Capillary Hydrostatic Pressure COP = Capillary Osmotic Pressure IFHP = Interstitial Fluid Hydrostatic Pressure IFOP + Interstitial Fluid Osmotic Pressure Page 9

    Fluid exchange

    Page 10

    PENGKAJIAN
    Tanda gejala: dyspnea, orthopnea PF: edema, BB , TD, asites, crackles,ronkhi, wheez, DVJ,gallop. Hemodinamik: CVP Riwayat & faktor resiko: Retensi Na & air: CHF, CH, SN, glukokortikosteroid Fungsi ginjal abnormal Pemberian cairan intravena >> Perpindahan cairan interstisial ke plasma. Page 11

    PEMERIKSAAN DIAGNOSTIK
    Ht BUN/kreat meningkat pada gagal ginjal BJ urin/sodium urin Osmolality serum/urin GDA: hipoksemia, asid resp (edema paru) Chest X-Ray: tanda kongesti vaskuler pulmoner

    Page 12

    Management overload
    Memperbaiki penyakit dasar Weight daily Monitor ketat I/O: pantau infus! Diet rendah garam 0.5-1 gr/hr (n= 3,5 gr/hr) Restriksi cairan (min IWL: 40 ml/jam) Pemberian diuretik Edema: elevasi kaki, ubah posisi Asites: paracentesis Edema paru: oksigen Ultrafiltrasi
    Page 13

    Examples Acidifying salts Arginine vasopressin receptor 2 antagonists Aquaretics Ethanol, Water CaCl2, NH4Cl amphotericin B, lithium citrate Goldenrod, Juniper

    Mechanism inhibits vasopressin secretion

    Location (numbered in distance along nephron) 1. 1.

    inhibit vasopressin's action

    5. collecting duct

    Increases blood flow in kidneys 1.

    Na-H exchanger antagonists


    Carbonic anhydrase inhibitors

    dopamine[8]
    acetazolamide[8], dorzolamide

    promote Na+ excretion


    inhibit H+ secretion, resultant promotion of Na+ and K+ excretion

    2. proximal tubule[8]
    2: proximal tubule

    Loop diuretics

    bumetanide[8], ethacrynic 3. medullary thick ascending inhibit the Na-K-2Cl symporter acid[8], furosemide[8], torsemide limb glucose (especially in promote osmotic diuresis uncontrolled diabetes), mannitol 2. proximal tubule, descending limb

    Osmotic diuretics

    Potassium-sparing diuretics

    amiloride, spironolactone, triamterene, potassium canrenoate.

    inhibition of Na+/K+ exchanger: Spironolactone inhibits aldosterone action, Amiloride 5. cortical collecting ducts inhibits epithelial sodium channels[8] inhibit reabsorption by Na+/Clsymporter inhibit reabsorption of Na+, increase glomerular filtration rate 4. distal convoluted tubules

    Thiazides

    bendroflumethiazide, hydrochlorothiazide caffeine, theophylline, theobromine

    Xanthines

    1. tubules

    Page 14

    Kerja diuretik

    Page 15

    Efek diuretik?
    Evaluasi pemberian diuretik: Tanda dehidrasi forced diuresis Perubahan kadar elektrolit: hiponatremia hipo/hiperkalemia Perubahan asam basa

    Page 16

    Diagnosa Kep & Intervensi


    1. Gangguan pertukaran gas b.d perubahan membran alveolar-kapiler sekunder thdp kongesti vaskular pulmoner yg tjd pada pertambahan CES. pantau adanya sesak,ansietas,batuk sputum berbusa, krekles, ronkhi, takikardia,takipnea. Pantau GDA thdp adanya hipoksemia & alkalosis respiratorik Posisikan semi-fowlers Berikan O2 sesuai protokol
    Page 17

    2. Kelebihan volume cairan b.d kelebihan intake/gg mekanisme regulasi. Monitor I/O Observasi dan dokumentasi adnya edema Timbanag BB tiap hari Pantau dan restriksi diet rendah garam Pembatasan cairab Higiene oral membran mukosa oral tetap lembab dan utuh Dokumentasi respon thdp diuretik: produksi urin? Observasi tanda dehidrasi
    Page 18

    Edukasi klien-keluarga
    Monitor I/O Tanda gejala overload: edema, BB > Gejala yg memerlukan lapor segera mis: sesak anafas, nyeri dada, nadi irreguler Kepatuhan thdp terapi, diet, pembatasan cairan Pentingnyapenimbangan BB/hari

    Page 19

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