Pathological Effects of Hypoalbuminemia on Water Movement (Nursing)

00:00 So how do we end up with peripheral edema and cirrhosis? Well, we call the pressure of when the protein moves into the vessel and it's able to draw in sodium and water we call that oncotic pressure.

00:16 Okay so you see that word there, right and your middle box oncotic pressure, is the amount of pressure that is exerted because you have albumin in your intravascular space drawing in those other substances.

00:29 When my liver whose job it is to make the albumin, look at the first box, when the livers job is to make albumin can't make an adequate amount of albumin, It's making less albumin than I have a lower or lesser oncotic pressure.

00:45 Now, that's a very formal way to say, Hey if I don't have a lot of albumin in my vessels, then I'm not going to have enough to track sodium and water that's going to be a problem.

00:54 So when I don't have an appropriate oncotic pressure because of an liquid amount of albumin then fluids are going to move out of the intravascular space and into the tissues.

01:06 That's what causes peripheral edema.

01:09 Okay, so when I go back in and assess that patient remember her with her cap on and she was telling us her legs felt heavy and her socks left marks.

01:19 She's having peripheral edema because of this very thing.

01:23 She has peripheral edema because her liver is struggling, she doesn't have enough albumin and fluid is leaking out into the interstitial spaces when it leaks into the interstitial spaces, you start getting those feet that look like that.

01:37 You start getting those cankles, you start pitting edema that you can assess with your finger on the patient.

01:44 So you understand what's going on inside the body and now you know what it looks like outside of the body.

01:50 But before we move on, I want to bring you back to that picture of the liver you already know the red is the artery, the blue is the portal vein.

02:00 Remember the portal vein is coming from? Right, the gut.

02:04 The intestines.

02:05 It was pretty cool that the liver has two major blood supplies, but it's because it is so important.

02:12 But we've got it less albumin, less oncotic pressure, fluids move out, that's how we end up with peripheral edema.

02:19 We know that peripheral edema picture that picture where we just white it out the whole body.

02:25 It's the arms and legs that's peripheral vascular system.

02:28 We have edema there but we're talking about what happens with ascites.

02:34 Okay back to that portal vein.

02:36 Put your finger on the portal vein.

02:40 We've got increased portal pressures.

02:43 We've got increased portal hypertension.

02:46 Now, let's think that through.

02:47 You already know that cirrhosis means the liver is all narrowly inside.

02:53 The liver is a major filter, things go through it and it's meant to go through it.

02:58 At a pretty rapid pace.

03:00 When the liver becomes damaged from whatever has cause liver damage when the liver becomes damaged, now it's harder for blood to go through it.

03:09 So back to that portal vein when it's trying to send you blood back up to the liver.

03:16 Okay, that's a really big workload because that liver is not so simple anymore.

03:22 It's not so easy for blood to flow through.

03:25 So you start having portal hypertension.

03:29 The blood pressure in that vessel that is bringing blood back up from the gut into the liver now as...

03:37 it's really got to be intense to try and push blood through that gnarly liver.

03:43 Now, you're starting to get a picture on why we end up with ascites because ascites is different than peripheral edema.

03:50 Peripheral edema, arms and legs, when we start talking about ascites, that's in a different location.

03:56 A lot closer to the liver.

03:58 I'm going to come back to that in just a minute before we can talk about ascites, I want to get one more important point in about albumin and its relationship with edema.

04:09 See when you're practicing.

04:10 This is the type of information I want you to have and to be aware of to know how to keep your patient safe.

04:16 So one of our roles and responsibilities is to monitor and assess the patient's serum albumin levels.

04:23 Remember when you see that word serum that means we've done a lab test we've drawn blood serum, send it to the lab and we look at the patient's results.

04:33 Now when you look at results, I know the normal range for that lab is going to be right next to your patient results, but in order to become a practicing nurse, you need to make it through your nursing school exams and the big one the NCLEX.

04:48 So learning lab values as a really critical part of success in nursing school and on exams.

04:55 The normal range we're going to give you is 3.4 - 5.4.

05:01 Now let me tell you the best way the easiest way the most effeicient way to learn these values is use what we've provided for you with a spaced repetition questions.

05:12 Just keep up with those. It makes it fun.

05:15 It's quick.

05:16 It's mobile and it's the best way to learn kind of boring things like magic numbers for normal values.

05:24 Now understanding what goes on behind it is the cool part, but the bottom line is you have to know those basic numbers.

05:32 Okay, so nurses who are on top of their game.

05:35 We're really watching out for their patients.

05:37 They will always know that somebody with liver disease is at risk for low serum albumin.

05:46 Now, what is the word for low serum albumin? Hypoalbuminemia.

05:52 Okay, Hypoalbuminemia.

05:55 Hypo means low, albumin, I know you know that word and emia means it's in the blood.

06:02 So we're back in that patients room together.

06:05 We've got our female patient with the hat on if you can visualize her she's told us about her peripheral edema.

06:13 We know that she has a history of liver problems.

06:16 So I'm going to be on the lookout right away anybody with liver problems.

06:20 I know they have less albumin.

06:22 They have an increased risk for edema.

06:24 So I'm always going to be assessing for edema.

06:27 If I get the benefit of a lab value, I'm also going to keep an eye on that and the trend.

06:32 Is this patients trend for serum albumin going up? Or going going down?