Chapter 28
How long is the max you can give formula or TPN ?
4 hours
The higher the ratio of ... the more rapid the loss of ... resulting in dehydration
ECF TBF
In hypotonic dehydration water transfer form the ... to the .. to establish osmotic equilibrium. Which than can result in .... In this type of dehydration symptoms are more ... than in isotonic.
ECF (to the) ICF shock severe
Constitues about half of the total body water at birth
Extracellular fluid (c)
Whare are some examples of acute diarrheal diseases
Rotavirus - most common Laxatives HIV
T or F shock is less apparent in hypotonic dehydration?
True, seizures are more likely to occur
When shock sets in due to dehydration what are your interventions
Ventilation Fluids Cardiovascular (Vasopressors/Epinephrine)
Billy, age 3 years, has just been ordered to take nothing by mouth (NPO). To prevent intake of fluids, the nurse should: a. place an NPO sign over his bed and remove fluids from the bedside. b. place him in a private room away from other children. c. apply an elbow restraint jacket to keep Billy from being able to drink by himself. d. provide ice chips every 30 minutes.
a
The American Academy of Pediatrics no longer advises withholding food and fluids for 24 hours after the onset of diarrhea or administering the BRAT diet (bananas, rice, applesauce, and tea or toast). a. True b. False
a
The nurse is starting a peripheral IV infusion in the scalp of 6-month-old Bennett. Which of the following is correct? a. This site should be used only when attempts at other sites have failed. b. Shave the site of the scalp for IV insertion before the needle is placed. c. The needle should be inserted in the opposite direction of blood flow or toward the head. d. The occipital area of the scalp is the site of choice.
a
To obtain relevant information from the parents of a child with fluid and electrolyte disturbances, the nurse should question the parents about: a. the type and amount of the child's intake and output. b. the child's general appearance. c. the child's weight over the past month. d. whether they have taken the child's temperature within the past 24 hours.
a
Which of the following alerts the nurse to a potential problem in a child receiving IV fluids? a. Edema, blanching, and cool skin are evident at the IV insertion site. b. The IV tubing is not changed or replaced for 16 hours. c. Blood appears in the tubing when the IV bag is held below the IV site level. d. There is unrestricted flushing of the catheter.
a
Which of the following individuals has the least water content in relation to weight? a. Obese adolescent female b. Thin adolescent female c. Obese adolescent male d. Thin adolescent male
a
Which of the following is the most prevalent gastrointestinal complication associated with TPN administration in pediatric populations? a. Liver disease b. Pancreatitis c. Intestinal obstruction d. Peptic ulcers
a
(50)A patient's central venous catheter is accidentally removed. Where is pressure applied? a. Exit site on the skin b. Entry site to the vein
b
(54)Pediatric TPN has a higher concentration of calcium and phosphorus. Knowing this, the nurse watches closely for: a. increased infection rate at the site. b. solution precipitation. c. pneumothorax. d. cholecystitis.
b
A patient's central venous catheter is accidentally cut. Which of the following is the correct action for the nurse to take at this time? a. Apply pressure at the exit site on the skin. b. Use a padded clamp and clamp the catheter proximal to the exit site. c. Remove the catheter immediately to prevent blood loss. d. Order a repair kit for the catheter so that it can be saved and further surgery to replace the cut catheter can be avoided.
b
An infiltration or extravasation is observed. The nurse should do all of the following except: a. stop the infusion immediately. b. remove the IV catheter immediately. c. elevate the extremity. d. notify the practitioner.
b
Chloe, age 4 weeks, is brought to the clinic by her mother. When asking about Chloe's feeding schedule, the nurse learns that the mother has been adding twice the required amount of dry formula powder to water in Chloe's bottles for the past 2 days. The mother thinks that this will help Chloe gain weight faster. Which of the following does the nurse recognize as true about this practice? a. The infant's kidneys are functionally mature at birth and able to handle this concentration of formula. b. The infant's kidneys are functionally immature at birth, and this concentration of formula can cause Chloe to be dehydrated. c. The infant's kidneys are functionally immature at birth, and this concentration of formula will cause Chloe to become overhydrated. d. The infant's kidneys are functionally mature at birth, but because of her greater body surface area and longer gastrointestinal tract, Chloe would need the formula diluted.
b
In infants and young children, the most accurate means of describing dehydration or fluid loss is: a. as a percentage. b. by milliliters per kilogram of body weight. c. by the amount of edema present or absent. d. by the degree of skin elasticity.
b
The nurse has orders to start an IV infusion in 4-year-old Martha. Which of the following does the nurse include in the plan? a. Gather supplies in Martha's room so that she will not have to be moved after the procedure. b. Gather supplies in the treatment room, because this is not a "safe place" for Martha. c. Realize that Martha will need to be restrained before the procedure begins. d. Start at the proximal site of the vein and move to a more distal site if the first attempt fails.
b
Water intoxication can occur in children from: i. excessive intake of electrolyte-free formula. ii. administration of inappropriate hypotonic solutions. iii. dilution of formula with water. iv. isotonic dehydration. v. vigorous hydration with water following a febrile illness. vi. fluid shifts from intracellular to extracellular spaces. a. i, ii, iii, and iv b. i, ii, iii, and v c. ii, iii, and iv d. ii, iii, v, and vi
b
Infants have a greater ... allowing greater quantities of fluid to be lost through the skin
body surface area (BSA)
(49)Which of the following discharge instructions is correct for the nurse to give to the parents of 14-year-old Edward, who has a central venous catheter? a. It is okay for Edward to continue being on the football team. b. Signs of localized infection are fever, chills, general malaise, and an ill appearance. c. If the catheter leaks, tape it above the leak and then clamp the catheter at the taped site. d. Edward will need to avoid tub baths and take only showers.
c
(52)The practitioner has ordered cyclic TPN. The nurse understands that: a. the child will be off the machine at night. b. the child will have increased risk for TPN-induced liver damage. c. the child will be off the machine for a number of hours during the day. d. the child will have decreased blood glucose levels.
c
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which of the following? a.Bring the child to the hospital for intravenous fluids. b.Alternate giving ORS and carbonated drinks. c.Continue to give ORS frequently in small amounts. d.Keep child NPO (nothing by mouth) for 8 hours and resume ORS if vomiting has subsided.
c
An infant with moderate dehydration has clinical signs of: a. mottled skin color, decreased pulse and respirations. b. decreased urinary output, tachycardia, and fever. c. tachycardia, oliguria, capillary filling within 2 to 4 seconds. d. tachycardia, bulging fontanel, decreased blood pressure.
c
Depression of the central nervous system, manifested by lethargy, delirium, stupor, and coma, is observed in which of the following? a. metabolic acidosis b. respiratory alkalosis c. metabolic and respiratory acidosis d. metabolic and respiratory alkalosis
c
Diagnostic evaluation of dehydration to initiate a therapeutic plan includes: i. serum electrolytes. ii. acid-base imbalance determination. iii. physical assessment to determine degree of dehydration. iv. type of dehydration based on pathophysiology. a. i and ii b. i, ii, and iii c. i, ii, iii, and iv d. iii and iv
c
In starting an IV infusion in most children, the nurse recognizes the care plan should include: a. Interruptions during the procedure are kept to a minimum. b. Use of a 20-gauge over-the-needle catheter is preferred. c. Allow the child to handle the equipment before the procedure. d. Before the procedure begins, prepare the IV fluid and tubing, set to deliver 20 drops/ml.
c
Johnny, age 13 months, is being admitted for parenteral fluid therapy because of excessive vomiting. Which of the following is most essential in implementing care for Johnny? a. Give Johnny oral fluids until the parenteral fluid therapy can be established. b. Question the physician's order for parenteral fluid therapy of 0.9% sodium chloride. c. Withhold the ordered potassium additive until Johnny's renal function has been verified. d. Replace half of Johnny's estimated fluid deficit over the first 24 hours of parenteral fluid therapy.
c
Rapid fluid replacement is contraindicated in dehydration that is: a. isotonic. b. hypotonic. c. hypertonic. Hockenberry, Marilyn (2010-10-26). Study Guide for Wong's Nursing Care of Infants and Children (Page 219). Elsevier Health. Kindle Edition.
c
The nurse is removing the peripheral IV line from 10-year-old Debbie. Which of the following strategies is correct for this procedure? a. Exert firm pressure at the IV site while removing the catheter. b. Turn off the IV pump after removal of the catheter. c. Allow Debbie to help remove the tape from the site. d. Cut the tape with bandage scissors to facilitate its removal on the lateral aspect (opposite to the thumb side) of the extremity.
c
What nursing action should be included in the care plan for 10-year-old Debbie, who requires IV fluid therapy? a. Position the extremity in a natural anatomic position, with the fingers and thumb immobilized. b. Use an Ace bandage and completely encircle the extremity with tape to secure the IV line, insertion site, and extremity. c. Allow Debbie to help select the IV site. d. For the IV placement, use Debbie's dominant hand or the same extremity where her identification bracelet is located.
c
What do you give when beginning oral rehydration therapy on a child?
clear liquid
(4)Infants and young children are at high risk for fluid and electrolyte imbalances. Which of the following factors contributes to this vulnerability? a. Decreased body surface area b. Lower metabolic rate c. Mature kidney function d. Increased extracellular fluid volume
d
Joan, age 3 years, is admitted for fluid and electrolyte disturbances. The nurse's assessment should include: i. general appearance observation. ii. vital signs. iii. intake and output measurements. iv. daily weights. v. review of laboratory results. a. i, ii, iii, and iv b. ii, iii, and iv c. iii, iv, and v d. i, ii, iii, iv, and v
d
Which of the following conditions would produce an increased fluid requirement? a. Heart failure b. High intracranial pressure c. Mechanical ventilation d. Tachypnea
d
Which of the following instructions for treating the child with mild dehydration is not correct? a. Administer 2 to 5 ml of oral rehydration solution (ORS) by syringe or small medication cup every 2 to 3 minutes until the child is able to tolerate larger amounts. b. Oral administration of ondansetron (Zofran) to the child with acute gastroenteritis and vomiting may prevent the need for intravenous (IV) therapy. c. ORS management consists of replacement of fluid loss over 4 to 6 hours. d. ORS should not be started until after all vomiting has stopped. \
d
Which of the following is not correct when securing a peripheral IV line? a. The catheter hub is firmly secured at the puncture site with a transparent dressing. b. The IV House site protector is used over the site. c. The connector tubing or extension tubing is looped and placed under the protective cover. d. A plastic medicine cup is cut in half with edges taped and placed over the site and connector tubing.
d
... is a common body fluid disturbance encountered in the nursing care of infants and children usually occurring because of vomiting and diarrhea
dehydration
... occurs whenever the total output exceeds the total input
dehydration
Hypertonic dehydration occurs in infants with ... who are given fluids by mouth which contain large amounts of ... or in children receiving .... ng tube feeding
diarrhea solute high protein
What are some examples that can increase fluid requirements in an infant (9 total)
fever vomiting/diarrhea DKA Burns Shock Tachypnea rADIANT WARMER pHOTOTHERAPY (Bilirubin) Postoperative bowel surgery
Infants and young children have a .... need for ware and are ... to alternations in fluid and electrolyte balance when compared with older children and adults
greater more vulnerable
The rate of metabolism in infancy is ... than in adulthood, which can lead to .... production leading to dehydration.
greater heat
Infants excrete and ingest a .... of fluid per kilogram of body weight than do older children
greater amounts
Infants have .. water loss than adults
greater and more rapid
... dehydration results form water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. NA < H2O
hypertonic
... dehydraiton occurs when the electrolyte deficit exceeds the water deficit. Na> H2O
hypotonic
Infants kidneys are functionally .... at birth and are .... in excreting waste products of metabolism
immature inefficient
Fluid within the cells
intracellular fluid (b)
... dehydration occurs in conditiosn in which electrolyte and water deficits are presented at approximately balanced proportions
isotonic
What is the primary form of dehydration occurring in children
isotonic
What are some signs of displaced central line
leaking, uncomfortable, edema and chest pain
What are some examples of chronic diarrheal diseases?
malabosrption syndromes IBS Food allergies
<50ml/kg loss of water
mild dehydration
50-90ml/kg loss of water
moderate dehydration
The ECF compartment constitutes ... of the TBW at birth
more than half
What are some signs of IV infiltration
redness, puffiness
>100 ml/kg loss of water
severe dehydration
What is the greatest threat to life in isotonic dehydration? And what type of symptoms/characteristics does this treaty cause
shock hypovolemic shock
Why is it important to alternate lines with IVs?
so that you have an even distribution, and you have clean lines
The earliest detectable sign of dehydration is ... followed by dry skin and mucous membranes, sunken fontanels, signs of ... failure, loss of skin elasticity and prolonged capillary refill time
tachycardia circulator (coolness and mottling of extremities)
Constitues 45-75% of body weight
total body water (a)
Why when you give an IV therapy you give K after voiding
you need to make sure the kidneys are ducting and too much K can cause cardiac irregularity