Exam 1- PEDS fluid and electrolytes

mild dehydration

-up to 5% body weight loss (abt 40-50 mL/kilo)

how do you measure UO in babies? and what is the normal UO?

-weigh their diapers should be 1-2 mL/kilo/hr

standard bolus

20 mL/kg -use isotonic fluid (LR or NS)

If a child is weighed and has lost 4 kg of weight....how many ml of fluid loss would this be?

4000

The nurse is completing the intake and output record for a child admitted for fluid volume deficit. The child has had the following: 4 ounces of pedialyte, ½ of an 8 ounce cup of clear orange jello, 2 graham crackers, 200 cc of NS IV and voided 345 cc urine and 50 cc loose stool. How many milliliters should the nurse document as the client's intake?

440 mL

oral replacement for child with mod dehydration

50-100 mL/kilo over 3-4 hr

What is the daily fluid requirement for an infant weighing 5 kg?

500

normal pH level

7.35-7.45

how can parents make they own oral replacement

8 tsp sugar, 1 tsp salt, 1 liter of good clear fluid

normal calcium level

9-11 (adult) 8.5-10.2 (peds)

A toddler comes to the clinic this week and weighs 10kg. Last week the child weighed 12kg. What is percent of weight loss? A. 17% B. 15% C. 18%

A. 17%

Mod Dehydration -LOC -Pulses -UO

LOC- irritable Pulses- rapid and tachycardia UO- less than 1 mL/kilo/hr

Hyponatremia -causes -S&S

causes: dehydration, mixing formula with too much water, water intoxication S&S: lethargic, rapid pulse

priority goals for diarrhea

***correct fluid and electrolyte balances ***** watch K+ levels!!!!!!!!! so monitor UOP -Determine the cause of diarrhea -Prevent the spread of infection - wash hands -Rehydrate the child -Manage the fever associated with the diarrhea *avoid antidiarrheals

isotonic dehydration

*isonatremic* -most of fluid loss is from EC component. -very common with vomit and diarrhea -FVD= decrease in extra cellular component solute concentration (esp. Na and H2O) -No change in intracellular space

treatment for hypertonic dehydration

-3% NS -protein solutions -colloids

treatment for isotonic dehydration

-Ringers -NS

Mod dehydration

about 6-9% of body weight loss (60-90 mL/kilo)

One type of dehydration in children is isotonic dehydration, which occurs when: a. The sodium loss is proportionally greater than water loss b. The loss of sodium exceeds water loss c. The loss of sodium and water are equal

c. The loss of sodium and water are equal

hypokalemia -causes -S&S

causes: diarrhea, GI suctioning, anorexia, bulimia S&S- irregular pulse, hyporeflexia, cardiac dysrhythmias

NI for child with jaundice

good fluid intake

Role of the liver in acid-base balance

helps metabolize proteins (helps produce hydrogen ions that are needed)

Role of the lungs in acid-base balance

responsible for releasing carbonic acid (made of carbon dioxide and water) -if CO2 is elevated you will see confusion and lethargy -if resp rate is high you will see acidosis

how to calculate percent of weight loss

subtract the childs present weight by original weight then divide that by original weight (slide 22)

why are children more prone to evaporation loss than adults?

they have more extracellular fluid than intracellular

common causes of gastroenteritis

*Rotavirus- most common virus to cause GE -Norwalk- common seen with contaminated food -Shigella- seen in summer months -Salmonella- food poisoning -Giardia- caused by parasite from contaminated drinking water -Acute vs. Chronic Diarrhea- if chronic get them allergy tested -gluten sensitivity -lactose -antibiotics -iron

hypertonic dehydration

*hypernatremic dehydration* -fluid shift from intracellular space to extracellular space -see this with diabetes insipidous, IVF overload, tube feedings, or concentrated formula use -Hypertonic fluids have a higher concentration. It will cause fluid shift from ICF to ECF and causes the extracelllur compartment to expand.

hypotonic dehydration

*hyponatremic dehydration* -compensatory fluid shift from extracellular to intracellular space -sodium goes into cell so you see a decreased NA level (loss of sodium compared to water -see this with prolonged dehydration, burns or renal disease -Hypotonic fluids have a lower osmolar concentration than the serum. This means the solution infused is more lidute than plasma, containing more water than particles. It will cause fluid to shift from ECF to ICF.

oral replacement for child with mild dehydration

- if less than 10 kilo give 60-120 mL for each diarrhea they have -if more than 10 kilo 120-240 mL

treatment for hypotonic dehydration

-D5W -½ NS -0.33 NS

***** if a child has fever what do we do and what is the formula

-give fluids -for each degree of temp thats abnormal, add an extra .42 of fluid per kilo

Which of the following may need extra fluids to prevent dehydration? Select all that apply A. 7-day old receiving phototherapy B. 6 month old with newly diagnosed pyloric stenosis C. 2yr old with pneumonia D. 13 yr old who has started her menses E. 2 yr old with burns to chest, back, and abdomen

A. 7-day old receiving phototherapy B. 6 month old with newly diagnosed pyloric stenosis C. 2yr old with pneumonia E. 2 yr old with burns to chest, back, and abdomen

A 4 month old is brought to the ER with the following VS: HR 198, BP 68/38. Sunken fontenal is noted and baby does not cry when IV is inserted. Parents state that baby has not held anything down for 18 hours. Which of the following would the nurse expect to do immediately? A. Administer a bolus of NS B. Administer a bolus of D10W C. Offer the child an oral rehydrating solution as Pedialyte

A. Administer a bolus of NS *Dextrose can cause cerebral edema so don't want to bolus with that (only maintenance)

The nurse has instructed caregivers on how to care for a dehydrated child at home and when the caregivers should contact a health professional. The nurse would instruct the family to contact a health professional when which of the following occurs? A. The child's urine output decreases B. The child is more mentally alert C. The child complains of nausea D. There is any pain

A. The child's urine output decreases

ORAL REHYDRATION THERAPY

APPROPRIATE CHOICES -Pedialyte -Rehydralyte -Cereal-based -Infalyte -Home made solution INAPPROPRIATE CHOICES -Water -Soft drinks -Fruit juices -Broths -Sports drinks

A nurse is administering IV fluids to an infant. Infants receiving I.V. therapy are particularly vulnerable to: A. Pulmonary emboli B. Hypotension C. Fluid overload D. Cardiac arrhythmias

C (must used small bags ans use veratrol set on pump all that)

what is the first sign of deydration

LOC

Mild Dehydration -LOC -Pulses -UO

LOC -alert but restless Pulses- strong but norm UO- normal UO

Severe Dehydration -LOC -Pulses -UO

LOC- CO2 is built up so lethargic Pulses- rapid or so weak u can't palpate it UO- no UO

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg, and is estimated to have lost 7% of this normal body weight. The nurse is double-checking the IV rate the physician has ordered. The formula the physician used was maintenance fluids and then replacement fluids (percentage of body weight lost x 10 per kilogram of body weight. According to the calculation for maintenance and replacement fluid, this child's hourly IV rate should be

Maintenance IV 3(50)+ 150 + 1000= 1150 Also give him the extra because of weight loss (910) 2060 in first 24 hrs 86 ml per hour **Start with maintenance but sometimes have to add more because of body weight loss

solvent vs solute

Solvent: a liquid that can hold another substance Solulte: a substance dissolved in a solution

what do you monitor while giving K+

UO -if it is low hold the K+ bc it can cause build up and cause the child to go into CA

What is the type of dehydration? a. The serum sodium level is normal b. The serum sodium level is below normal c. The serum sodium level is elevated

a. The serum sodium level is normal (isotonic) b. The serum sodium level is below normal (hypotonic) c. The serum sodium level is elevated (hypertonic)

One type of dehydration in children is hypertonic dehydration, which occurs when: a. The sodium loss is proportionally greater than water loss b. The loss of sodium exceeds water loss c. The loss of sodium and water are equal

a. The sodium loss is proportionally greater than water loss

when is water weight the highest in a child

at birth

One type of dehydration in children is hypotonic dehydration, which occurs when: a. The sodium loss is proportionally greater than water loss b. The loss of sodium exceeds water loss c. The loss of sodium and water are equal

b. The loss of sodium exceeds water loss

Regulation of homeostatic changes associated with fluids and electrolytes in infants and children is much slower than adults because of children's: a. Proportionately smaller stomach and intestines b. Immature kidneys and buffering systems c. Differences in the chemical composition of the body d. Immature nervous systems

c. Differences in the chemical composition of the body *Considerations - children under the age of 2 cannot concentrate or dilute urine well bc the renal tubes are immature. Watch formula mixing.

A child is more susceptible to dehydration states than adults because children: a. Forget to drink enough water b. Have diarrhea and vomiting very often c. Have a larger portion of the total body fluid in the extracellular space d. Have a faster response to increased solute loads in the renal system

c. Have a larger portion of the total body fluid in the extracellular space

Which of the following statements represents a true difference between the fluids and electrolytes of a child compared to those of an adult? a. Water constitutes a smaller percent of the body weight of children b. A smaller percent of the body weight is in the extracellular compartment in children c. Infants and children have a relatively greater body surface area than adults. d. Infants and children have a lower basal metabolic rate than adults

c. Infants and children have a relatively greater body surface area than adults.

hyperkalemia -causes -S&S

causes- acidodic states, renal insufficiency, K+ in IV, blood transfusion, false positive heel stick (intracellular fluid may have contaminated and has a higher level of K+ so may need a venous sample) S&S- MURDER muscle weakness, UO is decreased or have none, resp distress, decreased cardiac contractility, EKG changes, reflexes altered MUST MAKE SURE UOP IS ADEQUATE WHEN GIVING POTASSIUM

Hypercalcemia -causes -S&S

causes- increase of too much calcium food, se of meds (thiazide), too much intake of vit D, malignancy (leukemia) S&S- decreased heart rate, constipation, extreme nausea, polyuria

Hypocalcemia -causes -S&S

causes- laxatives, lack of absorption, vit d deficiency (women in northern part bc lack of sun) S&S- CATS convulsions, arrythmias, tetane, spasms and stridor

Hypernatremia -causes -S&S

causes: children with developmental delays do not perceive thirst, too high of concentration of formula*, sugar, inadequate breast milk, diabetes indipidous S&S- FRIED fever, restless, increased fluid retention, edema, decreased UO and dry mouth when we are hypernatremic we are thirsty...obviously children do not perceive thirst as well. We would see a decreased LOC...really watch for seizures

oral replacement for child with diarrhea, but no evidence of dehydration

cut down sugar and give an oral replacement *educate pt on sugars bc it can make diarrhea worse

Insensible water loss per unit of body weight is: a. Less in children and infants as compared to adults b. About the same in infants and children compared to adults c. Slightly higher in infants and children d. Significantly higher in infants and children

d. Significantly higher in infants and children

what do we teach mothers about formula

do not mix formulas and do not dilute them with extra water bc it will decrease sodium levels and will cause seizures

where do u draw blood from

extracellular space

how to prevent dehydration in newborns

high daily fluid volume

teaching point for oral therapy

if they do not improve in 4 hr take to dr

RR with pneumonia

increases= sensible volume loss with each breath *give extra fluid

what do we worry about when newborn is under a warmer

insensible fluid loss

-Use small bags of fluid (consider a 250 mL bag) -Always use infusion pumps -Set pressure limits -Double check your calculations* -Check IV frequently (every hour) -Monitor for signs and symptoms of FVO (crackles, edema, DNV, bounding pulses, weight increase, resp distress) -Remember pumps can malfunction, so check rates and IV frequently. -Use a volume control chamber or burette

just read

severe dehydration

more than 10% body weight loss (>90 mL/kilo)

What does it indicate if the urine SG is 1.005?

normal

assessment data for dehydration % BW LOSS LOC BP P R MM URINE SPECIFIC GRAVITY THIRST CAPILLARY REFILL FONTANELS SKIN TURGOR

on paper

oral replacement for child with severe dehydration

put them on iv fluids; 1-2 boluses bc maintenance fluids won't be enough

vital signs for newborns

resp rate, heart rate, and metabolic rate is higher

ROME

respiratory opposite metabolic equal

if you dip the urine of a child under the age of 2 and it shows abnormal what does this mean?

they are severely dehydrated -dehydration doesn't show up right away in children under 2

norm specific gravity

1.005-1.025

Normal bicarb

22-26

Normal Potassium level

3.5-5

normal CO2 level

35-45

fluid requirements * 1-10 kg * 11-20 kg * >20 kg ***have to know

1-10 kg: 100 mL/kg 11-20 kg: 1000ml plus 50 ml/kg for each kg over 10 >20 kg: 1500ml plus 20 ml/kg for each kg over 20

1. Hourly urine amounts? 2. How many ml of fluid are in a wet diaper? 3. How do we calculate fluid loss from weight loss?

1. 1-2 mL/kg 2. measure dry diaper then measure wet diaper 3. subtract the childs present weight by original weight then divide that by original weight

Role of the kidneys in acid-base balance

1. helps reabsorb bicarb to prevent losing it in urine 2. helps regenerate bicarb to body with depletion and needs restored -accumulation of acid decreases buffers

normal serum level for sodium

135-145

1. Less than 5% BW loss 2. LOC - irritable 3. BP - low or undetectable 4. Pulse - rapid/changes with posture 5. Skin turgor - tenting 6. MM - dry 7. Urine - nl output 8. Thirst - moderate 9. Capillary refill - >4sec 10. Fontanels - normal 11. Respirations - rapid 12. SG - >1.025 13. LOC - lethargic 14. Skin turgor - elastic 15. UOP - anuric 16. MM - moist 17. Capillary refill < or = 2 sec 18. Respirations - irregular and rapid 19. Fontanels - sunken 20. BP - normal

1. Mild 2. Mod 3. severe 4. severe? 5. severe 6. mod 7. mild 8. mod 9. severe 10. mild 11. mod 12. mod? 13. severe 14. mild 15. severe 16. mild 17. mild 18. severe 19. severe 20. mild

Nurse caring for a child admitted with moderate dehydration. Child is noted to be restless with periods of irritability. Baseline labs reveal a Na 152, Cl 119 and glucose of 115. Parents state the child has not urinated in 12 hours. After inserting a SL , the nurse reviews the physician's orders. Which order should the nurse question? A. Bolus of NS at 10ml/kg, repeat if child does not urinate B. Recheck serum electrolytes in 12 hours C. After bolus, begin maintenance fluids of D 5 NS with 10 meq of KCL D. Give clear liquid diet as tolerated

C. After bolus, begin maintenance fluids of D 5 NS with 10 meq of KCL

What would be the most appropriate rehydration for a 3 year old child that has loss 6 % BW, has a rapid pulse and is slightly oliguric? A. IVF with an initial bolus of RL followed by a rate of 20 to 40 ml/kg/hr B. Continuation of an age appropriate diet C. 120 - 240 ml of ORT for each diarrhea stool or emesis D. 100 mL/kg of ORT for 4 hours, plus additional for extra fluid loss

D. 100 mL/kg of ORT for 4 hours, plus additional for extra fluid loss

Which assessment finding would lead a nurse to suspect dehydration in a neonate? A. Bulging fontanels B. Excessive weight gain C. Urine specific gravity below 1.012 D. Urine output below 1ml/hr

D. Urine output below 1ml/hr