fluid & electrolytes

school-age children and adolescents

0.5 -1ml/kg/h

preschoolers and young school-age children output

1-2ml/kg/h

infants and toddlers output

2-3ml/kg/h

Which assessment finding would the nurse recognize as a sign that intravenous lactated Ringer solution was effective in treating an infant with dehydration from acute gastroenteritis?

Correct3 Three wet diapers in 24 hours

hyperemesis gravidarum (labs)

Elevated Hgb/Hct •Low sodium, potassium, chloride •Elevated renal and liver function tests •ketonuria

Hyponatremia (sodium <135 mEq/L) cause

Fever Increased water intake without electrolytes Decreased sodium intake Diabetic ketoacidosis Burns and wounds SIADH Malnutrition Cystic fibrosis Renal disease Vomiting, diarrhea, nasogastric suction

Which factor is frequently associated with hyperemesis gravidarum?

High level of chorionic gonadotropin

severe treatment

IV fluid and Electrolyte therapy bolus 20ml/kg 0.9 NS or LR replacement rate for next 24hrs oral fluid only if alert resume regular diet when dehydration corrected reassess continusly

Hyperkalemia (potassium >5 mEq/L) cause

Increased intake of potassium (e.g., salt substitutes) Decreased urine excretion Kidney failure Metabolic acidosis Hyperglycemia Potassium-sparing diuretics Dehydration (severe) Too rapid IV administration of potassium Burns

Hypernatremia (sodium >150 mEq/L) symptoms

Intense thirst Oliguria Agitation, restlessness Flushed skin Peripheral and pulmonary edema Dry, sticky mucous membranes Nausea and vomiting Serum sodium 150 mEq/L: disorientation, seizures, hyperirritability when at rest

Hyperkalemia (potassium >5 mEq/L) symptoms

Irritability, anxiety, increased restlessness Twitching, hyperreflexia Weakness, flaccid paralysis Nausea, diarrhea, abdominal cramps Bradycardia, irregular pulse Decreased blood pressure Cardiac arrest (concern if potassium >8.5 mEq/L) Apnea, respiratory arrest

Hypokalemia (potassium <3.5 mEq/L) symptoms

Muscle weakness, paralysis Leg cramps Decreased bowel sounds, nausea Weak and irregular pulse, tachycardia or bradycardia, cardiac dysrhythmias Hypotension Ileus Irritability, fatigue Decreasing blood pressure

Hyponatremia (sodium <135 mEq/L) symptoms

Neurologic: • Usually do not show signs until sodium reaches 125 mEq/L • Behavioral changes: irritability, lethargy, headache, dizziness, apprehension Cardiovascular: • Increased heart rate • Decreased blood pressure • Cold, clammy skin Muscle cramps (especially abdominal) Nausea

A child is diagnosed with dehydration resulting from diarrhea. The child's condition improves and a regular diet is started. Which foods would the nurse suggest that the parents offer their child?

Poached eggs strained banana animal crackers Poached eggs are nutritious and are easily digested. Strained bananas help replace the potassium lost in diarrhea. Animal crackers are not irritating to the gastrointestinal tract. Creamed foods and puddings contain milk, which may irritate the gastrointestinal tract in some children.

Which medication requires the nurse to monitor the client for signs of hyperkalemia?

Spironolactone

Hypokalemia (potassium <3.5 mEq/L) cause

Stress Starvation Malabsorption Excessive loss of GI fluids through vomiting, diarrhea, sweat, nasogastric tube Administration of diuretics (especially furosemide, ethacrynic acid, thiazide diuretics) IV fluids without added potassium Administration of corticosteroids Diabetic ketoacidosis

Hypernatremia (sodium >150 mEq/L) cause

Water loss or deprivation High sodium intake Diabetes insipidus Diarrhea Fever Hyperglycemia Renal disease

mild to moderate dehydration

Weight loss : less than 5%-10% pulse: normal to increased, weak respiratory: normal to fast BP: normal G.A : fatigued, restless, irritable, thirsty and eager to drink mucous membrane: dry Anterior fontanel: sunken Eyes: slightly sunken, tears decreased capillary refill : prolonged; extremities cool skin turgor : prolonged recoil urine output: Decreased, concentrated urine

severe dehydration

Weight loss : more than 10% pulse: tachycaric, bradycardic in most severe cases; thready respiratory: Rapid and deep BP: decreased as a sign of hypovolemic shock G.A : lethargic, Apathetic, unconscious, drinks poorly or unable to drink mucous membrane: parched Anterior fontanel: markedly depressed Eyes: markedly sunken, tears absent capillary refill : prolonged, minimal, extremities cold, motted or cyanotic skin turgor : tenting urine output: minimal

Acid-Base Imbalances

arterial blood gas ph 7.35-7.45 paco2 35-45 bicarbonate 22-26

minimal treatment

breastfeed normal fluids if drinking well replace losses as necessary with ors continue age-appropriate diet

minimal or no dehydration

less than 3% pulse: normal respiratory: normal BP: normal G.A : well alert, drinks normally, might refuse liquid mucous membrane: normal moist Anterior fontanel: normal Eyes: normal, tear present capillary refill : less than 2 secs skin turgor : normal urine output: mildly decreased

mild-moderate treatment

ort 50-100ml/kg/over 3-4 hours replace continuing losses if vomiting - give ondansetron (zofran) breastfeed resume regular diet after dehydration corrected reassess Q 1-2 hrs

fluid volume excess

weight: gain pulse: rapid bounding RR: moist breath sounds, dyspnea, crackle, rales BB: increase skin& mucus membrane: edema sensory: fatigue

Signs and Symptoms of Dehydration

• Fewer wet diapers (especially no wet diaper for more than 6-8 h) • No tears when your child is crying if older than 2-3 months • Inside mouth is dry or sticky • Irritability; high-pitched cry • Difficulty in awakening • Increased respiratory rate or difficulty breathing • Sunken soft spot, sunken eyes with dark circles • Abnormal skin color, temperature, or dryness

fluid volume excess (treatment)

•Diuretics •Fluid restrictions •Low sodium diet •Proper skin care

educate to parents

•ORS - Pedialyte/Enfalyte •Breastmilk •Nutritious foods •Complex carbohydrates •Fruits, cooked vegetables •Lean meats •Yogurt with live culture