Peds Exam 1: Fluid/Electrolytes - Intake and Output

proportional, shift

Isotonic dehydration occurs when fluid and sodium loss are ___________ (sodium levels are normal). In this type of dehydration, there is no _______ between components of the ICF and ECF fluid compartments.

sick

A child with hypotonic dehydration will appear more ______ than a child with isotonic dehydration.

Dehydration

A critical condition that results from ECF fluid loss

reassessed

After each bolus, the child should be ___________ to determine fluid status.

unstable, repeated

An IV fluid bolus may be indicated if the child is ______ and continues to show these signs. The fluid bolus may need to be ____________.

skin

Assessment of the ______ can also be used to assess turgor, mucus membranes, salivation, and tearing.

tearing

Be cautious of assessing ___________ as a sign of dehydration because lack of tearing may occur if the child has been crying for a period of time.

5

By the time a child reaches _____ years of age the percentage of ECF will drop to 15%.

tap, thiazide, gastric

Causes of hypotonic dehydration include: treating child for dehydration with _____ water only, ______ diuretics such as hydrochlorothiazide, and failure to replace body fluid loss such as _______ secretions.

diarrhea, electrolytes, osmotic, sodium

Common causes of Hypertonic dehydration include: excessive _________ (especially in infants), treating dehydration with high concentrations of ____________, long-term _______ diuretics such as Mannitol, and IV treatments with high concentrations of _______.

hypovolemic, death

Dehydration that is not corrected can lead to ________ shock and _______.

kidneys, metabolic, communicate thirst, GI (gastrointestinal)

Developmental differences in fluids include the infants/young child: immature ________, higher __________ rate, inability to _________ _______, and immature _____ system.

20, 20, faster

During the 1st phase of re-hydration using IV therapy, _____ mL/kg will be given over _____ minutes. Unless the child is unstable, hypotensive, or show signs of shock, then the administration will be ________.

improvement

Even if you are seeing the child for the 1st time, it is still important to assess their weight because we need this measurement to determine if ___________ has been made.

Pedialyte, Infalyte, Rehydralyte

Examples of ORS include: _________, _______, and _________.

intracellular, extracellular

Fluids in the body reside in both the ________ and ________ space.

breast milk, formula

For infants, _______ ______ or _______ may be used for oral re-hydration, but be aware the child may not consume as much as needed and/or adequate supply may not be available so ORS may need to be used in conjunction with these two options.

2-5, 5-10, emesis

For oral rehydration, the child may start with small amounts such as ___ to ____ mL via syringe for an infant or small medication cup of _____ to ______ mL for a child every 3-5 minutes. Using this approach may help the child to take fluids and decrease _____ over time.

vomiting, oral, sweating

Isotonic dehydration is commonly seen in children with ________ and dehydration, decrease in _____ intake especially in the summer months when it is hot, and excessive _________.

50-60%

Teenagers and school age children have approximately ____-_____% body fluid.

adolescence, stretch, sphincter, 2, 2

The bladder capacity increases with age and does not meet max capacity until ___________. Innervation of "_______" receptors in the bladder wall, which initiates urination and control of bladder __________ does not occur until the age of ____. Therefore, toilet training may not be entirely successful until after ____ years of age.

oral feedings

The final phase of rehydration is to return to normal and begin ______ _________.

invasive, cause

The focus on dehydration interventions is centered around the least ________, and the _______ of the dehydration.

ECF (extracellular fluid)

The greatest variable in terms of fluid is found in the ______.

oral

The least invasive treatment for dehydration is ________ rehydration.

2, 1

The minimum amount of urine production for infants is ____ mL/kg/hour while after the first year of life the minimum production of urine decreases to ___ mL/kg/hour.

Isotonic dehydration (isonatremic dehydration)

The most common dehydration found in children, it accounts for approx. 80% of all dehydration in children.

weight, trend

The most significant parameter to assess hydration in an infant/child is ________. However, this is only important if we have a ________.

intake & output

The next most important assessment secondary to weight trends is ______ & _________. Just like weight, this may be difficult if you are seeing the child for the 1st time.

rapid fluid, sodium

The priority of treatment of dehydration with IV therapy is ______ _____ replacement regardless if all information including serum _______ level is known.

osmotic, ECF

The response of fluid moving from ECF to ICF in hypotonic dehydration helps to reestablish an _______ equilibrium within the body. It also increases the ______ fluid losses.

136-146

The serum sodium level is dependent on the child's age, but is generally between ____ and _____.

Normal Saline (NS), or Lactated Ringers (LR)

The solution of rapid fluid replacement involves the use of which two solutions?

2, Henle, sodium, water, urine, concentrate

The tubular system is immature for the first ____years, in particular the loop of _____ which is short, thereby reducing the ability to reabsorb ________ and ______ in diluted urine and increase ______ production for the first year of life. Also, the ability to _________ the urine is poorly regulated at this time.

glucose, sodium, potassium, chloride, lactate

The types of oral solutions (ORS) need to contain: water, _______, _______, _______, ________, and ________.

expensive, complications

The use of oral re-hydration is less ________ and involves fewer ________ than IV therapy.

2, weight

To determine the fluid status in an infant/child using the assessment of weight, you need _____ weights to understand if there is any significant difference. If you are seeing the child for the 1st time, their ______ has no true meaning of their hydration status.

Kool-Aid, 60-90

To help children who do not like the taste of ORS you may enhance the flavor by adding a teaspoon of unsweetened _____-_____ to each ____ to ____ mL.

sensitivity

Using multiple predictors to assess dehydration increases the ______________ of assessing the fluid deficit.

hypernatremic, 48

Usually by the 2nd phase the sodium level is known and if the child is ______________, it is important to administer the fluids slowly to avoid rapid fluid shifts to the cells especially in the brain causing cerebral edema. Administration of replacement fluid will occur over _____ hours.

1.5 mL/hr

What is the MINIMUM hourly urine output for an infant (<1 year/12 months)?

Tachycardia

What is the earliest detectable sign of dehydration in an infant/child?

Intravascular fluid or plasma, interstitial spaces, and spinal column

Where is ECF found?

Within the actual body's cells

Where is ICF found?

Hypertonic

Which is considered to be the most dangerous type of dehydration?

Infants and young children

Which two pediatric populations are MOST at risk for becoming dehydrated during periods of illness or exposure to environmental elements?

low blood pressure (hypotension)

Which vital is usually considered a late sign of dehydration and could indicate the onset of cardiovascular collapse?

High, low urine output

Will the lab value of specific gravity be high or low in a dehydrated child? Why would this lab be difficult to ascertain especially in late stages of dehydration?

accuracy

Without weighting a child's diaper yourself, _________ cannot be validated. You must know the precise amount to count it as intake.

Assessment

________ of the infant and child is essential to determine dehydration.

ECF, metabolism, immature

It is the _____ that contributes to dehydration in part from the greater surface area, higher rates of ___________, and _________ kidneys.

osmolality, glucose

NS and LR are used as the solutions for rapid replacement therapy because they are close to the body's serum ___________ and do not contain _________ that is not indicated for this initial stage of treatment.

Hypertonic dehydration (hypernatremic dehydration)

Occurs when water loss exceeds sodium loss. The serum sodium level is greater than 146 mmol/L. due to the high levels of sodium, the body will compensate by pulling water from the ICF fluid.

mild, moderate

Oral rehydration can only be used for _____ and ______ dehydration.

alert, awake, commands, drink

Oral rehydration can only be used in patients who are _______ and __________. Patients who are unable to follow _________ or refuse to _______ will not be able to consume oral re-hydration fluids.

dry, mucus, fontanels, mottling, elasticity, capillary

Other key assessment findings associated with dehydration in infants/children include: _____ skin & _______ membranes, sunken _____________, signs of circulatory failure (coolness & ________ of extremities), loss of skin ___________, and prolonged _________ filling time.

consciousness, stimuli, eyes

Other predictors of dehydration in the pediatric population include: a change in the level of _____________ (irritability to lethargy), altered response to _________, and sunken __________.

large, oral

Patients who are severely dehydrated will require a _______ volume or fluids, which is not typically appropriate for the 4-6 hour time period of _____ rehydration.

60-65%

Preschool children are comprised of _____-_____% total body fluid.

glucose

Remember than infants do not have much storage of __________ and that dehydration will be a stressor for the body so the _________ levels will need to be monitored and treated accordingly.

15-20%, decrease, increased

Renal blood flow in children is ____ to _____% of what we would expect to see in adults. This is due to __________ in cardiac output and ___________ renal vascular resistance.

BUN, elevated

Serum ______ measures the amount of urea in the blood, which is an end product of protein metabolism and excreted by the kidneys. It may become ________ if the child is dehydrated, but an elevation can also occur due to hemorrhage, high protein intake, corticosteroid therapy, or renal disease.

Osmolarity

Serum _________ is another lab value that can be used to assess dehydration, it is more sensitive than urine specific gravity.

creatinine

Serum __________ is entirely excreted by the kidneys, making it the best indicator of renal function. It may also determine if an alteration in BUN is related to dehydration or renal issues.

136

Serum sodium in hypotonic dehydration is _____ (<_____ mmol/L).

5, nephrons, adolescence, gradual

Significant growth in the child's kidney occur in the first ____ years with the majority of the enlargement due to __________. However, the growth in the kidneys occur until ___________. This is also true of the ureters but in a more ________ process until adolescence.

Hypotonic dehydration (hyponatremic dehydration)

Sodium loss exceeds water loss and serum sodium is low (<136 mmol/L). Fluid moves from ECF to ICF due to higher concentrations of sodium in the intracellular space.

40

In adolescents, we view their minimum urine output as similar to adults - ____ mL/hour.

depression

In children younger than 2 years, we may assess their fontanel, a _________ of the child's fontanel may indicate dehydration.

cell, brain

In hypertonic dehydration high levels of sodium result in _____ shrinkage, which may cause ______ shrinkage. This is why this is considered to be the most dangerous type of dehydration.

30%

In infants and toddlers, ICF comprises approximately ______% of total body water.

24-48, glucose, glucose, sodium, potassium

In the 2nd phase of re-hydration using IV therapy, the replacement of the deficit of fluids plus required maintenance will be given over the next _____-______ hours.

45%, 25%, 10%

In the newborn, ECF is approximately ____% of total body water but within the first 10 days, this will drop to _____% due to insensible perspiration, which can amount to a decrease of _____% of the infant's birth weight.

40%

In the older child and adolescent, ICF compromises approximately _____% of total body body water.

glucose, sodium, potassium

In the second phase, the solution should contain the ________, and _______ levels necessary to maintain normal levels. _________ is withheld until kidney function is restored and assessed and circulation has improved.

65-75%

Infants and Toddlers are comprised of ____-_____% body fluids.

filtration, absorption, 2, filtration

Glomerular _________ and ___________ are relatively low in infants and young children until about the age of ______. This altered filtration results in ineffective __________.

fluids, vomiting, severe

IV therapy to treat dehydration is typically used in children who are unable to take ______ to meet the needs of rehydration, those who continue _________ even when small quantities are used, and children with _______ dehydration.

quickly, swelling, ICP

If Hypertonic dehydration is corrected too _______ the shift of fluids into the ICF space may cause brain cell ________ or increased _____.

hypertonic, rapid

If the child is experiencing ___________ dehydration, the 1st stage of I therapy rehydration is contraindicated. But if this unknown, than _______ rehydration will occur.

high, 146

In Hypertonic dehydration, serum sodium is ______ (>_____ mmol/L)

normal, 136-146

In Isotonic dehydration fluid levels are _______ (between ______-_____ mmol/L)