fluid calc
The nurse is educating the family member of an infant on signs of dehydration. What statement by the family member indicates that the teaching was effective?
"I will go to the emergency department if my baby has a dry mouth and the skin is sticking together when pinched." Rationale: Emergency care should be sought if the infant is showing signs and symptoms of severe dehydration. The infant should be taken to emergency care for immediate intervention if there has not been a wet diaper in 24 hours. Fluid with electrolytes, such as Pedialyte, is more appropriate to administer to a dehydrated infant than free water. An infant might be inconsolable for numerous reasons, and this symptom alone is not necessary to seek emergency care.
The nurse is educating a family member of a toddler about dehydration. What statement by the family member indicates good understanding?
"My child's total body water percentage is similar to mine." Rationale: By toddlerhood, a patient's TBW is similar to that of an adult's. Toddlers are not less vulnerable to dehydration since their rate of metabolism is different than an adult's. A toddler does not have 30% higher TBW than an adult. Toddlers might be prone to dehydration, but it is because of their metabolism rate and body surface area that contribute to differences in fluid management.
A patient who is showing signs of severe hydration was admitted. What IV fluid can the nurse anticipate administering?
0.9% sodium chloride solution Rationale: An isotonic solution such as 0.9% sodium chloride solution is the appropriate fluid to administer for severe dehydration. A hypotonic solution such as 0.45% sodium chloride solution will increase dehydration. A solution with dextrose can lead to osmosis diuresis and can worsen dehydration.
A toddler currently weighs 12 kg and has a history of gastroenteritis for the past 3 days. The family reports that the toddler has had decreased oral intake and fewer wet diapers over the past 12 to 16 hours. The toddler's last known weight was 13 kg about 10 days ago. What are the correct IV maintenance fluid rate and IV rehydration fluid requirement for this patient?
46 ml/hr, 62 ml/hr Rationale: When the patient's baseline weight or dry weight is known, it should be used to calculate maintenance fluids. A patient who weighs 13 kg would have an hourly maintenance fluid requirement of 46 ml/hr. IV rehydration fluid requirements are based on the patient's deficit. Thus, the percentage of the patient's weight loss is 13 kg minus 12 kg divided by 13 kg and then multiplied by 100, which equals 7.7%. Rehydration requirements are calculated by multiplying the percentage of weight loss (7.7%) × 10 (ml for each percent loss) × 13 kg = 1001 ml. Half of this fluid (500 ml) should be administered in the first 8 hours of therapy at a rate of 62 ml/hr. The other half should be administered over the next 16 hours at a rate of 31 ml/hr. The other calculations are incorrect.
A 3-year-old pediatric patient is in the emergency department with a history of diarrhea and temperature of more than 37.7°C (99.9°F) for the past 2 days. The family members report that the patient is intermittently irritable and lethargic, and they are concerned that the patient's eyes look funny. The nurse observes that the patient's eyes are slightly sunken, the mucous membranes are dry, the apical pulse is 102 bpm, and the blood pressure is within the age-based normal range. The nurse should understand that this patient needs what intervention?
60 ml/hr of ORT for 3 to 4 hours Rationale: This patient's clinical picture is consistent with moderate dehydration; therefore, initiating ORT at a rate of 60 ml/hr for 3 to 4 hours would be appropriate. ORT would be a more appropriate initial intervention for this patient than IV rehydration therapy. IV fluid may be necessary if the patient is unable to tolerate ORT. This patient does not have indications of impending hypovolemic shock; therefore, a bolus of IV fluids is not indicated.
A patient who weighs 22 kg is admitted to the unit after a surgical procedure. The nurse is asked to administer IV fluids at the patient's maintenance fluid rate. At what rate should the nurse program the IV pump?
64 ml/hr Rationale: The maintenance fluid rate for the patient is 64 ml/hr based on this calculation: 1500 ml + 20 ml/kg for every kilogram above 20 kg; 1540 ml/24 hr = 64.2, rounded down to 64 ml/hr. A common error when calculating a patient's maintenance fluid rate is to multiply the patient's entire weight by 20 ml, rather than multiplying only the number of kilograms greater than 20 kg. If this error is made, the resulting maintenance fluid rate would be 81 ml/hr. Rates of 23 ml/hr and 92 ml/hr are miscalculations.
A patient who weighs 27 kg is admitted to the pediatric unit with suspected pancreatitis. The patient has a nothing-by-mouth status, and IV fluids are ordered. What is an appropriate maintenance fluid rate for this patient?
68 ml/hr Rationale: For a patient who weighs 27 kg, this formula should be used: 1500 ml for the first 20 kg plus 20 ml/kg for every kilogram above 20 kg, to be given in 24 hours. 1500 ml + (20 ml × 7 kg) =1500 ml + 140 ml =1640 ml total ÷ 24 hr = 68.3 ml/hr, round down to 68 ml/hr A rate of 68 ml/hr is appropriate for a patient who weighs 27 kg. A rate of 34 ml/hr is approximately half the amount of fluid required for a patient who weighs 27 kg. A rate of 85 ml/hr or 77 ml/hr is more fluid than this patient requires based on weight; these rates would be derived if the maintenance fluid calculations were performed incorrectly.
The nurse is caring for a patient with severe dehydration. After the patient has received two IV fluid boluses of 0.9% sodium chloride solution, the practitioner decides to order IV maintenance fluids. What type of IV fluid would the nurse anticipate administering?
D5 in 0.9% sodium chloride solution Rationale: Maintenance fluids should contain glucose as well as an isotonic crystalloid solution, so D5 in 0.9% sodium chloride solution would be the appropriate IV fluid. Infants and children have a higher metabolism and limited glucose stores. The added stress from illness or injury can quickly deplete those stores causing hypoglycemia. Hypotonic solutions such as 0.45% sodium chloride solution or D5 can worsen dehydration. Isotonic crystalloid solutions such as lactated Ringer solution or 0.9% sodium chloride solution do not contain the needed glucose and would be more appropriate for administering fluid boluses, which the patient has already had.
An infant is admitted with fever, vomiting, and diarrhea for the past 2 days. On initial assessment, the infant's anterior fontanel is sunken, and the mucous membranes are dry. The infant has an apical pulse of 190 beats per minute, a respiratory rate of 56 breaths per minute, and a 5-second capillary refill. The family reports no wet diapers in the past 4 hours. The nurse should recognize that this infant is showing signs of which fluid imbalance?
Severe dehydration Rationale: Signs of severe dehydration include tachycardia, hyperpnea, parched mucous membranes, sunken fontanels, delayed capillary refill (greater than 4 seconds), and anuria. With tachycardia, hyperpnea, a very prolonged capillary refill, a sunken anterior fontanel, dry mucous membranes, and anuria, this infant meets the criteria for severe dehydration. Signs of moderate dehydration include slight tachycardia and tachypnea, a slightly delayed capillary refill (2 to 4 seconds), normal to sunken fontanels, dry mucous membranes, and oliguria. Signs of mild dehydration include normal heart rate, normal respiratory rate, normal fontanels, rapid capillary refill, moist mucous membranes, and decreased urine output. Signs of fluid overload include dyspnea and rales on auscultation of breath sounds.
A patient receiving a fluid bolus for dehydration begins to show signs of respiratory distress. What would be the most appropriate action for the nurse?
Stop the IV fluids. Rationale: Respiratory distress after fluid administration can be a sign of fluid overload. Stopping the IV fluids is the most appropriate action. Auscultating the lungs is appropriate but should not be the nurse's first action. Changing the type of infusing fluid is premature without further assessment. Increasing the IV fluid rate might increase respiratory distress.
