16- abd pain, vomit Flashcards
3 components of glasgow coma scale
eye opening response 1-4
verbal response 1-5
motor response 1-6
why do kids have higher risk of dehydration compared to adults?
Higher surface area:body mass->evaporation
Higher basal metabolic rates than adults, which generates heat and expends water,
Higher percentage of body weight that is water
Diabetic ketoacidosis presentation
vomiting diffuse abdominal pain preceding history of polydipsia and enuresis significant dehydration mental status altered tachypnea- kussmaul
steps to do immediately if DKA suspected
isotonic saline (0.9%) IV bolus STAT electrolytes random glucose test UA blood gas continuous cardiac monitoring
DM diagnosis
random blood glucose >200 + symptoms
oral glucose tolerance test >200 (2 hr post-prandial)
fasting blood glucose >126
Hg A1c >6.5
next steps to do in next hour with DKA
vitals insulin drip (after 1 hr of fluids) maintenance and replacement fluids frequent glucose measurements serum osmolality CBC monitor cerebral edema endocrinologist consult admit to hospital
DKA labs
pH low
sodium low- dictional- H2O follows glucose into ECM
postassem normal- varies- drops with insulin
bicarb low
Cr high- dehydration
glucose high
blood and urine ketones high
corrected sodium equation in DKA
Corrected sodium = [{(measured glucose - 100) / 100} x 1.6] + measured sodium
example of isotonic/isonatremic dehydration and how many hours to replace
gastroenteritis- diarrhea
most common in kids
12 hours to replace
example of hypotonic/hyponatremic dehydration and how many hours to replace
consume diluted fluids
adrenal insuff.
replace over 24 hours to not get locked in -central pontine myeilnosis
example of hypertonic/hypernatremic dehydration and how many hours to replace
breastfeeding failure
diabetes insipidus
replace over 48 hours to avoid cerebral edema
Holliday-Sugar method of calculating maintenance fluids
100 mL/kg/day for the first 10 kg of body weight
50 mL/kg/day for the second 10 kg of body weight
20 mL/kg/day for each additional 1 kg of body weight
percent saline in initial IV bolus compared to maintenance IV fluids
isotonic initialy 0.9%
then replace with 0.45%
signs of cerebral edema
A. Headache B. Recurrence of vomiting D. (bradycardia) F. Rising blood pressures (hypertension) G. Decreased oxygen saturation (hypoxia) H. Restlessness, irritability I. Increased drowsiness (lethargy) J. Cranial nerve palsies: CN VI - Abducens nerve K. Abnormal pupillary responses: unequal pupils, fixed dilated pupils, absent response unilaterally or bilaterally
admission orders
ADC VANDISMAL
A =Admit (floor, room, service, attending, resident)
D=Diagnoses (list in order of priority)
C=Condition (good, fair, guarded, critical)
V=Vitals (q 2 hrs, q shift, routine)
A=Activity (ad lib, bed rest, up to chair, walk 3x/d)
N=Nursing (ins and outs, drains, wound care, etc.)
D=Diet (regular, low sodium, diabetic, NPO, etc.)
I=IV fluids (type and rate)
S=Studies (imaging, ECG)
M=Medications (include both scheduled and prn)
A=Allergies (drug or food)
L=Labs (CBC, lytes, cultures, etc.)
