ch 23 fluid and electrolytes Flashcards by McKenna Michael

differences in infants related to body surface area

-body surface area is larger
-GI tract is longer
-larger quantities fluid lost through skin and GI tract

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differences in infants related to metabolic rate

-metabolic rate higher
-greater production metabolic wastes

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differences in infants related to kidney function

-kidneys immature
-unable to concentrate or dilute urine
-unable to conserve or secrete sodium
-unable to acidify urine

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water balance differences in infants/children

-greater need for water
-greater content extracellular Na and Cl
-more vulnerable to alterations in fluid electrolyte balance

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how much increased water is needed to replace insensible water loss for each 1 degree rise in temp above 99F

7 mL/kg

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what situations result in increased water requirements

-fever
-tachypnea
-radiant warmer
-V/D
-DI
-DKA
-shock
-burns
-post-op bowel surgery

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what situations result in decreased water requirements

-heart failure
-increased ICP
-renal failure (oliguric)
-SIADH

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how to calculate child’s daily fluid requirements based off weight in kg

-for 1st 10kg body weight: 100 mL/kg
-for 2nd 10 kg body weight: 50 mL/kg
-for remaining body weight: 20 mL/kg

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greatest threat to life in isotonic dehydration

shock

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S+S isotonic dehydration

-electrolyte and water deficits balanced (H2O loss = NaCl loss)
-major losses from ECF (decreased plasma volume affects skin, kidneys, muscles)
-no osmotic force
-*sodium within normal limits (130-150)
-most common dehydration in kids

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S+S hypotonic dehydration

-electrolyte loss exceeds water loss
-ICF more concentrated, fluid shifts from ECF to ICF, increases ECF loss
-physical signs more severe
-*Na<130
-shock

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S+S hypertonic dehydration

-water loss greater than electrolyte loss
-fluid shift from ICF to ECF
-most dangerous for kids
-seizures (can cause permanent damage)
-*Na>150

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why is rapid fluid replacement contraindicated in Tx of hypertonic dehydration

water intoxication
cerebral edema

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general S+S dehydration

-variable temp
-irritable
-dry skin and mucous membranes
-lethargic, fatigue
-poor skin turgor
-altered LOC
-poor perfusion (prolonged cap refill)
-weight loss
-decreased urine output
-sunken fontanels

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degrees of dehydration (3) according to mL/kg

mild: <50 mL/kg (5% deficit)
moderate: 50-90 mL/kg (10% deficit)
severe: >100 mL/kg (15% deficit)

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earliest sign dehydration

tachycardia

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what S+S are good predictors of dehydration greater than 5% deficit
(2+ signs)

-cap refill >2 secs
-absence of tears
-dry mucous membranes
-ill general appearance
-decreased urinary output

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best 3 individual examination signs for assessing dehydration

-prolonged cap refill (>2 secs)
-abnormal skin turgor
-abnormal resp pattern

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oral rehydration Tx for dehydration

rapid fluid replacement over 4-6 hrs

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parenteral rehydration Tx for dehydration

-initially: replace ECF volume
-isotonic solution
-20-30 mg/kg IV bolus over 20 mins

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isotonic fluids given for dehydration

-0.9% NS
-LR
-D5 .25NS
*NO DEXTROSE

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electrolyte Tx for dehydration

-sodium bicarb (to combat acidosis)
-potassium replacement (*don’t give until child voids)

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normal urine specific gravity
-child
-infant

child: 1.016-1.022
infant: 1.001-1.020

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possible complications of diarrhea

-dehydration
-electrolyte imbalance
-metabolic acidosis

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infectious causes acute diarrhea

-rotavirus -c diff -e coli

causes watery explosive diarrhea

sugar intolerance

causes greasy bulky stools

fat malabsorption

causes of neutrophils or RBCs in diarrhea

bacterial infection irritable bowel disease

causes of eosinophils in diarrhea

protein intolerance parasitic infection

when would you get a stool specimen for diarrhea

lasted longer than 3-4 days bloody stool mucus in stool

causes of stool pH<6

carbohydrate malabsorption lactose deficiency

4 main types shock

-hypovolemic -cardiogenic -distributive shock -obstructive shock

causes hypovolemic shock

reduction in circulating blood volume: -trauma -bleeding -burns -diarrhea

causes cardiogenic shock

decreased cardiac output: -following cardiac surgery

causes distributive shock

from vascular abnormality: -neurogenic shock -anaphylactic shock -septic shock

causes obstructive shock

-cardiac tamponade -tension pneumothorax *may resemble hypovolemic shock

S+S hypovolemic shock

-narrow pulse pressure -tachycardia -weak peripheral pulses -pale, cool skin -delayed cap refill >2 secs -decreased urine output -irritable LOC

S+S distributive shock

-possible crackles -tachycardia -bounding or weak peripheral pulses -warm or cool skin -lethargic LOC

S+S cardiogenic shock

-labored resps -crackles and grunting -tachycardia -hypoTN -narrow pulse pressure -weak peripheral pulses -cool pale skin -delayed cap refill > 2 secs

S+S obstructive shock

-labored resps -crackles and grunting -hypoTN -narrow pulse pressure

3 classifications (severities) shock

-compensated -hypotensive (decompensated) -irreversible (terminal)

S+S compensated severity of shock

-irritable -normal BP -narrow pulse pressure -tachycardia -thirst -pallor -diminished urinary output

S+S hypotensive (decompensated) severity of shock

-tachypnea -moderate metabolic acidosis -oliguria -cool pale extremities -cap refill >3 secs -hypoTN (*late sign)

Tx shock

-oxygen and ventilation -fluids -vasopressor

Tx septic shock

prompt admin Abx

3 stages septic shock

-early -normodynamic (cool or hyperdynamic decompensated) -hypodynamic (cold)

S+S early stage septic shock

-chills -fever -warm flushed skin -normal BP and urinary output

S+S normodynamic (cool or hyperdynamic decompensated) stage of septic shock

-cool skin -urinary output starting to diminish -normal BP and pulses

S+S hypodynamic (cold) stage of septic shock

-cardiovascular function deteriorating -cold extremities -weak pulses -hypoTN -oliguria or anuria -lethargic or comatose -multiorgan failure

S+S anaphylaxis

-headaches -anxiety -stridor -SOB -abdominal pain -itchiness -swelling -tachycardia -hypoTN

S+S 1st degree burn (partial thickness)

-epidermis intact, no blisters -erythema (skin blanches with pressure) -painful -discomfort 2-3 days -healing 3-7 days

S+S 2nd degree burn (partial thickness)

-wet, shiny, weeping surface -blisters -wound blanches with pressure -painful and very sensitive to touch and air -superficial partial thickness heals in <21 days -deep partial thickness heals in >21 days

S+S 3rd degree burn (full thickness)

-variable color (deep red, brown, white, black) -dry surface -blood vessels visible -no blanching -insensate -requires autografting

S+S 4th degree burn (full thickness)

-color variable -charring in deepest areas -extremity movement limited -insensate -amputation likely -requires autografting

effects of burns on cardiovascular system

-drop in cardiac output (shock) -cardiac output returns to normal within 1-2 days -edema

effects of burns on renal system

-increased fluid requirements -elevated BUN and creatinine -hematuria -high risk kidney failure

effects of burns on GI system

-decreased blood flow to GI -atrophy of GI tract -increased metabolic rate -elevated glucose levels -elevated body temp -potential gut barrier dysfunction (could lead to sepsis)

possible pulmonary complications of burns

-inhalation injury -aspiration of GI contents -bacterial pneumonia -pulmonary edema -pulmonary emboli

possible GI complications of burns

-feeding intolerance -ulcers -bleeding -potential GI tract barrier loss

possible complications of burns

-GI tract -pulmonary -wound sepsis -CNS (burn encephalopathy)

emergency care Tx of burns

-stop burning process -assess condition -cover burn -transport -provide reassurance

Tx minor burns

-clean with mild soap and water -debride -antimicrobial ointment -cover with light gauze -sometimes: silver wound dressing

Tx major burns

-adequate airway -fluid replacement -nutrition support -meds for pain -burn wound management

what is the parkland calculation formula for admin of fluids for dehydration

-for LR: 4 mL x BSA% x weight(kg) -give half of solution for 8 hrs -give other half solution for next 16 hrs