Dehydration - Fluid & Electrolytes

Question 1

Difference between children & adults r/t fluid & electrolytes

Answer 1

children can enter into dehydration much quicker

Question 2

what makes children more susceptible to dehydration - physiological differences (5)

Answer 2

larger body surface area in relationship to their weight
increased baso-metabolic rate
inability to concentrate urine (urine is very diluted)
higher respiratory rate - (child resp. rate = 40)
under 3, body fluids aren’t stored as efficiently (stored in extracellular compartment) - insensible fluid lose

Question 3

urine specific gravity increases or decreases in a child with dehydration

Answer 3

increases (eg: 1.020)
normal range of urine specific gravity (1.003-1.030)
THE HIGHER THE DRYER

Question 4

what is an insensible fluid lose

Answer 4

fluid lost at the surface

Question 5

infants

Answer 5

no

Question 6

when does posterior fontanel close

Answer 6

8 weeks

Question 7

when does anterior fontanel close

Answer 7

12-18 months

Question 8

a sunken fontanel is consistent with dehydration, t or f

Answer 8

true

Question 9

% of extracellular vs intracellular fluids by age (e/i)

Answer 9

infant 40/40
toddler (3 yr) 30/40
adult 20/40

Question 10

water balance is regulated by

Answer 10

ADH - anti-diuretic hormone = acts on kidney tubules to reabsorb h20

Question 11

formula for fluid bolus when dehydrated

Answer 11

20ml/kg of isotonic solution infused over 4 hours

reevaluate dehydration symptoms (diaper, eyes, fontanel)

Question 12

what does ORS stand for?

Answer 12

oral re-hydration solutions (pedialyte)

Question 13

Cardiac symptoms r/t dehydration

Answer 13

increase in pulse rate (hr); then a decrease with later stage of dehydration
weak/thready pulse

Question 14

Blood pressure r/t dehydration

Answer 14

bp drops - late sign - severe dehydration

resp failure - hypo-volemic shock

Question 15

fluid overload s/s

Answer 15

cough
moist breath sounds
water intoxication

Question 16

fluid for children is a delicate balance, t or f

Answer 16

true

Question 17

95% of your potassium (k) is excreted via your

Answer 17

kidneys

Don’t add K to iv fluids until wet diaper if oliguria or anuria. Too much K can build up in intravascular fluid.

Question 18

Too much K (hyperkalemia) can lead to

Answer 18

arrhythmia’s

cardiac arrest

Question 19

Potassium values

Answer 19

PANIC (7.0 mEq/L)
infant 3.6-5.8
child 3.5-5.5
adult 3.5-5.3

Question 20

classified hyperkalemia with value above

Answer 20

5

can lead to heart arrhythmia (can be seen on ekg)

Question 21

hypokalemia value k is less than

Question 22

risk for hypokalemia

Answer 22

child on diuretics

ingesting lg amounts of ASA

Question 23

A child w/an NG tube should have what monitored closely

Answer 23

potassium levels

Question 24

Dehydration types (3)

Answer 24

hypertonic dehydration (hypernatremic) = more fluid loss than sodium (sodium >150)
isonatremic dehyrdation (isotonic) = lose equal parts water and sodium (sodium levels in norm. range)
hyponatremic/hypotonic = more sodium loss than water, generally sodium is

Question 25

most frequent dehydration we will run into

Answer 25

isotonic/isonatremic dehydration

Question 26

body weight and dehydration

Answer 26

10% body loss = severe dehydration
5% body loss = mild dehydration
5-9% body loss = moderate dehydration

Question 27

norm sodium levels

Answer 27

135-148 mEq/L

Question 28

kids with cystic fibrosis experience which type of dehydration - particularly in summer

Answer 28

hyponatremic/hypotonic - loose more salt than water; salt tablets given to replace the loss
taste salty

Question 29

2 different ways to classify dehydration

Answer 29

weight

serum sodium levels

Question 30

most abundant cation & chief base of blood

Answer 30

sodium

Question 31

children with hypernatremia are almost always

Answer 31

dehydrated

Question 32

re-hydration solutions are made up of what?

Answer 32

75-90 mEq Na+ per liter - electrolyte solution

Question 33

for severely dehydrated patients bolus with what?

Answer 33

20ml/kg of isotonic solution over 20 minutes (bolus)

Question 34

for re-hydration follow this formula (after bolus)

Answer 34

calc. maint. fluids add additional fluids based on weight loss as follows:
50ml/kg for mild
100ml/kg for moderate
150ml/kg for severe
2/3 of fluids within 8 hours of admission

Question 35

BRAT diet is not recommended t or f

Answer 35

true

Question 36

If no urine output teach parent to

Answer 36

call the Dr

Question 37

if child is admitted to the hospital with dehydration what should be part of your care plan

Answer 37

daily weights - same time/scale each day

accurate i/o

Question 38

daily weights is the best indicator of what

Answer 38

fluid status

Question 39

never give k in an iv push, t or f

Answer 39

true

Question 40

whats d5 1/2?

Answer 40

dextrose 5%, .45 Na+

Question 41

whats d5 1/3?

Answer 41

dextrose 5%, .33 Na+

Question 42

whats d5 1/4?

Answer 42

dextrose 5%, .225 Na+