Exam 1: Conditions That Produce F&E Imbalances

Question 1

Diarrhea

Answer 1

Increase in frequency, fluidity and volume of stools

Question 2

Types of Diarrhea

Answer 2

-Acute and chronic

Question 3

Acute Diarrhea

Answer 3

• Self limiting

- subsides without specific treatment

Question 4

Chronic Diarrhea

Answer 4

• > 14 days
• Often caused by chronic conditions (i.e malabsorption syndrome, IBD, immunodeficiency, food allergy and lactose intolerance)

Question 5

Diarrhea: Evaluation

Answer 5

• Careful history such as living conditions, travel, exposure to untreated drinking/washing water, contact with animals, ABT and recent diet.
• Stool studies if indicated.

Question 6

Nursing Management of Diarrhea: Assessment

Answer 6

Fluid and electrolyte imbalances

Question 7

Nursing Interventions for Diarrhea

Answer 7

• Rehydration: continue to feed infants breast milk or formula
• Maintenance fluid therapy
• Reintroduction of adequate diet as soon as tolerated: bland but nutritional food (i.e crackers, flour tortillas); once they can tolerate bland can progress to normal diet.
• Protect the skin

Question 8

What should you avoid giving patients with diarrhea?

Answer 8

• Sugary drinks
• No BRAT diet: bananas, white rice, apple sauce and white toast (will increase K+)
• ABT (alters normal intestinal flora)
• Anti-diarrhea medication is contraindicated

Question 9

Diarrhea Transmission

Answer 9

Fecal-oral route

Question 10

Rotavirus

Answer 10

• Cause 70-80% of infectious diarrhea
• Most severe in 3-24 months (<3 months have some protection from maternally acquired antibodies)
• Vaccine now available.

Question 11

Rotavirus Vaccine

Answer 11

• Given at 2 & 4 months OR 2,4,6 months

- PO Vaccine (makes parents more willing to give to children)

Question 12

Shock

Answer 12

• AKA circulatory failure

- An acute, unstable physiologic state of inadequate oxygen delivery to the tissues.

Question 13

Shock can result in

Answer 13

• Cellular dysfunction

- Eventual organ damage/failure

Question 14

What are the types of shocks?

Answer 14

1. Hypovolemic Shock
2. Cardiogenic Shock
3. Distributive Shock
4. Obstructive Shock
5. Septic Shock

Question 15

Hypovolemic Shock

Answer 15

• Most common in children

- Overall decrease in circulating blood or volume.

Question 16

What can cause hypovolemic shock?

Answer 16

• Trauma
• Bleeding
• Burns
• Diarrhea
• Dehydration
• Surgery

Question 17

Cardiogenic Shock

Answer 17

• Usually general in heart disease (PICU)
• Due to impaired cardiac muscle function.
• Cardiac output is not sufficient to meet the body’s metabolic demands.

Question 18

What can cause cardiogenic shock?

Answer 18

• Congenital heart disease

- May be seen after cardiac surgery

Question 19

Distributive Shock

Answer 19

-Due to vascular abnormality that produces maldistribution of blood supply throughout the body.

Question 20

Distributive Shock includes???

Answer 20

1. Neurogenic Shock
2. Anaphylactic Shock
3. Septic Shock (most common if child has fever always work up for septic shock)

Question 21

Obstructive Shock

Answer 21

• Not common in children

- Venous congestion with poor perfusion.

Question 22

What can cause obstructive shock?

Answer 22

• Cardiac tamponade
• Tension pneumothorax
• Pulmonary embolism

Question 23

Septic Shock

Answer 23

-Caused by infection

Question 24

Presentation of Septic Shock

Answer 24

• Diffuse vasodilation
• Increased capillary permeability
• Maldistribution of blood flow

Question 25

Stages of Septic Shock: Early S&S

Answer 25

• Chills, fever
• Vasodilation with increased cardiac output
• Best survival chance

Question 26

Stages of Septic Shock: Second

Answer 26

• Lasts only a few hours
• Cool skin, pulses and BP normal
• UO decreases
• Mental state becomes depressed

Question 27

Stages of Septic Shock: Late S&S

Answer 27

• Hypothermic
• Weak pulses
• Hypotension
• Oliguria
• Lethargic/comatose
• Multi-organ failure is common

*For children <1 y/o who have low HR, take temperature because they are probably cold; rectal best route

Question 28

Management of Shock

Answer 28

1. Ventilation: lungs are most sensitive
2. Fluid Administration
3. Improvement of pumping action of heart: exogenous catecholamine’s

Question 29

What fluids would you give someone with shock?

Answer 29

1. Isotonic crystalloid solution (NS or LR) → IV bolus → 10-20 ml/kg over 10-15 minutes
2. Colloids → often given to children → Albumin

Question 30

Management of Septic Shock

Answer 30

1. Hemodynamic stability → fluid volume resuscitation
2. Adequate oxygenation → possible sedation and mechanical ventilation to decrease work of breathing
3. Antimicrobial treatment → broad spectrum ABT immediately and remove sources of infection if possible

Question 31

Burns

Answer 31

-Children <5 y/o are at risk.

Question 32

What should the nurse teach families to prevent burns?

Answer 32

-Teach to look at child’s height and where they are able to reach (push stuff to the back of the counter)

Question 33

What are the most common causes of burns in children?

Answer 33

• Most common accidents for children are in the kitchen and bathroom
• Hot liquids
• Burns to hands and face
• Hot water in bathroom (turn down water heater once you have kids)

Question 34

Most common complications of burns in children

Answer 34

1. Infection

2. May have delay in growth and development if recovery is prolonged.

Question 35

Pediatric differences in effects of burns

Answer 35

• Higher mortality rate in very young children
• Child’s skin is thinner → can have more severe burns with less heat and time exposure
• Larger body surface area
• Increased risk for protein and calorie deficiency
• More severe scarring
• Immature immune systems increase infection risk
• May delay growth if burn is extensive