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NURS 406 > Exam 1: Fluid Balance And Imbalance > Flashcards

Exam 1: Fluid Balance And Imbalance Flashcards

1
Q

Maintaining Water Balance: Increased requirements in

A
  • Fever
  • V/D
  • Diabetes Insipidus
  • DKA
  • Burns, Shock, Tachypnea
  • Warmer/Phototherapy
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2
Q

Maintaining Water Balance: Decreased requirements in

A
  • Congestive HF
  • SIADH
  • Mechanical ventilation
  • Increased ICP
  • Post-Op
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3
Q

Fluid Balance/Imbalance: Differences in Children

A
  • Infants and young children have greater need for water.
  • Water and electrolyte disturbances occurs more frequently, more rapidly and adjust less promptly.
  • Metabolism is higher -> higher rate of peristalsis.
  • Kidney function is immature.
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4
Q

Dehydration

A

Whenever the total output of fluids exceeds the total intake.

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5
Q

What should the nurse monitor for dehydration?

A
  • Monitor I&O closely: 1 g wet diaper = 1 mL urine

- Calculate fluid requirements! 100, 50, 20 rule.

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6
Q

What are types of dehydration?

A
  • Isotonic
  • Hypotonic
  • Hypertonic
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7
Q

Isotonic Dehydration**

A
  • Most common
  • Reduces circulating blood volume
  • Shock is the greatest threat to life.
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8
Q

What are clinical manifestations of dehydration?

A
  • No tears >3 months old**
  • Tachycardia
  • Dry mucous membranes
  • Sunken eyes
  • Sunken fontanel → anterior fontanel closes at 18 mo
  • Loss of skin elasticity
  • Prolonged capillary refill
  • Decrease to no urine output (elevated urine SG >1.020)
  • SHOCK
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9
Q

Dehydration Symptoms: Shock

A
  • Caused by severe depletion
  • Preceded by tachycardia and signs of poor perfusion.
  • BP alterations are a very late sign of shock
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10
Q

Mild Dehydration: Signs and Symptoms

A
  • <5% weight loss
  • Normal VS
  • Well alert
  • Moist mucus membranes
  • Capillary refill <2 seconds
  • UO slightly decreased
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11
Q

Management of Mild Dehydration

A
  • Monitor amount of fluid lost
  • Replace fluid orally: oral rehydration therapy aka pedialyte
  • Continue age appropriate diet
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12
Q

Moderate Dehydration: Signs and Symptoms

A
  • 5-10% weight loss
  • Weak pulse, fast RR
  • Fatigued, thirsty and eager to drink
  • Dry mucus membranes/sunken fontanel
  • Decreased skin turgor, prolonged capillary refill
  • Decreased, concentrated urine
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13
Q

Management of Moderate Dehydration

A
  • Oral rehydration solution; 50-100 ml/kg
  • If can’t take oral, do IV bolus (20 ml/kg); evaluate after each bolus
  • Can only bolus 3x’s max; After 3rd bolus give some sort of blood product.
  • Resume age appropriate diet as soon as dehydration corrected.
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14
Q

Severe Dehydration: Signs and Symptoms

A
  • > 10% weight loss
  • Tachycardia (bradycardia more severe)
  • Decreased BP; increased RR
  • Lethargic
  • Drinks poorly, unable to drink
  • Absent tears
  • Minimal UO
  • Depressed fontanel
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15
Q

Management of Severe Dehydration

A
  • IV therapy
  • Bolus 20 ml/kg or NS or LR
  • Evaluate after each bolus
  • If able, also take oral rehydration
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16
Q

How can you calculate percentage of weight loss?

A
  • Old weight minus new weight
  • Divide answer by old weight
  • Multiply by 100
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17
Q

Dehydration Management: What should not be given?

A
  • Sports drinks make diarrhea worse, especially in children
  • Do not give large amounts of water alone
  • Do not give potassium if UO is not appropriate for age.
18
Q

Dehydration Treatment

A
  • PO Replacement (if alert and awake): replacement of fluid loss over 4-6 hours with oral rehydration solution (i.e pedialyte)
  • IV Rehydration (if unable to drink or drink adequate amounts): Administer isotonic solution (i.e 0.9% NS or LR)
19
Q

Dehydration: Administration of IV Bolus

A
  • 20 ml/kg per bolus**
  • Can only give 3 bolus because if you give a whole bunch of fluid, you are diluting the blood o oxygen rate will be low and pulse ox will go down.
  • Will give blood after 3 bolus
20
Q

Urine Output by Age: Infant and Toddlers

A

> 2-3 ml/kg/hr

21
Q

Urine Output by Age: Preschool and Young school-age

A

> 1-2 ml/kg/hr

22
Q

Urine Output by Age: School-age and Adolescent

A

0.5-1ml/kg/hr

23
Q

Dehydration Management: What is particularly important to assess?

A
  • I&O, UO, V.S.
  • Daily weight
  • Stools, Vomiting
  • Sweating, behaviors
  • Serum electrolytes
  • Skin, mucus membranes, tears
  • Anterior fontanel
24
Q

Water Intoxication

A
  • Occurs less frequently than dehydration
  • May occur after ingestion of large amounts of fluid.
  • Decrease in serum sodium leads to CNS symptoms
  • Could cause death
25
Q

Symptoms of Water Intoxication

A
  • Increased urinary output
  • Irritable
  • Headache
  • Vomiting/diarrhea
  • Seizures
26
Q

Causes of Water Intoxication Include

A
  • Outdoor activities
  • Alteration in formula preparation in infants
  • Excessive water ingestion
  • Tap water enemas
27
Q

Types of IV Access Include

A
  • Peripheral IV

- Central Lines

28
Q

Central Line IV’s include

A
  • PICC line
  • Short-term Central Venous Catheter
  • Broviac
  • Portacath
29
Q

Peripheral IV Guidelines

A
  • Using a light to visualize the vein can be helpful
  • Secure the IV site
  • Keep fingers/toes accessible to check capillary refill
  • Do not attach ID Band to the same extremities as IV (could act as a tourniquette)
30
Q

How often should you check IV site?

A

Minimum q2h

31
Q

How can you secure the peripheral IV site?

A

A “pillow” will help secure the site and keep it flat/straight, but only if needed.

32
Q

What are the preferred peripheral IV sites?

A

…

33
Q

Central Line

A
  • Utilized for long term access
  • Surgically placed
  • An order is needed to discontinue
34
Q

What is the most common complication of central line IV’s?

A

Blood stream infections

35
Q

Management for Central Line IV’s

A

Dressing must be changed weekly.

36
Q

PICC Line

A
  • Done in arms and legs (NICU)

- NOT sutured in so be careful with dressing changes!

37
Q

Short-term Central Venous Catheter

A
  • Neck or groin area
  • 1-3 lumens
  • Big catheter
38
Q

Central IV: Broviac

A
  • Comes out of the center of the chest
  • Long term
  • Surgical placed above heart on center of chest.
  • Used for patients on TPN all the time.
39
Q

What is important to remember about a Broviac IV line?

A
  • Needs dressing on it so patient isn’t breathing on it.
  • Needs to always be covered/sealed; needs to remain sterile!
  • Sterile procedure to change the dressing
40
Q

Central IV: Portcath

A
  • Surgically placed under skin
  • 1-2 lumens
  • For chemotherapy and sickle cell therapy.

NURS 406 (18 decks)

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