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PHA 397 - Make-Up Therapeutics > Exam 1 - Outpatient Pediatric Fluid and Electrolytes > Flashcards

Exam 1 - Outpatient Pediatric Fluid and Electrolytes Flashcards

1
Q

Who has more TBW, Premature babies or Adults?

A

Premature babies

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2
Q

Which is higher in premature babies, ECF or ICF?

A

ECF

-50% in premature babies, while ICF is 35% in premature babies

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3
Q

What is the calculation for % of dehydration in peds pts?

A

% Dehydration = (Normal wt - Actual wt)/Normal wt

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4
Q

What are the 3 stages of dehydration?

A

1) Mild
2) Moderate
3) Severe

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5
Q

What is the % dehydration that is mild dehydration?

A

<5%

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6
Q

What are the s/s of mild dehydration?

A 
Normal to dry mucous membranes
Slight thirst
Tears present
Normal skin
Flat anterior fontanel
Slightly increased urine specific gravity
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7
Q

What is the % dehydration that is moderate dehydration?

A

6-9%

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8
Q

What are the s/s of of moderate dehydration?

A 
Irritable 
Moderate thirst 
Dry mucous membranes
With or without tears
Anterior fontanel may or may not be sunken in 
Skin +/-
Increased urine specific gravity
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9
Q

What is the % dehydration that is severe dehydration?

A

10-15%

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10
Q

What are the s/s of severe dehydration?

A 
Hyperirritable to lethargic
Intense thirst
Parched mucous membranes 
Absent tears 
Sunken anterior fontanel 
Tenting skin 
Significantly increased urine specific gravity
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11
Q

T/F: Clear liquids are always super helpful.

A

FALSE

-Misconception that they are helpful

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12
Q

Why are clear liquids not always helpful?

A

B/C they are hyper-osmolar and lack electrolytes

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13
Q

What should be used instead of clear liquids in dehydration?

A

Glucose-Sodium coupled transport mechanism

-Ration of 1 - 2:1 (glucose:Na)

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14
Q

What is the concern with more osmolar liquids?

A

DIARRHEA

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15
Q

When do you refer to MD for dehydration?

A 
Young age (<6 months, <8kg) 
High risk - DM
Fever >38 C for infants <3 months or >39 C for infants 3-36 months 
Visible blood in stool, high output
Persistent vomiting 
Change in mental status
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16
Q

When does mild to moderate dehydration begin?

A

AT HOME

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17
Q

What is the ORS dosage for rehydration in mild to moderate dehydration?

A

50-100 mL/kg over 4 hours

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18
Q

Over how many hours should ORS be given in mild to moderate dehydration?

A

OVER 4 HOURS

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19
Q

How many mL per kg of body weight or ORS should be given in mild to moderate dehydration?

A

50-100 mL/kg body weight

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20
Q

In mild to moderate replacement of losses, how many mL should pts weighing <10 kg receive?

A

60-120 mL ORS for each diarrheal stool or vomiting episode

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21
Q

How many oz is 60-120 mL ORS?

A

2-4 oz

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22
Q

In mild to moderate replacement of losses, how many mL should pts weighing >10 kg receive?

A

120-240 mL ORS for each diarrheal stool or vomiting episode

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23
Q

How many oz is 120-240 mL ORS?

A

4-8 oz

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24
Q

T/F: During oral rehydration you can consume lactose.

A

FALSE

-Avoid lactose

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25
Q

During oral rehydration, what foods should older children avoid?

A

Foods high in simple sugars

  • Soft drinks
  • Undiluted apple juice
  • Jell-o
  • Presweetened cereal
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26
Q

Why is the BRAT diet not recommended for prolonged use?

A

Inadequate energy and protein content

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27
Q

What are the must use IV rehydration conditions?

A

Bloody diarrhea
Severe dehydration (shock or near shock, >10% fluid deficit)
If pt has an intestinal ileus
Intractable vomiting
High stool output (>10 mL/kg/hr) associated with lower rate of success with ORS

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28
Q

Who has the most maintenance caloric requirements?

A

Premature neonates

-The younger you are the more you get

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29
Q

What are the advantages of enteral over parenteral nutrition?

A
  • Maintenance of structural and functional GI integrity
  • Decreased potential for bacterial translocation
  • Enhanced utilization of nutrients; improved glucose tolerance and decreased hyperinsulinemia
  • Greater ease and safety of administration
  • Decreased hepatobiliary complications associated with TPN
  • Decreased cost
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30
Q

Name the indications for Enteral Nutrition.

A

Diminished ability to ingest nutrients
Failure to meet full nutritional needs orally
Altered absorption or metabolism of nutrients (chronic diarrhea, short bowel syndrome, inflammatory bowel disease, GERD)

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31
Q

Name the contraindications to Enteral Nutrition.

A 
Necrotizing enterocolitis
GI obstruction
Intestinal atresia 
Severe inflammatory bowel disease 
Acute pancreatitis
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32
Q

What macronutrient do you consider most important for the development of an infant?

A

PROTEIN

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33
Q

What minerals and vitamins become exceedingly important for a premature infant?

A

Ca
Vitamin D
Phosphorus

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34
Q

What is the gold standard feeding for babies?

A

Breast milk

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35
Q

T/F: Breast milk provides immunologic protection.

A

TRUE

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36
Q

How long does the American Academy of Pediatrics recommend breast feeding?

A

For the first 6 months of life and continuation for the second 6 months as optimum nutrition in infancy

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37
Q

Name the benefits of breast milk.

A
  • Optimum nutrient for term and near term infants
  • Anti-infective properties reduce instances of bacterial and viral illnesses
  • Suggested to lower the risk of immune-mediated dx (Crohn’s disease, DM, Eczema, Asthma, Allergic gastroenteritis)
  • Psychological and long-term cognitive advantages
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38
Q

Name the contraindications to breast feeding.

A
  • Contagious lesions on the breast (syphillis or herpes)
  • Chickenpox or shingles
  • Pertussis
  • Cytomegalovirus
  • TB
  • HIV
  • Hep B if untreated
  • Infant intolerance to breast milk
  • Certain meds
  • Permaturity (<35 weeks gestation)
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39
Q

T/F: You still need to fortify and add protein to donor breast milk.

A

TRUE

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40
Q

T/F: Donor breast milk is un-pasteurized.

A

FALSE

-Donor breast milk is pasteurized

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41
Q

Who needs human milk fortifier?

A

Very low birth weight infants receiving breast milk

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42
Q

What does human milk fortifier contain?

A

Extra sodium, calcium, phosphorous, vitamins, and calories

ALSO - protein and fat (iron)

43
Q

Name the two hydrolyzed human milk fortifier products.

A

1) Enfamil Human Milk Fortifier - Mead Johnson

2) Similac Human Milk Fortifier - Ross

44
Q

Name the 100% donor human milk - human milk fortifier.

45
Q

What is the concern with Prolacta?

A

It displaces volume of moms breast milk

46
Q

What makes breast milk best?

A

Increased immunity
Decreased autoimmune disease
Higher IQ

47
Q

Name the 2 pre-term infant formulas.

A

1) Similac Special Care

2) Enfamil Premature Formula

48
Q

What formula do low birth-weight infants requiring rapid growth need?

A

Pre-Term formula

49
Q

What does Pre-Term formula contain?

A

Increased proteins, Calcium, and Phosphorous

50
Q

T/F: Babies taking Pre-Term formula do not require supplemental iron.

A

FALSE

-Babies taking Pre-Term formula require supplemental iron

51
Q

Name the two Transitional formulas.

A

1) Neosure

2) Enfacare

52
Q

What type of formula is Similac Special Care?

A

Pre-Term formula

53
Q

What type of formula is Enfamil Premature Formula?

A

Pre-Term formula

54
Q

What type of formula is Neosure?

A

Transitional formula

55
Q

What type of formula is Enfacare?

A

Transitional formula

56
Q

What formula do infants requiring increased caloric intake at discharge from hospital need?

A

Transitional formula

57
Q

T/F: Pre-Term formula is OTC.

A

FALSE

-Pre-Term formula requires prescription

58
Q

T/F: Transitional formula is OTC.

59
Q

Who needs Transitional formula?

A

Former premies, babies between 34-37 weeks

60
Q

What does Transitional formula contain?

A

Increased protein, calcium, vitamins, and mineral

-Less than Pre-Term formula

61
Q

Which type of formula can you ad lib feed?

A

Transitional formula

62
Q

Name the 5 milk protein term formulas.

A

1) Similac
2) Enfamil
3) Enfamil Enspire
4) Enfamil AR
5) Similac for Spit-Up

63
Q

Who needs milk protein term formula?

A

Normal full-term infants with no special nutritional needs

Supplement breast-fed infants

64
Q

What type of formula is Enfamil Enspire?

A

Milk protein term formulas

65
Q

What type of formula is Enfamil AR?

A

Milk protein term formula

66
Q

What type of formula is Similac for Spit-Up?

A

Milk protein term formula

67
Q

Which two formulas are good for spit-up and decrease the need for a PPI or H2RA?

A

Enfamil AR

Similac for Spit-Up

68
Q

Name the partially hydrolyzed allergy formulas.

A

1) Similac Sensitive
2) Similac Total Comfort
3) Enfamil Gentlease
4) Enfamil Sensitive
5) Enfamil Reguline

69
Q

Which two formulas can be used for opioid withdrawal babies?

A

1) Similac Sensitive

2) Enfamil Gentlease

70
Q

Which of the partially hydrolyzed formulas is lactose free?

A

Similac Total Comfort

71
Q

What are partially hydrolyzed allergy formulas for?

A

Gassy, fussy babies

72
Q

Name the soy allergy formulas.

A

1) Isomil

2) Prosobee

73
Q

Who would need a soy allergy formula?

A
  • Children sensitive to cow’s milk
  • Following diarrhea
  • Lactose intolerance
  • Lactase deficiency
  • Galatosemia
74
Q

T/F: Some of the soy allergy formulas are lactose free.

A

FALSE

-Soy allergy formulas are all lactose free

75
Q

What type of formula is Prosobee?

A

Soy allergy formula

76
Q

Name the Casein Hydrolysate based formulas.

A

1) Nutramigen
2) Alimentum
3) Pregestimil

77
Q

What type of formula is Alimentum?

A

Casein Hydrolysate based

78
Q

What type of formula is Pregestimil?

A

Casein Hydrolysate based

79
Q

What type of formula is Nutramigen?

A

Casein Hydrolysate based

80
Q

Who needs Casein Hydrolysate based formulas?

A

Babies that can’t tolerate cow’s milk protein or soy protein

81
Q

What are some additional additives to milk (“MLLPP”)?

A 
Milk Fat Globule Membrane
Lutein
Lactoferrin
Prebiotics
Probiotics
82
Q

Name the elemental formulas.

A

1) PurAmino
2) Neocate
3) EleCare

83
Q

What is in “Advance” and “NeurPro” formulas?

A

DHA & ARA

-Added fatty acids - helps with visual acuity and gives higher IQ in babies

84
Q

Name the 2 older child formulas.

A

1) Pediasure

2) Kindercal

85
Q

Who needs older child formulas?

A

Older children not eating well, hospitalized, tube feedings, etc.

86
Q

What formula is best for a premature infant with increasing bradys within 30 minutes of feeding?

A

Similac for Spit-Up

Enfamil AR

87
Q

What formula is best for an infant with an intolerance to cow’s milk protein?

A

Lactose free - Soy formula = “IP” I - Isomil; P - Prosobee

Casein Hydrolysate formula = “NAP” N - Nutramigen; A - Alimentum; P - Pregestimil

Free amino acid formula = “PEN” P - PurAmino; E - EleCare; N - NeoCate

88
Q

What are the infant caloric needs?

A

100-120 kcal/kg/day

89
Q

Do Pre-term or Term infants need more calories?

A

Pre-term infants need more calories (120 kcal/kg/day)

90
Q

What are the infant fluid needs?

A

140-160 mL/kg/day

91
Q

20 kcal/oz = ?

A

20 kcal/30mL

92
Q

How many feedings is an infant getting if they feed every 3 hours?

A

8 feedings

24 hr/3 hr = 8

93
Q

Who needs multivitamins?

A

Preterm infants

High risk infants for >6 months

94
Q

Who needs vitamin D?

A

Preterm infants

Term breastfed infants

95
Q

Who needs iron?

A

Preterm infants if NOT FULLY supplied in preterm formula or breast milk fortifier

High risk infants

Term infants at 4 months

96
Q

What amount of iron do preterm infants <32 weeks gestation need?

A

Infants <32 weeks gestation need 4-6 mg/kg/day

97
Q

What amount of iron do preterm infants >32 week gestation need?

A

Infants >32 weeks gestation need 2-4 mg/kg/day

98
Q

When should infants receive fluoride?

A

Around 4 months, if exclusively breast fed

99
Q

What is protein a good source for?

100
Q

What labs are measured for bone mineralization?

A
  • Ca
  • Phos
  • Alkaline phosphatase
  • X-ray/Skeletal survey
101
Q

What is prealbumin a good indicator of/for?

A

As kids get older prealbumin helps tell if they are growing and getting enough protein

102
Q

What macronutrient do you consider most important for the development of an infant?

103
Q

When is the composition of carbohydrates in infant formula a concern?

104
Q

What minerals and vitamins become exceedingly important for a premature infant?

A

Ca
Vitamin D
Phos

PHA 397 - Make-Up Therapeutics (15 decks)

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