Fluid and Electrolyte

Question 1

3 parts that make up extracellular fluid

Answer 1

interstitial fluid
intravascular fluid
transcellular space

Question 2

where is interstitial fluid located?

Answer 2

surrounds cell

found in lymph

Question 3

intravascular fluid

Answer 3

found in blood vessels

Question 4

transcellular fluid

Answer 4

found in sweat, cerebral, pleural and digestive juices

Question 5

which type of fluid will show physical signs of dehydration

Answer 5

extracellular fluid

Question 6

which type of fluid will show neurological symptoms of dehyrdation

Answer 6

Intracellular fluid

Question 7

why do infants/children get dehydrated faster?

Answer 7

increased BSA, higher metabolic rate

immature kidney function

Question 8

under normal circumstances the amount of water consumed closely approximates

Answer 8

the amount of urine excreted in a 24 hour period

Question 9

water in food and from oxidation closely approximates

Answer 9

the amount of water lost in feces or through evaporation

Question 10

meeting fluid requirements involves doing what 3 things?

Answer 10

maintenance (normal losses of fluids and electrolytes)
deficit (total amount of fluids and electrolytes lost from an illness
on-going loss- requirement of fluids and electrolytes to replace ongoing losses ( from third spacing, blood loss, diarrhea)

Question 11

what is the holliday-segar method for calculating maintenance fluid?

Answer 11

based on wt in kilo’s
first 10 kilo’s multiply by 100
next 10 kilo’s multiply by 50
>20 kilo’s multiply by 20

ex: 24 kilo child
10x100= 1000ml
10x50= 500 ml
4x20= 80ml
total volume= 1580ml for all day

Question 12

how does fever increase maintenance fluid requirements

Answer 12

for each 1 degree over 99% fluid requirements increase by 7ml/kg/day

Question 13

factors that increase the need of maintenance fluid requirements

Answer 13

fever
tachypnea
increased environment temp.
burns
ongoing loss
diabetic ketoacidosis, DI
shock
radiant warmer/ phototherapy
post op bowel surgery

Question 14

factors that decrease maintenance fluid requirements

Answer 14

mist tents, incubator, swamp bed
humidified ventilator
oliguria, anuria
hypothyroidism
CHF
increased ICP
SIADH

Question 15

causes of fluid excess

Answer 15

excessive oral intake
hypotonic overload
plain water enemas
renal failure
CHF
malnutrition

Question 16

symptoms of fluid excess

Answer 16

edema
slow bounding pulse
crackles in lungs
lethargy
hepatomegaly
weight gain
seizures, coma

Question 17

management/nursing care for fluid excess

Answer 17

limit intake
diuretics
VS
neurologic status
seizure precautions

Question 18

causes of fluid depletion

Answer 18

lack of oral intake
abnormal losses ( diarrhea, vomiting, hyperventilation, burns, hemorrhage)
* these causes deplete children/ infants faster than adults

Question 19

what are the three types of dehyration

Answer 19

isotonic
hypertonic
hypotonic

Question 20

isotonic dehydration

Answer 20

electrolytes and water are lost in same concentration
most common type
sodium is within normal limits

Question 21

hypertonic dehydration

Answer 21

more water loss than electrolytes

sodium is greater than 145

Question 22

hypotonic dehydration

Answer 22

more electrolyte than water.
common cause: water toxicity ( adding to much water to formula)
sodium is less than 135

Question 23

clinical assessment of mild dehydration

Answer 23

3-5% wt loss
active and alert
normal VS
skin springs back
normal fontanel

Question 24

Clinical assessment of moderate dehydration

Answer 24

6-9% wt loss
irritable, alert, thirsty
> 3 sec cap refill
slight increased pulse
slight tachypnea
normal or slight orthostatic hypotension
dry mucous membranes
skin tents briefly
normal or slightly sunken slightly

Question 25

clinical assessment of severe dehydration

Answer 25

``` greater than 10% wt loss lethargic, looks sick delayed cap refill >4 seconds very fast thready pulse fast deep respirations orthostatic to shock BP parched skin absent tears significantly sunken fontanels sunken eyes ```

Question 26

management of dehydration

Answer 26

correct imbalance and treat underlying cause

Question 27

when can you use oral rehydration therapy

Answer 27

when child is alert, awake, not in shock

Question 28

when do you provide rapid replacement of fluid loss?

Answer 28

over 4-6 hours used for on-going losses providing maintenance fluids

Question 29

causes of hyponatreimia

Answer 29

``` fever increased water intake decreased sodium intake diabetic ketoacidosis burns, wounds SIADH malnutrition CF renal disease vomiting, diarrhea, NG suction ```

Question 30

clinical manifestations of hyponatremia

Answer 30

sodium less than 135 neurological (less than 125) behavior change, irritability, lethargy, headache, dizziness, apprehension cardio- increased HR, decreased BP, cold, clammy skin muscle cramps (esp. abdomen) nausea

Question 31

causes of hypernatremia

Answer 31

``` water loss/ deprivation high sodium intake DI diarrhea fever hyperglycemia renal disease increased insensible loss ```

Question 32

clinical manifestations of hypernatremia

Answer 32

``` serum sodium higher than 147 intense thirst oliguria agitation flushed skin peripheral and pulmonary edema dry, sticky mucous membranes n/v severe CNS for Na >150 (disorientation, seizure, hyperirritability when resting) ```

Question 33

causes of hypokalemia

Answer 33

``` stress starvation malabsorption excess loss of fluid through vomiting, diarrhea, sweat, NG tube diuretics (furosemide, ethacrynic acid, thiazide) IV without potassium corticosteroids DKA ```

Question 34

clinical manifestations of hypokalemia

Answer 34

muscle cramps (legs), weakness CVS: weak, or irregular pulse, tachycardia, bradycardia, cardiac dysrhythmias, hypotension GIL Ileus or decrease in bowel movements CNS: irritability, fatigue, paralysis, weakness

Question 35

how to treat hypokalemia

Answer 35

determine and treat cause monitor VS, EKG administer supplemental K+ ( assess renal function before beginning)

Question 36

how to treat hyperkalemia

Answer 36

determine and treat cause monitor VS, EKG administer IV fluids may give IV insulin or cation exchange resin

Question 37

causes of hyperkalemia

Answer 37

``` increased K+ intake decreased urine excretion kidney failure metabolic acidosis hyperglycemia potassium sparing diuretics severe dehydration rapid IVF potassium burns ```

Question 38

clinical manifestations of hyperkalemia

Answer 38

``` irritability, anxiety twitching hyperreflexia weakness flaccid paralysis nausea, diarrhea bradycardia cardiac arrest for k+ greater than 8.5 apnea, respiratory arrest ```

Question 39

how to treat hypocalcemia

Answer 39

serum less than 8.8 determine and treat cause administer calcium supplements if IV monitor site as it can cause irritation

Question 40

causes of hypocalcemia

Answer 40

``` inadequate calcium intake vit D deficiency renal insufficiency calcium loss (infection, burns, loop diuretics) alkalosis hypoparathyroidism ```

Question 41

clinical manifestations of hypocalcemia

Answer 41

``` numbness, tingling of fingers, toes, nose, ears, and circumoral area hyperactive reflexes, seizures muscle cramps/tetany laryngospasm lethargy poor feeding in neonate positive trousseau's and Chvostek's sign hypotension, cardiac arrest ```

Question 42

how to treat hypercalcemia

Answer 42

serum calcium greater than 10.8 determine and treat cause monitor serum calcium levels monitor EKG

Question 43

causes of hypercalcemia

Answer 43

``` milk alkali syndrome (chronic intake of tums or milk) excessive IV or oral calcium acidosis prolonged immobilization hypoproteinemia renal disease hyperparathyroidism hyperthyroidism ```

Question 44

clinical manifestations of hypercalcemia

Answer 44

``` lethargy, weakness anorexia, thirst itching behavior changes confusion, stupor n/v/ constipation bradycardia, cardiac arrest ```

Question 45

what is the ORS of choice in the peds world?

Answer 45

pedialyte

Question 46

can you keep a kid at home in mild dehydration?

Answer 46

yes, ORS

Question 47

can you keep a kid at home in moderate dehydration?

Answer 47

get a clinic appt, ORS

Question 48

Mod to severe dehydration what do you tell parents?

Answer 48

bring to ER, get IV started before you loose access, ORS

Question 49

what is the expected urine output her hour for a child

Answer 49

1-2ml per KG per Hour