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Peds Exam 2 > Fluid and Electrolyte > Flashcards

Fluid and Electrolyte Flashcards

1
Q

3 parts that make up extracellular fluid

A

interstitial fluid
intravascular fluid
transcellular space

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2
Q

where is interstitial fluid located?

A

surrounds cell

found in lymph

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3
Q

intravascular fluid

A

found in blood vessels

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4
Q

transcellular fluid

A

found in sweat, cerebral, pleural and digestive juices

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5
Q

which type of fluid will show physical signs of dehydration

A

extracellular fluid

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6
Q

which type of fluid will show neurological symptoms of dehyrdation

A

Intracellular fluid

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7
Q

why do infants/children get dehydrated faster?

A

increased BSA, higher metabolic rate

immature kidney function

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8
Q

under normal circumstances the amount of water consumed closely approximates

A

the amount of urine excreted in a 24 hour period

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9
Q

water in food and from oxidation closely approximates

A

the amount of water lost in feces or through evaporation

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10
Q

meeting fluid requirements involves doing what 3 things?

A

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)

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11
Q

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

A

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
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12
Q

how does fever increase maintenance fluid requirements

A

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

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13
Q

factors that increase the need of maintenance fluid requirements

A 
fever
tachypnea
increased environment temp.
burns
ongoing loss
diabetic ketoacidosis, DI
shock
radiant warmer/ phototherapy
post op bowel surgery
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14
Q

factors that decrease maintenance fluid requirements

A 
mist tents, incubator, swamp bed
humidified ventilator
oliguria, anuria
hypothyroidism
CHF
increased ICP
SIADH
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15
Q

causes of fluid excess

A 
excessive oral intake
hypotonic overload
plain water enemas
renal failure
CHF
malnutrition
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16
Q

symptoms of fluid excess

A 
edema
slow bounding pulse
crackles in lungs
lethargy
hepatomegaly
weight gain
seizures, coma
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17
Q

management/nursing care for fluid excess

A 
limit intake
diuretics
VS
neurologic status
seizure precautions
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18
Q

causes of fluid depletion

A 
lack of oral intake
abnormal losses ( diarrhea, vomiting, hyperventilation, burns, hemorrhage)
* these causes deplete children/ infants faster than adults
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19
Q

what are the three types of dehyration

A

isotonic
hypertonic
hypotonic

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20
Q

isotonic dehydration

A

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

21
Q

hypertonic dehydration

A

more water loss than electrolytes

sodium is greater than 145

22
Q

hypotonic dehydration

A

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

23
Q

clinical assessment of mild dehydration

A 
3-5% wt loss
active and alert
normal VS
skin springs back
normal fontanel
24
Q

Clinical assessment of moderate dehydration

A 
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
25
Q

clinical assessment of severe dehydration

A 
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
26
Q

management of dehydration

A

correct imbalance and treat underlying cause

27
Q

when can you use oral rehydration therapy

A

when child is alert, awake, not in shock

28
Q

when do you provide rapid replacement of fluid loss?

A

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

29
Q

causes of hyponatreimia

A 
fever
increased water intake
decreased sodium intake
diabetic ketoacidosis
burns, wounds
SIADH
malnutrition 
CF
renal disease
vomiting, diarrhea, NG suction
30
Q

clinical manifestations of hyponatremia

A

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

31
Q

causes of hypernatremia

A 
water loss/ deprivation
high sodium intake
DI
diarrhea
fever
hyperglycemia
renal disease
increased insensible loss
32
Q

clinical manifestations of hypernatremia

A 
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)
33
Q

causes of hypokalemia

A 
stress
starvation
malabsorption
excess loss of fluid through vomiting, diarrhea, sweat, NG tube
diuretics (furosemide, ethacrynic acid, thiazide)
IV without potassium
corticosteroids
DKA
34
Q

clinical manifestations of hypokalemia

A

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

35
Q

how to treat hypokalemia

A

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

36
Q

how to treat hyperkalemia

A

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

37
Q

causes of hyperkalemia

A 
increased K+ intake
decreased urine excretion
kidney failure
metabolic acidosis
hyperglycemia
potassium sparing diuretics 
severe dehydration
rapid IVF potassium
burns
38
Q

clinical manifestations of hyperkalemia

A 
irritability, anxiety
twitching
hyperreflexia
weakness
flaccid paralysis
nausea, diarrhea
bradycardia
cardiac arrest for k+ greater than 8.5
apnea, respiratory arrest
39
Q

how to treat hypocalcemia

A

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

40
Q

causes of hypocalcemia

A 
inadequate calcium intake
vit D deficiency
renal insufficiency
calcium loss (infection, burns, loop diuretics)
alkalosis
hypoparathyroidism
41
Q

clinical manifestations of hypocalcemia

A 
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
42
Q

how to treat hypercalcemia

A

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

43
Q

causes of hypercalcemia

A 
milk alkali syndrome (chronic intake of tums or milk)
excessive IV or oral calcium
acidosis
prolonged immobilization
hypoproteinemia
renal disease
hyperparathyroidism
hyperthyroidism
44
Q

clinical manifestations of hypercalcemia

A 
lethargy, weakness
anorexia, thirst
itching
behavior changes
confusion, stupor
n/v/ constipation
bradycardia, cardiac arrest
45
Q

what is the ORS of choice in the peds world?

A

pedialyte

46
Q

can you keep a kid at home in mild dehydration?

A

yes, ORS

47
Q

can you keep a kid at home in moderate dehydration?

A

get a clinic appt, ORS

48
Q

Mod to severe dehydration what do you tell parents?

A

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

49
Q

what is the expected urine output her hour for a child

A

1-2ml per KG per Hour

Peds Exam 2 (13 decks)

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