Fluid and electrolytes Flashcards
How do you calculate maintenance fluids?
4-2-1
4 ml/kg/hr for 1-10 kg
2 mL/kg/hr for 11-20 kg
1 mL/kg/hr for every kg >20
Differentiate between isotonic, hypertonic, and hypotonic solutions?
Isotonic: same osmolality as plasma; no movement inside or outside cell
Hypertonic: high concentration of solute than plasma; water moves out of the cell
– ie. body losing water in salt water
Hypotonic: lower concentration of solute than plasma; water moves into the cell
– ie. pruny skin in freshwater from cells swelling up
What is appropriate urine output?
Normal: 2-4 mL/kg/hr
Minimum: 1 mL/kg/hr
What is shock?
S/S: tachypnea, tachycardia, increased WOB, cyanosis, apnea, changing LOC, later bradycardia, altered perfusion, decreased pulses, decreased pain response, hypotension
Therapy: ventilation, fluid administration, cardiac support, vasopressors, antibiotics (septic shock)
What is metabolic acidosis?
Net loss in bicarb
Increase in acids
pH of 7.34 or lower
Causes: diarrhea, DK, adrenal insufficiency
What is metabolic alkalosis?
Increase in bicarb
Decrease in acids
pH of 7.46 or higher
Causes: vomiting, chronic K depletion (diuretics, anorexia)
CASE STUDY: Lily, 6 m.o., 8 kg F, admitted with 2 days of decreased PO’s, vomiting, and diarrhea. Per mom, , “fussier” in last 12 hours. VS: 38.9 R, 175, 40, 86/43. Upon further assessment, Lily has a sunken anterior fontanel, dry mucous membranes and decreased urine output.
What is the best approach to manage Lily’s dehydration?
A. mIVF + PO
B. q4h BMP’s + mIVF
C. Daily weights + mIVF
D. Fluid replacement + mIVF
D
PO intake is not a option while patient is vomiting
CASE STUDY: Lily, 6 m.o., 8 kg F, admitted with 2 days of decreased PO’s, vomiting, and diarrhea. Per mom, , “fussier” in last 12 hours. VS: 38.9 R, 175, 40, 86/43. Upon further assessment, Lily has a sunken anterior fontanel, dry mucous membranes and decreased urine output.
Calculate the maximum amount Lily would receive per bolus.
Calculate the amount she would receive in mIVF.
Bolus: 20 mL/kg=160 mL
mIVF: 4x8=32 mL/hr
A 2 y.o. patient is admitted with hypertonic dehydration What is the priority nursing intervention? A. Administer 3% NS B: Administer D5 1/2NS C. Perform daily weights D. Perform neuro assessment
D
Na is greater than 145 so watch for neuro changes, such as confusion and tremors
3% NS is a hypertonic solution
D5 1/2 NS is correct but the PRIORITY is the neuro assessment
In a 3 m.o. infant, fluid and electrolyte imbalance can occur quickly, primarily because an infant has:
A. A lower percentage of body water than an adult
B. Immature kidney function
C. A lower daily fluid requirement than an adult
D. A more rapid heart rate than an adult
B
Kidneys cannot concentrate urine, infants have less of a fluid reserve
Infants have a higher percentage of body water than an adult
When caring for a 12 m.o. infant with dehydration and metabolic acidosis, the nurse expects to see which of the following: A. A reduced WBC B. Tachypnea C. Apnea D. A decreased platelet count
B
A 10 m.o. patient with dehydration has a serum Na of 137. What type of dehydration does the patient have? A. Isotonic B. Hypotonic C. Hypertonic D. Osmotic
A
Which of the following assessments is the most reliable indicator of adequate fluid replacement in an adolescent with extensive burns? A. BP stable at 98/58 B. Respirations at 60 bpm C. Cap refill less than 2 seconds D. Hourly urinary output of 15 mL
C
The golden rule of rehydration is urine output, however 15 mL/hr is decreased for an adolescent
A patient is hyponatremic. Which of the following is an appropriate action?
A. Encourage patient to increase water intake
B. Restrict the amount of water the patient drinks
C. Bolus patient with 3% NS
D. Check serum Na levels q12h
B
Restricting fluids will concentrate the blood
Encouraging water will further dilute blood
Labs should be checked more frequently
Which of the following is not a common cause of hypokalemia? A. Diarrhea B. Laxative use C. Diabetic ketoacidosis D. Renal failure
D
Renal failure causes HYPERkalemia
