Fluid & Electrolyte exam 1

Question 1

Fluid needs of the child: calculation

Answer 1

Body Weight (kg): Amount of fluid per day

1 - 10 100 ml / kg

11 - 20 1000 ml plus 50 ml/kg for each kg > 10 kg

> 20 1500 ml plus 20 ml/kg for each kg > 20kg

Question 2

PEDS differences

Answer 2

Percentage of body weight
Loss of water per day
Immature kidney function
Water and electrolyte disturbances more likely
Larger body surface area (BSA)
Higher basal metabolic rate
Greater fluid requirements

Question 3

H20 depletion causes

Answer 3

Fever
Vomiting / diarrhea
Diabetes
Burn
Shock
High output kidney failure
Phototherapy
Environmental heat

Question 4

H2O depletion sig

Answer 4

Weight loss **
Increased heart rate
Thirst, No tears
Variable temperature
Depressed fontanel in infant
Dry skin and mucous membranes
Poor skin turgor and skin perfusion
Fatigue, lethargy
Diminished urinary output
Altered level of consciousness

Question 5

H2O depletion labs

Answer 5

High urine specific gravity
Increased BUN
Increased hematocrit
Increased Sodium (Na)
Variable serum electrolytes
Increased serum osmolarity

Question 6

H20 excess causes

Answer 6

Water intoxication
- Child maltreatment
IV overload
Incorrect feeding
- Too much
- Inappropriate preparation
Swimming lessons
Too rapid dialysis
Tap water enemas

Question 7

H2O excess signs

Answer 7

Rales “wet” (difficulty breathing)
Increased venous pressure
Slow, bounding pulse
Weight gain
Lethargy
Increased spinal pressure /seizure /coma

Question 8

H20 excess labs

Answer 8

Low urine SG
Decreased HCT and serum electrolytes

Question 9

H2O excess decreased requirements

Answer 9

CHF
SIADH
Increased ICP
Oliguric renal failure

Question 10

What is Edema?

Answer 10

Anasarca – Generalized fluid accumulation in body tissues - heavy
Increased CVP
Capillary permeability - sieve
Decreased plasma proteins
Treatment = treat underlying disease
Nursing Care: Weigh daily, I/O, skin care, fluid administration, support family & child

Question 11

Isotonic IV fluid

Answer 11

Lose electrolytes and water equally
Primary form in kids
Lose circulating blood volume
Na normal
Biggest concern is SHOCK

Question 12

Hypotonic IV fluid

Answer 12

Lose more electrolytes than water
Na < 135 mEq/L

Question 13

hypertonic IV fluid

Answer 13

Water loss in excess of electrolytes
Most dangerous type
Na > 150 mEq/L
Seizures more likely

Question 14

Dehydration degree

Answer 14

For each 1% weight loss = 10 ml/kg of fluids lost
Take pre illness weight and current weight
Earliest sign = tachycardia

Question 15

Dehydration degree mild, moderate, and severe

Answer 15

Mild:
< 50ml/kg *cap refill < 2 sec

Moderate:
50-90 ml/kg *cap refill 2-3 sec

Severe:
>100 ml/kg *cap refill > 3 sec

Question 16

Dehydration management

Answer 16

Oral – when alert and awake
Rapid replacement over 4-6 hours

IV – unable to ingest enough fluid
Rapid expansion of the ECF to prevent SHOCK (20ml/kg)
0.9% solution - no dextrose (why?)
3 Phases expansion / replace deficits / Maintenance

Question 17

Oral intake

Answer 17

Oral Rehydration Therapy- (First):
Use Pedialyte (1/2 str Gatorade)
Not clear liquids / no caffeine
Not BRAT diet
No juice – high osmolarity

NPO – spray mouth

IVT – Add K+ to IV with adequate UOP

Intraosseous Infusion (Emergent)

Central Venous Lines – - apply pressure