N410 Peds Fluids

Question 1

Releases Antidiuretic Hormone (ADH)?

Answer 1

Posterior pituitary gland

Question 2

Hormone that promotes water retention in the renal system by increasing the permeability of renal tubules to water?

Answer 2

Antidiuretic Hormone (ADH)

Low ADH (too much water loss, hyperosmolarity) ex = DI
High ADH (SIADH: hyponatremia and hypo-osmolality) ex = cancer, CF

Question 3

Hormone secreted by the adrenal cortex?

Answer 3

Aldosterone

Question 4

What does aldosterone do?

Answer 4

Hormone that enhances SODIUM REABSORPTION in renal tubules, thus promoting osmotic REABSORTPION OF WATER.

It’s release is stimulated by angiotensin (Renal renin-angiotensin stystem).

Question 5

Why is ADH released?

Answer 5

In response to increased osmolality and decreased volume of intravascular fluid.

Question 6

Diminished blood flow to the kidneys stimulates what?

Answer 6

Renin angiotensin system

Question 7

What hormone does the renin-angiotensin system generate and what does it do?

Answer 7

ANGIOTENSIN: Vasoconstrictor and stimulates reabsorption of water in tubules
Hormone that enhances sodium reabsorption in renal tubules, thus promoting osmotic reabsorption of water. Renin secretion leads to generation of angiotensin, a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

Question 8

Type of water loss through skin and respiratory tract

Answer 8

Insensible water loss

High insensible water loss:
Radiant warmers
Phototherapy
Skin defects and skin breakdown (burns)
Fever
The proportionately longer gastrointestinal tract in infancy (diarrheal losses)
• Increased temperature
• Increased humidity
• Hyperventilation
• Diabetes insipidus
• Hyperglycemia

Decreased losby:
Humidified mechanical ventilation
hypothyroid
hypothermia

Question 9

Conditions with decreased fluid requirements:

Answer 9

• Heart failure
• Syndrome of inappropriate antidiuretic hormone
• Mechanical ventilation
• After surgery
• Oliguric renal failure (decreased UO)
• Increased intracranial pressure

Question 10

What leads to the increased risk of dehydration in the pediatric population?

Answer 10

More ECF to lose and lost quickly
Increased BSA body surface area (in relation to the mass of active tissue)
Increased BMR basal metabolic rate (higher to support cellular and tissue growth)
Increased insensible losses through fever
Immature kidneys

Question 11

S/Sx of severe dehydration?

Answer 11

alert to comatose
fontanels sunken
deeply sunken eye orbits
oral mucosa dry
tenting
heart rate increased, progressing to bradycardia
blood pressure normal, progressing to hypotension
extremities cool, mottled or dusky
significantly delayed capillary refill
urine output significantly less than 1 ml//kg/hour

Question 12

What is gastroenteritis?

Answer 12

Inflammation of the GI tract w/ vomiting, fever and diarrhea.

Question 13

What is considered diarrhea?

Answer 13

> 3 water stools/day

Question 14

DEHYDRATION: When water is lost and sodium concentration becomes elevated, kidneys react by:

Answer 14

Compensatory mechanisms in the kidney stop ADH secretion so water is retained.

Question 15

Which of the following is defined as the forces that favor filtration from the capillary

Answer 15

Capillary hydrostatic pressure and interstitial oncotic pressure

Question 16

Depression of the central nervous system (CNS), manifested by lethargy, delirium, stupor, and coma, is observed in which of the following?
Metabolic acidosis Incorrect
Respiratory alkalosis
Metabolic and respiratory acidosis Correct
Metabolic and respiratory alkalosis

Answer 16

Metabolic and respiratory acidosis
Hydrogen ion imbalances result in CNS involvement. Depression of the CNS, as manifested by lethargy, delirium, diminished mental capacity, stupor, and coma, is found in acidosis that is either metabolic or respiratory in origin.
Respiratory acidosis can also manifest these clinical findings.
Respiratory and metabolic alkalosis are reflected clinically by CNS excitation and stimulation, nervousness, tingling sensations, and tetany that may progress to seizures.

Question 17

Several types of long-term central venous access devices are used. Which of the following is a benefit of using an implanted port (e.g., Port-a-Cath)?
Accessed without piercing skin
Easy to use for self-administered infusions
Easy access for blood work
Catheter unable to dislodge from port even if the child “plays” with the port site

Answer 17

Easy access for blood work
The port is completely under the skin. Other advantages include cosmetic appearance and easy access for blood work and fluid and medication administration. The skin must be accessed with a special needle before the infusion can begin. Placement in the chest makes it difficult to use for self-administered injections. The catheter can be dislodged from the port if the child rubs the port site.

Question 18

Which of the following is a major complication of total parenteral nutrition in children?
Anemia
Asthma
Liver disease
Renal impairment

Answer 18

Liver disease is the most important gastrointestinal complication of total parenteral nutrition.

Renal function is monitored to ensure electrolyte balance, but impairment is not an expected complication.

Question 19

Which of the following should the nurse recognize as an early clinical sign of compensated shock in a child?
Confusion
Sleepiness
Hypotension
Apprehension

Answer 19

apprehension

Early signs are vague and subtle, including apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and diminished urinary output.

LATER SIGNS: Confusion, sleepiness, and hypotension.

Question 20

Which of the following statements regarding burn injuries in children is correct?
Burns are the most frequent cause of accidental death during childhood.
The prognosis for a burned child is directly related to the amount of tissue destroyed.
The standard “rule of nines” chart is typically used for assessing the size of a burn in small children.
Children younger than age 2 years have significantly lower mortality rates than older children with similar burns.

Answer 20

The prognosis of a child with a burn is directly related to the amount of tissue destroyed.

The location of the wounds, age of the child, causative agent, respiratory involvement, general health of the child, and other injuries are also considered. Burned clothing is removed to prevent further damage from smoldering fabric and hot beads of synthetic fabric. Jewelry is removed to stop the transfer of heat from the metal to the skin. Burn and fire injuries are the third leading cause of unintentional injury-related death in children younger than the age of 14 years. The body proportions of the child are different from those of an adult. Use of the standard adult rule of nines will give an inaccurate estimate of the burn area. Physiologic factors, including greater relative percentage body water, minimum protein stores, and an immature immune response, contribute to a significantly higher mortality in children younger than age 2 years.

Question 21

To prevent burns from hot water in the home, the nurse should recommend that families set their water heater thermostat to

Answer 21

49 C/ 120 F

Question 22

What are some causes of gastroenteritis?

Answer 22

Viral - rotavirus
bacterial - shigella, salmonella, E. Coli
parasitic - giardiasis, ascariasis
antibiotic induced - c. difficile
infections outside the GI system - UTI, flu
dietary - excessive juice or fruit or lactose intolerance

Question 23

Priority concerns for Major Burns?

Answer 23

Priority concerns include the establishment and maintenance of an adequate airway,
initiation of fluid administration, and
evaluation and treatment of the wound.

• Ascertain the adequacy of the airway, and provide oxygen, intubation, and ventilatory support as indicated.
• Insert a large-bore intravenous (IV) line, preferably through unburned skin, to deliver fluids at a sufficiently rapid rate to effect resuscitation.
• Remove clothing and jewelry, and examine for secondary trauma.
• Evaluate the burn wound, and determine the extent and depth of injury.
• Obtain an admission weight.
• Calculate fluid requirements, and establish the appropriate regimen.
• Insert a nasogastric tube to empty stomach contents and maintain gastric decompression.
• Insert an indwelling Foley catheter to obtain specimens and monitor hourly output.
• Provide IV medication for control of pain and anxiety only after adequate oxygenation is ensured and fluid resuscitation is initiated.
• Obtain baseline laboratory studies.
• Perform escharotomy or fasciotomy to the chest and extremities for constricting circumferential eschar, elevated compartment pressures, or impaired circulation.
• Apply topical antimicrobials and dressings to the burn wounds.
• Obtain a history regarding the injury and other pertinent data.
• Administer appropriate tetanus prophylaxis.
• Prophylactic antibiotic administration is not recommended.

Question 24

Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration?
  Isotonic, osmotic
  Hypotonic, isotonic
  Osmotic, hypertonic
  Hypertonic, hypotonic

Answer 24

In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration.
Rapid replacement is contraindicated in hypertonic dehydration.

Question 25

Burn meds?

Answer 25

Morphine, fentanyl (Sublimaze), and
midazolam (Versed) are the most commonly used agents

Oxandrolone is an anabolic steroid that works to maintain and restore muscle mass, increase weight gain, and promote wound healing

Question 26

Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?

Answer 26

One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts).

Grains alone do not provide the appropriate amounts of essential amino acids.
Dairy products and dark green vegetables do not provide the appropriate amounts of essential amino acids.