pediatric fluids and elecrtolytes Flashcards
1
Q
PEDIATRIC DIFFERENCES
A
- newborns and infants have larger ecf volume because brain and skin occupy a greater portion of their body weight
- infants have increased daily fluid requirements and little fluid volume reserve=vulnerable to dehydration
- children under 2 lose greater proportion of fluid daily so are more dependent on adequate in take
- greater bsa and amount of skin surface= greater insensible water loss through skin
2
Q
DIFFERENCES
A
- large BSA also = greater risk when skin is affected such as burns
- longer guts therefore greater loss in the presence of diahrrea
- higher BMR (increased HR and RR ) . increases the rate at which body water must be replenished ( water turn over )
- the exercising child dehydrates easily and must consume more water during exercise , esp in hot weather
3
Q
SYTEMIC ROUTES OF FLUID LOSS
A
kidneys
- normal- 1-2ml/kg/hr
- oliguria : <1 ml/kg.hr
- anuria: no urine output
- polyuria: > 3ml/kg/hr
LUNGS
ELIMINATE WATER VAPOR
GI tract
- fluid circulates through the GI system
- bulk of fluid is reabsorbed in small intestine
Skin
- sensible perspiration
- insensible perspiration
4
Q
NORMAL SALINE
A
-restores water and sodium loss , maintains sodium and chloride at present levels
5
Q
LACTATED RINGERS
A
-replaces fluid loss from burns, diarrhea , and bleeding
6
Q
FLUID VOLUME EXCESS
A
- HYPERVOLEMIA or excessive fluid volume in the blood
- from compromised regulatory mechanisms for sedum and water
- such as congestive heart failure, kidney failure, and liver failure
- also fromm intake of sodium from foods , IV solutions , or diagnostic contrast dyes
7
Q
CAUSES OF FLUID VOLUME EXCESS
A
- renal / liver failure
- congestive heart failure
- over administration of fluids
- high sodium intake
8
Q
SIGNS AND SYMPTOMS
A
- peripheral edema
- puffy eyes
- full/bulging fontanels
- wet chest
- pulmonary edema
- pleural effusions
- ascites
- distended neck veins
- bounding pulses
- decreased urinary output (oliguria)
9
Q
NURSING INTERVENTIONS
A
- implement fluid restriction as ordered
- provide a restricted - sodium diet as appropriate if ordered
- administer prescribed loop, thiazide, and or potassium sparing diuretics
- monitor location and extent of edema
- monitor lung sounds for crackles
- monitor serum osmolatity , serum sodium, blood urea nitrogen , BUM/creatinine ratio , and hematocrit for decreases
10
Q
ASSESSING HYDRATION STATUS
A
best indicators
- I and O at least 1-2ml/kg/hr
- weight (same time of day , same scale )
- other indicators include
- vitals
- skin color and turgor
- tears
- fontanels
- urine specific gravity
- serum hematocrit
11
Q
SIGNS OF DEHYDRATION
A
- weight loss
- change in LOC
- response to stimuli
- decreased skin elasticity and turgor
- prolonged cap refill
- increased HR
- sunken eyes
- sunken fontanels
- absent tears
- dry mucus membranes
- decreased urine output
- low blood pressure
12
Q
FLUID RESUSITATION
A
for shock, severe dehydration , burns= 20ml / kg over 30min, can repeat X 3
13
Q
REPLACEMENT FLUIDS
A
- are given at an estimated 10ml/kg = 120 ml
- replacement formulas vary depending on cause of fluid deficit , clinical severity , and blood chemistry results
- rate of replacement is also determined by cause of fluid deficit, clinical severity, and blood chemistry results
14
Q
SPECIAL FLUID REQUIREMENTS
A
in certain situations, as indicated below, patients require more or less hydration than their standard daily requirements
HYPER-HYDRATION
- chemotherapy
- increased insensible losses
- increased respiratory rate
- fever
FLUID RESTRICTION
- SIADH (syndrome of inappropriate antidiuretic hormone secretion )
- renal failure
- cardiopulmonary failure
15
Q
DIARRHEA IN CHILDREN
A
- diarrhea is defined as an increase In # and volme and or dcrease in consistency of stools
- worldwide leading cause of death in children under 4 , only respiratory illness account for more medical admission to hosiptals
- Incidence increased since day care use is up
16
Q
TYPES OF DIARRHEA
A
Gastroenteritis
- stomach and intestines
Enteritis -
small intestine
Colitis
colon
enterocolitis
- colon and intestines
Acute <14 days
chronic >14 days
17
Q
CAREFUL HISTORY
A
- recent travel
- exposure to untreated drinking or washing H2O
- contact with animals /birds
- day care centers
- recent treatment with antibiotics
- recent diet changes
18
Q
DIARRHEA IN CHILDREN nursing diagnosis
A
- fluid volume deficit
- altered nutrition : less than body requirements
- risk for transmitting infection r/t microorganisms invading GI tract
- impaired skin integrity r/t irritation caused by frequent , loose stools
- anxiety, fear r/t separation from parents , unfamiliar environment, distressing procedures
- altered family processes r/t situational crisis/ knowledge deficit
19
Q
prevention
A
PRIMARY PREVENTION
- hygiene teaching for staff , families and daycare workers
- avoidance of dairy products if lactose intolerant or wheat products with celiac disease
- avoid unnecessary use of antibiotics (c. diff)
20
Q
PREVENTION FROM GETTING WORSE
A
-oral rehydration formulas to restore fluid balance and minimize complications
- tertiary prevention
- IV therapy
- TPN for short bowel
21
Q
SECONDARY PREVENTION OF ACUTE DIARRHEA
A
- assess vitals , skin turgor, mucus membranes, mental status 4 hrs
- weigh child daily
- maintain strict I and O record
- oral rehydration therapy
- avoid high sugar ,high sodium, caffeinated carbonated fluids,
- breast mild and H2o as tolerated
- avoid BRAT diet in infants and young children
- after rehydration offer child regular diet as tolerated
22
Q
DIAGNOSTIC TESTS
A
- complete blood count
- serum chemistries
- urinalysis
- routine stool examination
MICROSCOPIC STOOL EXAMINATION FOR:
- WBC, C and s , bacteria
- RBC inflammation
- Oan P ova and parasites
- reducing substances lactose intolerance
23
Q
WHAT DOES THE POOP LOOK LIKE
A
- watery, exsplosive- glucose intolerance
- foul smelling , greasy , bulky- fat malabsorption
- gross or occult blood- shigella, campylobacter, E.coli
- recent antibiotic use - C difficle
24
Q
FAILURE TO THRIVE
A
- inability to obtain or use calories for growth in children ( under 2 yrs)
- weight falls below 5th percentile for age
25
Q
ETIOLOGY
A
NON ORGANIC ( SOCIAL ISSUE CAUSE )
- inadequate nutrition
- parent/child disturbance
- poverty
- family stress
- insufficient breast milk
26
Q
ETIOLOGY
A
ORGANIC FTT R/T UNDERLYING MEDICAL PROBLEM
- genetic
- metabolic disorders (inborn errors, of metabolism)
- endocrine
- malabsorption
- increased energy needs
- structural defects
27
Q
SIGN AND SYMPTOMS
A
- growth curve
- flattened weight curve
- decline in linear growth
- relative preservation of head growth
- fatigue and irritability
- subcutaneous fat loss
- wasting of limbs and buttocks
- anxious expression
- edema may be present in severe cases
28
Q
DIAGNOSIS
A
- complete nutritional, developmental , and social history
- serial growth measurements
- serum labs
- stool studies
29
Q
TREATMENT
A
NUTRITION ORDERS
- calorie count
- sufficient intake of calories , fat , vitamins and minerals
- dietary modifications for organic disease
- parental education and dietary consult
- social work consult to address family and economic needs
30
Q
PROGNOSIS
A
- early diagnosis of organic disorders
- non organic FTT difficult to treat due to parental resistance to outside intervention
- reversal of FTT is essential for adequate brain development during the first 2 years of life
- lack of treatment may result in long term cognitive, growth and behavioral sequel
- outcomes worse with significant attachment disorders or long standing severe malnutrition
31
Q
KEY COMPONENTS OF CARE
A
- model effective feeding techniques
- consistent care
- promote bonding
- feed in quiet environments
- calorie counts
- daily weights
- detailed charting
