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
