Pediatric Hydration Assessment Flashcards
What is sensible fluid losses
Measurable losses of fluid
List examples of sensible fluid losses
Urine
Emesis
Diarrhea
Blood
Describe insensible fluid losses
Unmeasurable fluid losses
List examples of insensible fluid losses
Lungs
Skin
Respiratory tract
Water excreted in feces
What factors influence insensible fluid losses
Suctioning
Diaphoresis
Fever
Hyperthermia
Increased activity
Hyperventilation
Radiant warmers
Phototherapy
How many ml do adults lose daily under normal circumstances?
40 to 600ml daily
Why do infant and toddlers have more water loss from the skin compared to adults?
Bc they have a higher body surface area to weight ratio than adults
_______: bc of their high resp rate, have ______ __________ losses from the _______ ________
Infants: bc of their high resp rate, have higher insensible losses from the respiratory tract
What is fluid volume deficit
Fluid output exceeds fluid intake
Fluid volume deficit:
Loss of water and electrolytes due to:
Fever, GI suction (ex; low intermittent suction), vomiting, diarrhea, increased urine output (polyuria)
Signs and symptoms of fluid volume deficit
Dry mucous membranes
Decreased skin turgor
Urine output <1ml/kg/hr
Hypotension
Sunken eyes
Depressed fontanels
Lack of tears
Dry, cracked tongue
What is fluid volume excess
Hypovalemia;
Too much fluid volume in body
Fluid volume excess S&S
Peripheral edema
Puffy eyes
Full/bulging fontanels
“Wet” chest
Pulmonary edema
Pleural effusions
Ascites ( fluid accumulation within the abdominal cavity)
Distended neck veins
Bounding pulses
Deceased urinary output
Special considerations;
R/T fluids (infants)
-have proportionally more body water
-vulnerable to fluid volume deficit
-have high metabolic rate and large metabolic wastes to excrete daily
-relatively larger water intake than older children
-immature kidneys which are unable to concentrate urine efficiently
-greater fluid loss through the skin
-prone to fluid/electrolyte imbalance
How do you measure intake?
- Monitor oral intake
- note time and amount
-document on fluid balance record - Monitor intake and output given parenterally (by iv) or any other means
- End of shift document intake
-document fluid balance record
How to measure urine output (INfants)
1.NOT in diapers
-measure each void using measuring devices available on unit
- IN DIAPERS
-weight dry diaper (grams)
-place dirty diaper in garbage bag
-place soiled diaper in bag on scale
-find weight in grams (1g=1ml)
-document urine or stool
What are other outputs?
Emesis
Blood
Loss from nasogastric tube or other tubes
How do you calculate fluid balance
Total intake - total output = _____ml
If the patient has more fluid __ than __ the patient is in a positive balance.
If the patient has more fluid __ than __ the patient is in a negative balance.
- In/out =positive
2.out/in= negative
How do you calculate output in ml/kg/hr?
-done at the end of your shift
Total urine output
—————————
Patient weight
—————————
# hours in your shift
=ml/kg/hr
Urine output:
What are the expected outcomes for children less than 1 year and older than 1
Less than one:
-minimally 2 ml/kg/hr
One year or older
-minimally 1 ml/kg/hr
What is ad lib on demand
How much a newborn should be drinking:
—————>means drink when they want and however much they want
TFI (total fluid intake)
From day of birth to day 5
Birth: 60 ml/kg/day
1: 80
2: 100
3: 120
4: 140
5: 160
How to calculate ml/kg/day
Multiply TFI by weight of baby
