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ABSN > Peds Exam 2 - F&Ls > Flashcards

Peds Exam 2 - F&Ls Flashcards

1
Q

holliday segar formula

A

need to have memorized
-first 10kg add 100 ml/kg/d
-next 10kg add 50 ml/kg/d
->20kg add 20 ml/kg/d
ex) 7kg child would get 700 ml
ex) 12kg (10x100)+(2x50) = 1100 ml
ex) 30kg (10x100)+(10X50)+(10x20) = 1700 ml
divide by 24 to get per hr

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2
Q

factors increasing maintenance fluid requirements

A

-fever over 99
-tachypnea
-increased environment temp
-burns
-V/D
-DKA
-shock
-radiant warmer, phototherapy
-post opt bowel surgery

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3
Q

factors decreasing maintenance fluid requirements: skin

A

mist tent, incubator, swamp bed

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4
Q

factors decreasing maintenance fluid requirements: lungs

A

humidified ventilator

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5
Q

factors decreasing maintenance fluid requirements: renal

A

oliguria, anuria

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6
Q

factors decreasing maintenance fluid requirements: misc.

A

hypothyroidism

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7
Q

factors decreasing maintenance fluid requirements

A

-CHF
-increased intracranial pressure
-syndrome or inappropriate antidiuretic hormone (SIADH)

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8
Q

types of dehydration: isotonic

A

-lytes = water
-serum Na 135-145
-80% of all dehydration pts
no need to correct slowly

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9
Q

types of dehydration: hypertonic

A

-water loss > lyte loss
-Na > 145
-15% of all dehydration pts
-dry doughy skin
-if lowered too quickly causes massive cerebral edema or seizure
correct Na slowly

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10
Q

types of dehydration: hypotonic

A

-lyte loss > water loss
-Na <135
-5% all dehydration pts d/t GI loss
-shift from ECF to ICF
-child appears ill
correct very slowly

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11
Q

what do you have to have the child do before giving K+ in IV fluid

A

urinate

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12
Q

water balance - maintenance

A

normal ongoing losses of fluid and electrolytes

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13
Q

water balance - deficit

A

total amount of fluids and electrolytes lost from an illness

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14
Q

water balance - on going losses

A

requirement of fluids and electrolytes to replace ongoing losses

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15
Q

how much do you increase fluid needs by for a fever

A

by 7ml/kg/d

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16
Q

if you have fluid excess, what precaution do you put them in

A

seizure

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17
Q

how do you diagnosis dehydration

A

clinical signs: abnormal turgor, respiratory pattern & prolonged cap refill
labs not needed

18
Q

oral rehydration therapy

A

-rapid replacement of fluid loss over 4-6hrs, replacement for continuing losses, and providing for maintenance fluid requirements
when child is alert, awake & not in shock, if not then IV fluid

19
Q

clinical manifestation of mild dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow

A

3-5%, active/alert, normal, normal, normal, normal, moist, present, normal, springs back, normal, normal

20
Q

clinical manifestation of moderate dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow

A

6-9%, irritable/alert/thirsty, >/3, slightly inc, slight tachy, normal or low ortho, dry, less than expected, normal, tents briefly, normal or slightly sunken, reduced

21
Q

clinical manifestation of severe dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow

A

> /10%, lethargic/sick, delayed >4, fast & thready, fast & deep, ortho to shock, parched, absent, sunken, prolonged, sunken significantly, severely reduced

22
Q

parental fluid therapy

A

initiated when the child is unable to ingest sufficient amounts of fluid & lytes to
1) meeting daily losses
2) replace previous deficits
3) replace ongoing abnormal losses

23
Q

three phases of parental fluid therapy

A

1) expand ECF volume quickly and to improve circulatory and renal function
2) replacement of lytes deficits, provide maintenance water & lyte requirements, and catch up w/ ongoing losses
3) introduction of oral feeding and gradual correction of total body deficits

24
Q

rehydration therapy for mild dehydration

A

ORS 50ml/kg within 4hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)

25
Q

rehydration therapy for moderate dehydration

A

ORS 100 ml/kg within 4 hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)

26
Q

rehydration therapy for severe dehydration

A

IV fluids 40ml/kg/hr until pulse & consciousness return (after kidney function verified may add K+) then 50-100 cc/kg of ORS

27
Q

maintenance therapy for mild/moderate/severe dehydration

A

continue breast feeding and formula if tolerated, if receiving solid food, continue regular diet

28
Q

how to treat hyponatremia

A

administer IV fluids w/ appropriate saline concentration

29
Q

what is a key sign of low Na

A

abdominal cramping & think brain

30
Q

what is a key sign of low K+

A

leg cramping & think heart -> weaker irregular pulses, tachy, low BP, irritability & fatigue

31
Q

hyperNa treatment

A

-fluids
-measure I&Os
-monitor labs & neuro status

32
Q

key signs of hyperNa

A

thirsty, flushed skin, agitated, dry sticky membranes & seizures

33
Q

treatment of hypoK

A

-monitor vitals, including EKG
-administer supplemental K+ (assess renal output first)

34
Q

treatment of hyperK

A

-monitor vitals including EKG
-administer IV fluids
-may give IV insulin or cation exchange resin

35
Q

key signs of hyperK

A

N/d, bradycardia

36
Q

treatment of HypoCa

A

-administer Ca supplements as prescribed
-monitor IV site as Ca may cause IV irritation

37
Q

key signs of hypoCa

A

poor feeding in neonate, tetany, trousseau and chvostek, hypotension, cardiac arrest, hyper reactive reflexes, muscle cramps

38
Q

treatment of HyperCa

A

-monitor serum Ca levels
-monitor EKG

39
Q

key signs of hyperCa

A

bradycardia, N/V, itching, lethargy, weakness

40
Q

when giving IV fluids we do…

A

LR boluses until they urinate and then we can add K+
infants we give K+ and dextrose if they are NPO and need glucose

41
Q

what type of gauge do we put in for IV fluids

A

smallest possible (22-24 G) unless surgery then 18-20 G

ABSN (90 decks)

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