Peds Exam 2 - F&Ls

Question 1

holliday segar formula

Answer 1

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

Question 2

factors increasing maintenance fluid requirements

Answer 2

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

Question 3

factors decreasing maintenance fluid requirements: skin

Answer 3

mist tent, incubator, swamp bed

Question 4

factors decreasing maintenance fluid requirements: lungs

Answer 4

humidified ventilator

Question 5

factors decreasing maintenance fluid requirements: renal

Answer 5

oliguria, anuria

Question 6

factors decreasing maintenance fluid requirements: misc.

Answer 6

hypothyroidism

Question 7

factors decreasing maintenance fluid requirements

Answer 7

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

Question 8

types of dehydration: isotonic

Answer 8

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

Question 9

types of dehydration: hypertonic

Answer 9

-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

Question 10

types of dehydration: hypotonic

Answer 10

-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

Question 11

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

Answer 11

urinate

Question 12

water balance - maintenance

Answer 12

normal ongoing losses of fluid and electrolytes

Question 13

water balance - deficit

Answer 13

total amount of fluids and electrolytes lost from an illness

Question 14

water balance - on going losses

Answer 14

requirement of fluids and electrolytes to replace ongoing losses

Question 15

how much do you increase fluid needs by for a fever

Answer 15

by 7ml/kg/d

Question 16

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

Answer 16

seizure

Question 17

how do you diagnosis dehydration

Answer 17

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

Question 18

oral rehydration therapy

Answer 18

-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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

parental fluid therapy

Answer 22

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

Question 23

three phases of parental fluid therapy

Answer 23

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

Question 24

rehydration therapy for mild dehydration

Answer 24

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

Question 25

rehydration therapy for moderate dehydration

Answer 25

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

Question 26

rehydration therapy for severe dehydration

Answer 26

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

Question 27

maintenance therapy for mild/moderate/severe dehydration

Answer 27

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

Question 28

how to treat hyponatremia

Answer 28

administer IV fluids w/ appropriate saline concentration

Question 29

what is a key sign of low Na

Answer 29

abdominal cramping & think brain

Question 30

what is a key sign of low K+

Answer 30

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

Question 31

hyperNa treatment

Answer 31

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

Question 32

key signs of hyperNa

Answer 32

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

Question 33

treatment of hypoK

Answer 33

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

Question 34

treatment of hyperK

Answer 34

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

Question 35

key signs of hyperK

Answer 35

N/d, bradycardia

Question 36

treatment of HypoCa

Answer 36

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

Question 37

key signs of hypoCa

Answer 37

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

Question 38

treatment of HyperCa

Answer 38

-monitor serum Ca levels
-monitor EKG

Question 39

key signs of hyperCa

Answer 39

bradycardia, N/V, itching, lethargy, weakness

Question 40

when giving IV fluids we do…

Answer 40

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

Question 41

what type of gauge do we put in for IV fluids

Answer 41

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