session 9 Management of paediatric dehydration

Question 1

explain the clinical signs of dehydration in an infant and child

Answer 1

sunken eyes
dry mucous membranes
reduced urine output
poor skin turgor
cool peripheries
lethargic
grey motttled skin colour
sunken fontenelle in babies up to 11-15mths

Question 2

describe how to calculate fluid requirements for an infant or child

Answer 2

none: 3-5 % = 50mls/kg
some: 6-19% = 60 - 90 mls/kg loss
severe: >10% = 100 mls/kg loss
a child was estimated to be 5% dehydrated. They were weighed yesterday before they got sick as 8 kg. What is their estimated fluid replacement need?
50x8=400mls
over 4 hrs = 400/4 =100mls hr

Question 3

what are signs of hypvolaemic shock

Answer 3

tachycardia
hypotension
reduces level of consciousness

Question 4

what is the treatment for hypovolaemic shock

Answer 4

fluid bolus - 10ml/kg 0.9% normal saline
repeat 10ml/kg 0.9 % normal saline
maintenance fluid commenced

Question 5

why is it dangerous to give lemonade to a dehydrated child?

Answer 5

Osmosis - draws water away from cellular volume and the child can go into hypovolaemic shock

Question 6

How do you assess for dehydration

Answer 6

Weight
vital signs - character of pulse
thirst
LOC
skin turgor, cap refill, temp
mucous membranes
fontonelle
eyes 
urine output
urinalysis
electrolytes/ acid base balance

Question 7

what are the principles of nursing care for the child with body fluid and electrolyte imbalance from acute gastroneteritis

Answer 7

Daily weights
strict Fluid balance
weigh nappies
impaired skin integrity related to the presence of diarrhoea
BGL , postassium and sodium monitoring
promote comfort 
family support
antiemetics
NGT or IV cares
WASH HANDS post care

Question 8

what is normal urinary output for an infant and a child

Answer 8

2mL/kg/hr for an infant

0.5 mL to 1 mL/kg/hr for children

Question 9

What other electrolyte imbalance occurs from metabolic alkalosis due to vomiting displayed in gastroentetitis

Answer 9

Vomiting causes a loss of hydrochloric acid from the stomach leading to metabolic alkalosis - a secondary electrolyte problem occurs from this - hypokalaemia (low potassium).

Question 10

what is the 3 step process to interpreting blood gases

Answer 10

step 1 - Look at pH (normal 7.35-7.45)
step 2 - look at CO2 (normal 35-45 mmHg)
step 3 - confirm by checking the base excess of bicarbonate (normal +/- 2)