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Pediatrics-MJ > T2-Fluid and Electrolyte PPT > Flashcards

T2-Fluid and Electrolyte PPT Flashcards

1
Q

What is the largest single cause of death to children in 3rd world countries?

A

Gastroenteritis

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2
Q

Do children have large or small stomach capacity?

A

Small

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3
Q

Is GI motility slower or faster in younger children?

A

Faster

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4
Q

When are digestive enzymes present in children?

A

4-6 months

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5
Q

What is the infant susceptible to since digestive enzymes aren’t present till 4-6 months?

A

Gas and abdominal distention

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6
Q

What are 4 factors responsible for fluid and electrolyte differences between adults and children?

A
  1. % an distribution of body water
  2. BSA
  3. Rate of basal metabolism
  4. Status of kidney function
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7
Q

Infants and young children have a greater ____ in relation to body mass.

A

Surface area

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8
Q

Infants and young children have greater fluid loss in insensible loss. How?

A

Skin-perspiration

GI track

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9
Q

Infants have a significantly higher ____ rate than adults—so that causes an increase in what?

A

Higher metabolic rate…causes an increase in HEAT PRODUCTION and PRODUCTION OF METABOLIC WASTE (insensible fluid loss, increase need for water for excretion)

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10
Q

Are infants kidneys functionally mature or immature at birth?

A

Immature

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11
Q

Since infants have kidneys that are functionally immature at birth, what happens? (3)

A
  1. Urine concentration and dilution
  2. Sodium retention and excetion
  3. Urine acidity
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12
Q

T/F: Infants ingest and excrete a greater amount of fluid

A

TRUE

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13
Q

Infants have an immature immune system. What does this mean?

A

More vulnerable to pathogens–cause alterations in fluid and electrolytes

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14
Q

For infants and young children, how do we want intake and output to be?

A

Almost equal!

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15
Q

Infants and children have increased _____ and rapid emptying of the ______.

A

Increased motility

Rapid emptying of intestinal contents

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16
Q

Rapid excretion interfere with the absorption of ______

A

Nutrients, electrolytes, and water

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17
Q

What are normal routes of fluid excretion in infants and children?

A

Lungs
Urine
Feces
Skin

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18
Q

What are signs and symptoms of dehydration r/t fluid excretion via lungs, urine, feces, and skin?

A
  • Decreased urine output
  • Hard feces
  • Diphoresis of skin
  • Tachypnea (losing fluid from lungs)
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19
Q

What is formula for calculating output?

A

1-2 mL/kg/hr

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20
Q

What is formula for intake for 10kg?

A

100ml/kg

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21
Q

What is formula for intake for child 10-20 kg?

A

1000 ml + 50ml/kg for anything over 10 kg

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22
Q

What is formula for intake for child 20kg+?

A

1500 mL plus 20ml/kg for each kg over 20 kg

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23
Q

Causes of diarrhea: Composition. What types of food?

A

High carbohydrate formula or food intake as osmotic pull of water into GI lumen–Diarrhea

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24
Q

Causes of diarrhea: Introducing new food?

A

This may cause child to have difficulty digesting the new food

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25
Q

Causes of diarrhea: Allergy?

A

Allergy to formula, food, and ESP. MILK can cause diarrhea

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26
Q

Why would antibiotics cause diarrhea?

A

Alters normal flora causing increase growth of organisms

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27
Q

What kind of emotional disturbances can cause diarrhea?

A

Anxiety
Tension
Fatigue

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28
Q

What are some malabsorption syndromes that may cause diarrhea?

A
  • Lactose intolerance
  • Impaired disaccharide activity
  • CF
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29
Q

What kind of stool do CF patient who have diarrhea have?

A

Fatty, frothy stool

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30
Q

What is starvation diarrhea?

A

History of decreased intake over last several days (N,V; NPO)

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31
Q

If a patient has had N/V or been NPO the last few days and experienced starvation diarrhea, how will their first PO intake be following all that?

A

First PO intake is not well accepted by the body and moves quickly though GI tract

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32
Q

When is the only time you put cereal in milk for babies?

A

GER/GERD

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33
Q

Why don’t we want to put food in bottles for babies without GER/GERD?

A

Babies learn speech by giving them a spoon, so thats why you don’t want to put their food in the bottle

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34
Q

What is the most common cause of diarrhea in children less than 5 years…(6-12 months=higher risk)?

A

Rotavirus

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35
Q

T/F: E.Coli is always in stool

36
Q

What common organism that causes gastroenteritis mimics appendicitis?

37
Q

Loss of ____ leads to metabolic acidosis

38
Q

Monitor ___ for acidosis

39
Q

What shows effect of dehydration?

40
Q

If patient vomits, are they losing acid or retaining acid?

41
Q

If patient vomits, do they have metabolic alkalosis or metabolic acidosis?

A

Metabolic ALKALOSIS (they lost acid)

42
Q

If patient has diarrhea, do they loose acid or retain it?

A

Acid stays

43
Q

If patient has diarrhea do they have metabolic alkalosis or metabolic acidosis?

A

Metabolic ACIDOSIS (the acid stays)

44
Q

What does this lab result mean: elevate WBC (mostly bands)

A

Infectious diarrhea

45
Q

What does eosinophilia mean?

A

A parasitic infection

46
Q

If a patient comes in with vomiting, what do we ask?

A
  1. How much have you urinated?
  2. How many times have you vomited?
  3. Have you had any diarrhea?

[ask this for the last 24 hours]

47
Q

Oral rehydration:

What can they have? What can they not have?

A

CAN have:

  • Ricelytes
  • Pedialytes
  • Unsweetened jello

CANT have:
Fruit juice

48
Q

Oral rehydration: How do they progress in foods?

A

Progress to soft complex CHO foods

*no greasy or spicy foods and progress as tolerated for older adults

49
Q

Diet for vomiting and diarrhea general guidelines for infants?

-No milk or milk products for _____ (unless ordered by doctor)

A

24-48 hours

50
Q

Diet for vomiting and diarrhea general guidelines for infants?

Day 2?

A
  • May have SOY formula for 2 days, then return to regular formula
  • May begin with 1/2 strength formula for 24 hours and then back to regular
51
Q

Diet for vomiting and diarrhea general guidelines for infants?

Day 3?

A

Infant full strength formula

52
Q

***For test and ATI, continue to ____ or ____ UNLESS they are on an oral rehydration diet!

A

Breast feed or formula feed

53
Q

Where do we check skin turgor for infants?

A

Inner thigh or abdomen

54
Q

Severe diarrhea management: If we start an IV and they haven’t urinated, should we put potassium in?

55
Q

What is the most common type of dehydration in children? Why?

A

ISOTONIC—you catch it early enough before it progresses to hypo or hyper

56
Q

Calculation of percentage weight loss?

A
  1. Subtract childs present weight from original weight to get the loss
  2. Divide loss by childs original weight
57
Q

Present weight: 28 lbs

Original weight: 31 lbs

A

31 (original)- 28 (presnet)= 3 lbs

3 (loss) / 31 (original)= 0.09

9% weight loss

58
Q

If V/D continue and progresses to severe dehydration, what do we do?

A

Admit for IV therapy

59
Q

When pt comes in with severe dehydration, we need to admit them for IV therapy. What happens in ED before they are admitted?

A

10-20 ml/kg of normal saline boluses are give and repeated 2-3 times, then IV fluids are begun

60
Q

We DO NOT add potassium to IV until patient has voided. Why?

A

Initial therapy is used to expand ECF volume quickly and improve circulatory and renal function …….Potassium is WITHHELD until kidney function (renal) is restored and circulation has improved!

61
Q

If circulation does not improve, what happens?

62
Q

What is a late sign of shock?

63
Q

What is blood loss shock?

A

Hypovolemic

64
Q

What is pump failure shock?

A

Cardiogenic

65
Q

What is septic shock?

A

Change is distrubution

66
Q

What is anaphylaxic shock?

67
Q

Regardless of type of shock, what do we do?

68
Q

If child has shock, and is not breathing do we do ABC or CAB?

69
Q

What is shock patho?

A

Lose blood= diminished venous return= decreased CO and BP

70
Q

Shock signs?

A
  • Cool, cold, clammy skin
  • Poor cap refill
  • Reduced urine output
  • Anaerbobic metabolism= ACIDOSIS
  • Tachycardia, tachypnea
  • LOC changes (parent tells this)
71
Q

Early or late signs of shock:

  • Tachycarida
  • Delayed cap refill
  • Fussy, irritable
72
Q

Early or late signs of shock:

  • BRADYcardia
  • Change in LOC
  • Hypotonia
  • Cheyne stokes
  • HYPOtension
73
Q

Early or late shock: tachycardia

74
Q

Early or late shock: bradiacardia

75
Q

Stages of shock: What happens in compensated?

A
  • Mild tachycardia

* this is when we want to catch shock

76
Q

Stages of shock: Uncompensated

What happens?

A

-Pronounced tachycardia, prolonged cap. refill, BP maintained, somnolence

77
Q

Where will you prob end up with uncompensated shock?

78
Q

Stages of shock: Irreversible..What happens?

A

Thready pulse, BP decreases

Can cause COMA or DEATH

79
Q

Septic shock can cause SIRS (systemic inflammatory response syndrome). What happens here? (3)

A
  • Response to certain infections
  • Capillaries dilate—lets out ALBUMIN
  • 3rd spacing of fluids
80
Q

What may we find in assessment with septic shock?

A
  • Fever
  • Tachypnea
  • Tachycardia
  • Petechia
81
Q

What are the body temp stages of shock?

A

Warm

Cool Cold

82
Q

What is the best chance of survival in shock stages: warm, cool, or cold?

83
Q

Will we always see all temp stages of shock?

A

NO–it progresses so quickly so we may not always see all stages

*these stages don’t necessarily have to be in a sequential order

84
Q

Shock: Ventilation is first, then treat underlying cause. How is fluid administration done?

A

Crystalloid FIRST, then colloid

85
Q

What happens with the release of histamine for anaphylaxis shock? (4)

A
  • Vasodilation
  • Increased cap. permeability
  • Fluid leak into interstitial spaces
  • Decreased venous return
86
Q

What is one of the first signs of anaphylaxis shock?

87
Q

Is it ABC or CAB for anaphylaxic shock?

Pediatrics-MJ (61 decks)

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