The Child with Fluid & Electrolyte Alterations Flashcards

Question

Degrees of dehydration: Mild

Answer 1

Up to 5% weight loss Irritable (infants); thirsty

Answer 2

6-9% weight loss - lethargic & sleepy; restless & irritable - decreased skin turgor; dry mucous membranes; urine dark & decreased - pulse increased & BP normal or decreased

Answer 3

> 10% weight loss lethargy or non-responsive, decreased BP, rapid pulse, poor skin turgor, dry mucous membranes, decrease or absent urine output

Answer 4

occurs when total output of fluid exceeds total intake, regardless of underlying cause. may result from lack of intake but more often result of abnormal losses (vomiting, diarrhea), when oral intake only partially compensates for the abnormal losses. Other significant causes of dehydration are DKA & excessive burns. Dehydration - not enough fluid in ECF compartment (vascular & interstitial). Na+ generally lose with water, therefore may be hyponatremia Signs vary with severity or degree of body water deficit. Signs are result of: decreased fluid (turgor, dry mucous membranes), body's response to fluid deficit (increased HR, decreased BP) Mild -> hard to detect

Answer 5

Fever (add 12% per rise of 1 degree C) Vomiting Diarrhea High-output kidney failure Diabetes insipidus Diabetic ketoacidosis Burns Shock Tachypnea Radiant warmer Phototherapy Post-op bowel surgery

Answer 6

0.5 ml/kg/h

Answer 7

Caused by abnormal intestinal water & electrolyte transport which results - dehydration - electrolyte imbalance - metabolic acidosis Intestinal mucosa of young infant is more permeable to water than that of older child, therefore, more fluids & electrolytes are lost in infant with diarrhea

Answer 8

voluminous losses of fluid in frequent, watery stools losses with vomiting reduced fluid intake from nausea or anorexia increased insensible water losses from fever, hyperpnea continued (although diminished) renal losses

Answer 9

losses of Na, Cl, K & sometimes bicarb inadequate replacement of electrolytes when hypotonic or hypertonic solutions used

Answer 10

increased absorption of short-chain fatty acids produced in colon from bacterial fermentation of unabsorbed dietary CHO lactic acid from tissue hypoxia secondary to hypovolemia loss of bicarb in stools ketosis from fat metabolism when glycogen stores are depleted in untreated diarrhea dehydration or inadeqaute CHO intake; may result in malnutrition

Answer 11

Leading cause of illness in children < 5 years often caused by infectious agent (rotavirus, norwalk-like organisms, E. coli, Salmonella) may be associated with URTI or UTI, antibiotic therapy, or laxative use Usually self-limited (< 14 days) - no specific treatment occurs usually required unless dehydration occurs Spread through fecal-oral route, through contaminated water or close contact Major risk factors: lack of clean water, crowding, poor hygiene, nutritional deficiency, poor sanitation

Answer 12

> 14 days Often caused by malabsorption causes, IBD, immunodeficiency, food allergy, lactose intolerance, radiation, motility disorders, endocrine causes, parasitic infestations Increase in stool frequency & increased water content Malabsorption: celiac, short bowel, lactose intolerance Motility: hirschusprung disease Parasites: Giardia

Answer 13

Age: the younger the child, the greater the susceptibility & the more severe the diarrhea Impaired health: malnourished or immunocompromised child Environment: crowding, substandard sanitation, poor facilities for preparation & storage of food, inadequate health care education

Answer 14

Assessment of fluid & electrolyte imbalance Rehydration Maintenance fluid therapy Reintroduction of adequate diet First-line treatment is oral rehydration therapy (ORT) - more effective, safer, less costly, & less painful than IV rehydration

Answer 15

Oral rehydration solutions (ORS) - enhance & promote reabsorption of sodium & water - reduce vomiting, volume loss from diarrhea & duration of illness Continued feeding or reintroduction of normal diet (when child is dehydrated we want to promote eating normally and whatever they can tolerate) - lessens severity & duration of illness - Continue with BF & use ORS for replacement - lactose-free formula if usual formula not tolerated IV therapy for severe dehydration & shock (usually use saline solution with 5% dextrose. may add bicarb. Antibiotics - maybe

Answer 16

ORT is first line treatment. After rehydration, use ORS during maintenance fluid therapy by alternating ORS with water, breastmilk, lactose-free formula, or ½ strength lactose-containing formula. In older children, continue regular diet with ORS Replace ongoing stool losses 1:1 with ORS If vomiting, give small amounts of ORS frequently (5-10 mL q 1-5 mins.); may give with NGT or GT If no clinical signs of dehydration in infants, they do not need ORT

Answer 17

- Do not encourage po clear fluids, such as fruit juices, carbonated soft drinks & jello (high in CHO & low electrolyte, high osmolality - Do not drink caffeinated pop or other drinks (caffeine is mild diuretic) - Do not give chicken or beef broth (excessive sodium & inadequate CHO) - Do not use BRAT diet (bananas, rice, applesauce, & toast or tea) - little nutritional value (low in energy & protein), high in CHO, low in electrolytes

Answer 18

eat to what is tolerated with oral rehydration therapy

Answer 19

Education re: treatment & prevention Accurate weight Accurate intake & output Monitor IV therapy Specimen collection (sometimes they are not making urine it just looks like it) Skin care

Answer 20

Complex clinical syndrome Circulatory failure (shock) - tissue perfusion that is inadequate to meet metabolic demands of body - results in cellular dysfunction & eventual organ failure

Answer 21

1. hypotension (later sign) 2. tissue hypoxia 3. metabolic acidosis

Answer 22

If hemorrhage reduces the circulating blood volume sufficiently then the compensatory mechanisms support blood circulation by increasing the heart rate and constricting the peripheral blood vessels. This response shifts the remaining blood to larger blood vessels so that the vital organs continue to be perfused. When the blood loss exceeds 20% to 25%, the child's body can no longer compensate; blood pressure falls and circulatory collapse is imminent. Very fatal in little kids

Answer 23

Most common type in children Reduction in circulating blood volume beyond child's physiological ability to compensate related to: - blood loss (trauma, major bleeding) - plasma losses (burns) - ECF losses (diarrhea, dehydration)

Answer 24

mild tachycardia, weak distal pulses, strong central pulses, normal BP Mild tachypnea Normal, anxious, irritable Mottled; cap refill > 2 sec; cool, clammy extremities Renal: decreased urine output; increased SG

Answer 25

Mod tachycardia; thready distal pulses, weak central pulses, decreased systolic BP mod tachypnea confusion, agitation, combative behaviour, lethargy, decreased pain response pallor, cap refill > 3 sec, dry extremities, sunken eyes Oliguria, increased SG

Answer 26

Extreme tachycardia, decreased BP, absent distal pulses, thready central pulses Severe tachypnea Comatose state pale, cold skin, cyanosis, cap refill > 5 sec no urine output

Answer 27

degree of tachycardia & perfusion to extremities level of consciousness blood pressure Compensated: vital organ function maintained by intrinsic mechanisms & child's ability to compensate is effective Subtle signs initially In decompensated, signs become more obvious

Answer 28

1. Ventilation 2. Fluid administration 3. Improvement of pumping action of heart (vasopressor support) - first priority is to establish airway & administer oxygen - place one or more multi-lumen central lines or cutdown or intraosseous needle - preferably place central line above diaphragm to deliver drugs closer to heart & limit tissue injury from caustic meds - lines needed for rapid volume replacement, administration of drugs, and hemodynamic monitoring.