Week 3- fluids and electrolytes Flashcards
1
Q
pediatric differences in terms of fluids and electrolytes
- ECF
- Kidney/immunity
- fully dependent on
- more rapid
A
- higher proportion of extracellular fluid
- faster metabolic rate
- less developed kidney and immune functions
- fully dependent on caregiver for their care needs (don’t show signs of thirst, maintenance fluid requirement, more susceptible to dehydration)
- more rapid fluid shifts
2
Q
what conditions increase fluid needs
6
A
- fever (sweating, increase metabolic rate)
- Diarrhea
- Vomiting
- Burns
- infection
- resp distress (blow off water when breathing fast)
3
Q
conditions that decrease fluid needs
3
A
- renal conditions
HF
metabolic conditions
4
Q
signs of fluid overload
A
edema
bulging fontanelle (fastest sign)
crackles
bounding pulses
wet sounding cough
5
Q
what do we do that can cause fluid overload
A
- IV fluids
- improper calculations
- misjudge their needs
6
Q
Maintenance fluid requirements aim to
A
to replace the normal, everyday fluid losses that occur through breathing, sweating, and other bodily functions.
These calculations consider factors like a patient’s age, weight, and activity level to ensure they receive the proper balance of water and electrolytes to stay hydrated.
7
Q
how to calculate maintenance fluid requirements per day
A
below 10kg= 100ml per kg
10-20kg= 1000ml+50ml per kg over 10kg
>20kg= 1500mL+20m per kg over 20kg
8
Q
urine output per hr
A
0.5-1ml per kg per hr
9
Q
if breastfed to check fluid status
A
weight them before and after 1g=1ml
10
Q
maintenance fluid for a 14kg
per day and per hour
A
1200ml
50ml/hr
11
Q
infants and children are more susceptible to
A
dehydration due to their higher body surface area to weight ratio
12
Q
types of dehydration
A
- isotonic= same fluid and electrolyte loss (most often on peds)
- hypertonic= fluid loss greater than electrolytes
- hypotonic= more electrolyte than fluid loss
13
Q
what can cause hypertonic dehydration
3
A
GI resp illness , Diabetes insipidus
14
Q
assessing hydration status
A
VS: monitor HR, temperature and other VS
skin appearance: skin color, turgor, capillary refill time to assess fluid status and prefusion
Ins/Outs
lab values: electrolytes, urine specific gravity
15
Q
when do we see a decrease in BP
A
when lost 25% of their volume
16
Q
signs of dehydration
10
A
poor skin turgor (groin folds)
dry mucous membranes
no tears (under 6 weeks wont make tears)
dry lips
sunken eyes
sunken fontanelle
delayed cap refill
cool clammy skin (poor CO)
increase BUN, Cr (reduced blood flow through kidney)
low potassium (from vom or diarrhea
17
Q
dehydration treatment depends on
A
on the underlying cause and degree of dehydration.
18
Q
mild to moderate cases of dehydration use
sever
A
oral rehydration
IV
19
Q
promote _______ during dehydration
A
nutrition
20
Q
to promote nutrient intake we use
A
BRAT diet
banana, rice, apple sauce
toast
easy to digest, low residual
help bind stool
21
Q
ammodium
A
dont give antidiarrheals we want to get rid of whats causing the problem
22
Q
when is infant ready for solid foods
A
- lose of extrusion reflex (tongue doesn’t push out food)
- usually 6 months
- sit up
- turn head away if don’t want
- reach
- close mouth over spoon
23
Q
If the infant is breastfed, they will also need to start taking Vitamin D drops. WHY?
A
very low in breastmilk
need 400IU/day
24
Q
suggestions for first foods
A
- iron fortified cereals
- mixing with liquids (BM, or formula)
- warm cereal and start with a thin smooth texture, gradually increase thickness
- feed BM or formula first then follow with a spoonful or two of infant cereal
25
why we need iron fortified foods
as they grow triple blood volume, need enough circulating iron
26
when to give cows milk
after one year because iron molecules in cows milk are too large to use
27
6-8 months introduce
Well cooked, mashed, or milled vegetables and fruits, mashed potatoes, sticky rice, wheat free dry cereal
28
7-10 months advance to
Chopped cooked vegetables and fruits, cheese, strips of bread, toast, tortillas, crackers and cereal (may introduce wheat)
29
10-12 months reccomended foods
cut up, soft cooked and raw foods, tender chopped meats, casseroles, dry cereal, eggs, and cheese.
Pasteurized milk can be introduced at 12 months
30
Bring baby to table at ___ so they can see what they need to do and to get them interested in foods
4 months
31
Go through big growth spurts at _____ months and parents think this is the time to ____________but they likely aren’t ready –so ________
3-4 months
start feeding solid foods
increase BF for a few days and babe will likely settle
32
What nutrients are important
| 4
Iron
Protein
Calcium
Vit d
33
feeding toddlers start with
veggies then give fruits
lots of color
34
why give fats
brain development
35
fluoride
helps remineralizer teeth
too much can lead to thyroid cancer
36
FTT definition
children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender.
37
Weight and height below the are considered FTT
5th percentile
38
medical/organic factors related to FTT
| 4
1. genetic or hormonal: Chromosome problems, thyroid or growth hormone deficiencies, and other hormonal imbalances can affect a toddler's growth and development.
2. Neurological issues: damage to brain or CNS
3. chronic conditions: Long-term infections, gastrointestinal problems, heart or lung issues, and metabolic disorders
4. prenatal factors: Complications during pregnancy and low birth weight
39
ventilateed for long period can develop
aversion to feeding
40
non organic factors of FTT
| 4
emotional deprivation
poverty
ack of nutrition knowledge
exposure to illness
41
manifestations of FTT
lack of energy
easily fatigued
poor appetite
lack of interest in feeding
not meeting milestone stages
delayed fine and gross motor skills
constipation
42
little bit of dehydration can lead to ______ when FTT
constipation when FTT
43
Prolonged failure to thrive may lead to permanent
permanent mental, emotional, or physical delays.
44
obesity is typically defined as
95th percentile or higher on pediatric growth charts
45
overweight vs obese
overweight= weight between the 85th and 97th percentiles, while obesity is defined as being above the 97th percentile, based on Body Mass Index (BMI).
46
Childhood obesity can lead to
| 2
serious health problems
- type 2 diabetes
high blood pressure
- heart disease.
Early intervention is key to help children develop healthy habits.
47
Who is at risk for obesity?
| 3
sedentary lifestyle
consuming foods high in sugar and fat
genetics
48
screen time
2 hours max per day
49
Steps to Reduce incidence of Obesity
1. healthy eating habits: balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins. Limit processed foods, sugary drinks, and high-calorie snacks.
2. Regular physical activity: Incorporate at least 60 minutes of physical activity per day, such as active play, walking, swimming, or other age-appropriate exercises.
3. portion control: Teach children to recognize and respect their body's hunger and fullness cues. Serve appropriate portion sizes based on age and activity level.
4. limit screen time: Establish screen-free time and encourage alternative activities like reading, puzzles, or outdoor play to reduce sedentary behavior.
50
Successful weight management involves making
small, sustainable changes over time rather than drastic, short-term efforts.
51
what is GERD
severe long lasting condition which stomach contents come back up into the esophagus
lower esophageal sphincter (cardiac sphincter) is too relaxed or open
52
s/s of GERD
- vomiting/nausea
- taste of acid
- disinterest in eating
- poor weight gain
- heartburn
- regurgitation
- chest/upper abdominal pain
- FTT
- vomiting/regurgitation
- weight loss
- bleeding
53
treatments of GERD
depends on severity
- small frequent feedings
- position upright (30 degrees)
- frequent burping with feeding
- positional feedings
- small feeding - NG/NJ
- meds (PPI)
54
medications for GERD
surgery
PPI not recommended long term
nissen fundoplication
55
nursing considerations
GERD
- educate parents on home care
- positioning
- feeding administration
- monitoring growth and development
- family education
56
Pyloric stenosis
what is it
narrowing of the lower stomach sphincter (pylorus sphincter)
57
s/s of pyloric stenosis
- projectile vomiting immediately after feeding
- hunger
- irritability
- weight loss
- olive shaped mass in RUQ
- dehydration
- malnutrition
- small stools
- similar to GERD
58
treatment of pyloric stenosis
| 3
- surgery (pyloromyotomy)
- thickened formula mixed with infant cereal fed through a large-holed nipple or NJ tube
- feed slowly while sitting in an infant seat or held upright
59
pyloric stenosis is more common in
Caucasian boys
first born
60
pyloric stenosis diagnosed
in 2-5 weeks
61
Cleft lip and palate
opening/slit in the roof of the mouth
more common in boys
congenital defect (during 7-12 weeks gestation)
62
signs and symptoms of cleft lip/palate (2)
susceptible to
greatr risk for
- feeding difficulties, latching nasal reflux, swallowing
- nasal speaking noise/speaking problems
- susceptible to ear infection and hearing loss, resp infections, oral infection
- greater risk for aspiration
63
treatment of cleft lip/palate
| 4
- cheek support designed bottle nipples
dental appliances (artificial palate)
- surgery
- prevention of crying, bleeding
- pain management
64
nursing considerations cleft lip and palate
| 3
- nutrition adequacy : s/s of dehydration and malnutrition
- safety: sitting them up, support head to prevent aspiration
- family
education: post op teaching, oral hygiene
support
breastfeeding help
SLP
slowly reintroduce foods
watch for s/s of FTT
65
intussusception
what is it
one part of intestine slips into another part below it
ileocecal valve (small intestine opens into large intestine)
66
intussusception may cause
complete bowel obstruction
67
symptoms of intussusception
sudden onset of intermittent pain
vomiting- yellow greenish
palpable mass
cramping
decrease BM and flatus- blood and mucus in stools (currant jelly stools)
rectal bleeding
high pitched cry (pain)/ kicking/indrawing
68
treatment of intussusception
- pneumo enema or saline
- bowel resection of affected area
- emergent care
- air enema with or without saline
- surgery if bowels are severely affected (repositioning, partial bowel resection if necrotic)
69
diagnosis of Intussusception
- abdo US
- presentation
- hx
70
considerations for Intussusception
- pain management
- IV fluids
- NJ to relieve and decompress pressure
- sx prep
- bowel decompression
- teach about s/s
- medical emergency
- monitor s/s of bowel obstruction
- fluids/nutrition
71
presentation with Intussusception
| i i l
- irritability
- loud cries
- indrawing of legs
72
what is appendicitis
inflammation of the appendix often resulting in rupture
lumen become obstructed with fecal matter, with lymphoid tissue after a viral illness, or with parasites.
73
signs and symptoms of appendicitis
- guarding
- begins with periumbilical pain increasing within 4 hours
- sudden onset if RLQ pain
- McBurney point= most intense pain
- rebound tenderness
- N/V, anoremixa
- low grade fever (55% of cases)
74
tx of appendicitis
non ruptured: surgery
ruptured: surgery and abx
- usually appendectomy
- NG suction for abdo decompression until motility returns
- pain management
- fluid replacement if required
75
diagnosis of appendicitis
increase WBC, CRP
us shows thickness
soft tissue mass in the RLQ
CT scan with rectal contrast
stool culture
76
Signs of ruptured appendix and peritonitis include
| 6
- sudden relief of acute pain
- rigid guarding of the abdomen
- abdominal distention
- tachycardia
- chills
- irritability.
77
nursing considerations appendicitis
- perforation can happen within 36 hours of pain onset
- NPO if surgery required
- proper pain scale for age
- early ambulation post op!
- watch for infection
78
nursing considerations pyloric stenosis
- improve nutrition and hydration
- maintaining oral and skin integrity
- reduce risk of aspiration and dehydration
- addressing nutritional deficits
- alleviating family anxiety
79
mild
mod
severe
fluid loss
- Mild: Up to 5% (40-50 mL/kg)
–Moderate: 6% - 9% (60-90 mL/kg)
–Severe: 10% or more (100 + mL/kg)
80
Key Pediatric Differences in the GU & GI Systems
~Immature filtration system
~Lose more fluid to get rid of waste products.
~Shorter ureters
~Small gastric capacity
~Long small intestine
~Short colon
81
how does ORT work
- glucose and electrolyte solution
- glucose helps reabsorb sodium and water
82
Chicken or beef broth in dehydration
not given
excessive sodium and inadequate carbohydrate.
83
clear fluids in dehydration
| juice pop
Fruit juices, pop, sports drinks are not efficacious because of their high carbohydrate concentration, high osmolality, and low electrolyte content.
84
Treatment of Mild to Moderate Dehydration using ORT
~Start ORT replacement 50-100ml/kg over 4 hrs
~Recommend 5mls q5mins, give with a dropper, spoon, or syringe.
~Reassess q1-2h
~Replace continuing losses.
~Monitor u/o
~Continue breastfeeding along with ORT.
~Restart feeding soon---Small, frequent feeds as tolerated
85
Treatment of Severe Dehydration using IV therapy
| when to replce K loses
~Parenteral fluid therapy bolus (Usually 20ml/kg repeat prn)
~Monitor: Hydration assessment: u/o, VS, LOC, perfusion, skin turgor, Mucus Membranes, tears
~Calculate remaining fluid deficit (replace 50% of the deficit over 8hrs/remainder over 16hrs adding maintenance to total IV therapy)
~Replace K+ losses: after first void (anuria leads to retention of K+) slowly to avoid serum hyperkalemia (normal levels are 3.5 - 5.0mmol/L)
86
Gastroenteritis is commonly manifested in children by
diarrhea
87
children at increased risk for diarrhea
| 2
daycares
substandard living conditions
88
Acute Diarrhea is usually
self limiting resolves in 14 days
89
Diagnostic Evaluation of GER include the following:
*History and physical exam
*Barium Swallow
*Esophageal pH monitoring
*Endoscopy
*Scintigraphy and manometry
90
pyloric stenosis most common in
| 4
- first born
- males
- full term
- CaucasianF
91
characteristics of isotonic fluid loss
| _= _
___ MAJOR RISK
MAJOR LOSS FROM
CAUSED BY
Na= H2O
- most common
- shock is a major risk
- plasma Na remains within normal limits (135-145)
- major loss from ECF
- caused by vomiting and diarrhea
92
characteristics of hypotonic fluid loss
- greater sodium loss (less than 135)
- weakness, dizziness, decrease BP, lethargy
- caused by: low sodium intake, fever, tachypnea, V&D, renal disease, DKA, malnutrition, burns
93
hypertonic fluid loss characteristics
- more water loss (Na >145)
- most dangerous
- cerebral changes
- caused by: sever Na intake, renal disease, fever, DI, high insensible water loss, vomiting and diarrhea
94
complications of GER
| 3
- pneumonia
- FTT
- esophageal strictures
95
Newborns have a stomach capacity of approximately
10-20ml
96
encopresis
soiling of fecal contents into the underwear beyond the
age of expected toilet training.
