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32 Cards in this Set
- Front
- Back
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Dehydration
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common body fluid disturbance in infants and children, occurs when total output exceeds total intake, may result from a number of diseases that cause insensible losses
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Insensible fluid losses occur:
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through skin, resp tract, increased renal secretion, through GI tract
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water balance in infants
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infants and young children have a greater need for water and are more vulnerable to alterations in fluid and electrolyte balance
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fluid losses
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vary with age and are divided into insensible, urinary and fecal losses
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insensible losses
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approx 2/3 of fluid loss occurs through skin and the remaining 1/3 through resp tract, heat and humididty, body temp and resp rate influence insensible fluid loss
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body surface area
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infant's greater BSA allows larger quantities of fluid be lost in insensible losses through immature skin, the longer GI tract in infancy is another source of fluid loss, especially from diarrhea
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basal metabolic rate
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significantly higher because of larger BSA, any condition that increases metabolism causes greater heat production, insensible fluid loss and increased need for H2O, the basal metabolic rate is higher in infants and children to support growth and organ function
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kidney function
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functionally immature at birth, inefficient in excreting waste products of metabolism, for fluid balance-the inability of infant's kidneys to efficiently concentrate or dilute urine, conserve or excrete Na, acidify urine, more likely to become dehydrated when given excessively concentrated formula or excessive diluted formula
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fluid requirements
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depend on hydration status, size, environmental factors, underlying disease
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daily maintenance fluid requirements
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calculate wt in kg, allow 100ml/kg for first 10kg, allow 50ml/kg for second 10kg, allow 20 ml/kg for remainder of wt in kg, divide total amount by 24hrs to obtain rate in ml/hr
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mild dehydration
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3-5% wt loss, pulse normal, resp norm, bp norm, behavior norm, slight thirst, mucous memb norm, tears present, ant fontanel norm, external jugular vein visible when supine, cap refill > or = 2 sec, urine spec grav >1.020
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moderate dehydration
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6-9% wt loss, pulse slightly increased, resp slight tachypnea, bp normal to orthostatic > 10mmHg change, behavior irratible, more thirtsy, moderate thirst, mucous memb dry, decreased tears, normal to sunken fontanel, external jugular vein not visible except with supraclavicular pressure, slowed cap refill (2-4s)decreased skin turgor, specific urine gravity >1.020; oliguria
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severe dehydration
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>or = 10% wt loss, pulse very increased, hyperpnea, bp orthostatic to shock, hyperirritable to lethargic behavior, intense thirst, parched mucous memb, absent tears sunken eyes, sunken fontanel, external jugular vein not visible even with supraclavicular pressure, cap refill >4s and tenting, skin cool, acrocyanotic or mottled, oliguria or anuria
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Nursing management
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assess for signs of dehydration-observe general appearance and procede to more specific observations
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Conditions in which dehydration may develop more quickly
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diarrhea, vomiting, sweating, fever, diabetes, renal disease, cardiac anomalies, admin of certain drugs, trauma, herpangina, hand-foot-mouth disease, thrush
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intake and output
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accurate measurement are vital to assessment of dehydration, includes oral and parenteral intake and lossess from urine, stools, vomiting, fistulas, NG suction, sweat and wound drainage
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what to assess for urine
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freq, color, volume and consistency (when weighing diapers, 1 g wet diaper is = to 1ml of urine)
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what to assess for stools
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freq, volume and consistency
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what to assess for vomitus
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volume, freq, and type
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what to assess for sweating
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can be only estimated from freq of clothing and linen change
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what to assess for vital signs
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temp (normal, elevated, or lowered depending on degree of dehydration), pulse (tachycardia), resp (hyperpnea), bp (hypotension)
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what to assess for skin
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color, temp, turgor, presence or absence of edema, cap refill
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what to assess for mucous memb
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moisture, color, presence and consistency of secretions
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what to assess for body wt
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decreased in relation to degree of dehydration
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what to assess for fontanel (infants)
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sunken, soft, normal
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what to assess for sensory alterations
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presence of thirst
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Model for rehydration
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should consist of 75mEq of Na per liter, give 50-100ml/kg of oral rehydration solution over 3-4 hrs for mild to moderate dehydration, administer small volumes, replacement and maintenance solution should consist of 40-60 mEq of Na/L, reevaluate need for further hydration, initiate maintenance therapy using maintenance formula-daily volumes not to exceed 150ml/kg/day, after initial hydration continue breastfeeding or full strength formula, replace fluid losses from vomiting and diarrhea
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overhydration
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water excess, water intoxication, takes in more than excretes, increased risk for infants in first month, also for infants taking swimming lessons, infants get all their water from breast milk and/or formula, if given H2O, give slowly and only times fo extreme temp, can cause brain damage and seizures, also seen in SIADH
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behavioral changes in overhydration
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1st symptoms of H2O overload is behavioral changes such as confusion
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physiological changes
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seizure, cryiing, poor coordination, rapid breathing, flushed, possible coma
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electrolyte imbalances in overhydration
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hyponatremia
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Goal of treatment for fluid overload
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safety is 1st priority, restore normal fluid hydration, prevent future fluid overload, fluid restriction, sodium restriction, diuretics (more helpful when overhydration is accompanied with excess blood volume)
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