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97 Cards in this Set

  • Front
  • Back
In comparison to adults, do infants have more or less ECF? What does this imply?
More ECF

Because of a higher percentage of water in the ECF infants can lose fluids equal to their ECF in 2-3 days, meaning they become dehydrated much more easily.
What are some causes of Fluid & Electrolyte Imbalance in children?
Fever
Illness
Trauma
True or False: Premature Infants have 90% water (50% ECF) and are most at risk for Fluid & Electrolyte Imbalance.
True

They also have more surface area than a newborn, 5x more likely to experience water loss.
Infants and children have immature kidney function, why does this contribute to Fluid & Electrolyte Imbalance? (5)
Immature excretion of waste products of metabolism-
Can't concentrate urine
Can't dilute urine
Can't excrete or conserve sodium
Can't acidify urine
Infants and children have more or less fluid intake and output per kilogram than adults.
More
Infants and children have a greater ECF volume than adults, which creates a great risk of
dehydration
(greater fluid volume loss)
Younger children have a higher or lower metabolic rate (BMR) compared to older children and adults.
higher
The GI Tract of infants and young children is proportionately larger, and these children are more likely to experience water loss via _______. Also, the GI is more______ to water than the older child, contributing to insensible water loss.
diarrhea.
permeable
Infants and children, especially premature infants, have a much larger body surface area (BSA) than adults. This poses a higher risk of insensible water loss. What are some methods of insensible water loss?
Skin, especially head
Respiratory Tract
GI Tract
Which is lost first ECF or ICF?
ECF
List some common precipitating events in infants and children that cause secondary fluid losses. (8)
Fever (Each degree of increase adds 12% to fluid requirements)
*Vomiting
*Diarrhea
Illness (especially respiratory)
Diabetes Insipidus
*DKA
*Burns
Decreased Renal Function due to high-output Kidney Failure

* indicates main causes
Dehydration, by definition, is when the total output of fluid is greater than intake, regardless of ______.
cause
Electrolyte losses include which 3 types?
isotonic/isonatremic dehydration
hypertonic/hypernatremic
hypotonic /hyponatremic dehydration
What is the most common type of dehydration?
isotonic/isonatremic
In isotonic/ isonatremic dehydration, water and electrolyte losses are ____.
equal
What are some causes of isotonic dehydration?
-vomiting
-diarrhea
-insensible fluid loss
-decreased oral intake w/ increased activity
Define hypotonic /hyponatremic dehydration

What are some causes?
electrolyte loss is greater than water loss
Na < 130 - 135 mEq/L

Causes:
excess H20 intake
diluted formula --> hyponatremic seizures
Define hypertonic/ hypernatremic dehydration

What is a cause?
water loss > electrolyte loss
Na is > 150 mEq/L

IV fluids with increased sodium
Mild dehydration is a weight loss of ____ to _____ percent.
Moderate dehydration is a weight loss of _____ to ______ percent.
Severe dehydration is a weight loss greater than _____ percent.
3-5
6-10
10
________ is the presence of nitrogen containing compounds in the blood due to change in fluid shifts (contents in blood change)
azotemia
What does the skin look like in mild, moderate, and severe dehydration?
mild- pale
moderate- ashen or gray
severe- mottled
What is the fluid loss for mild, moderate, and severe dehydration?
mild < 50 ml/ kg
moderate 50-90 ml/kg
severe >100 ml/kg
What is the skin turgor like for mild, moderate, and severe dehydration?
mild- normal or decreased elasticity
moderate - poor turgor
severe- very poor turgor, tenting
What will the mucous membranes be like in mild, moderate, and severe dehydration?
mild- dry or normal
moderate- very dry
severe- parched
What will urine output be in mild, moderate, and severe dehydration?
mild- low
moderate- oliguria
severe- marked oliguria & azotemia
What is the normal urine output per 24 h period for neonates, infants, children, and adolescents?
neonate 50-300 cc's
infant 350-550 cc's
children 500-1000 cc's
adolescents 700-1400 cc's
What are the BP and HR changes in mild, moderate, and severe dehydration?
mild- BP normal, pulse may ↑
moderate- BP normal or ↓, Pulse ↑
severe- BP ↓ (late sign)
Pulse rapid & thready
How does the CRT change in mild, moderate, and severe dehydration?
mild- less than 2 sec
moderate- 3-5 sec
severe > 5 sec
What is the respiratory rate in mild, moderate, and severe dehydration?
mild- normal
moderate- normal to deep
severe- rapid and deep
What are the behavior changes in
mild, moderate, and severe dehydration?
mild- fussy, alert, thirsty
moderate- lethargic, but arousable (key), thirsty
severe- drowsy, limp, can be comatose
drastic changes in LOC
What is the urine specific gravity in moderate to severe dehydration?
moderate- 1.020-1.030
severe >1.030
What is an early sign of moderate dehydration?
LOC changes
What are some questions we might ask in assessing dehydration/ fluid and electrolyte status ?
Is anyone ill at home?
New foods?
Milk intolerance?
Recent Travel?
Medications?
# of stools?
Consistency & color of stools?
Blood in stools?
Weight Changes?
How many wet diapers?
When was last void?
Breastfeeding vs. Formula?
What 2 assessments will tell you the fluid status early and are very important primary interventions?
DW
I & O
What is the normal standard # of wet diapers per day? As a general rule of thumb, no diapers for ___ h is a cause for concern.
6
6
In addition to assessing general appearance and VS, it is important to assess what else?
fontanels
LOC
activity & behavior
cry
Labs
What labs need to be checked to assess fluid status?
CBC
Electrolytes
BUN
Creatinine
UA- specific gravity
What is ORS? What kind is usually recommended? How much is given?
Oral Rehydrating Solution - used first
Rehydralyte (Ross)
50-100 ml/kg of ORS over 3-4 hours

(for mild dehydration)
What is used to maintain hydration after ORS in treating dehydration?
Pedialyte (Ross)
or Ricelyte (Mead Johnson)
In treating dehydration, DO NOT encourage chicken broth, soda,"", gatorade fruit juice, or BRAT diet in children because ...

Low sodium fluids are good such as breast milk and formula.
high osmolarity
high sugar content
↑ carbohydrate contents aggravates diarrhea
all lead to --> more fluid loss
For moderate to severe dehydration, we give IV fluid replacement. How much is given? Then we give what?
60-80 ml/kg NS over 2 hours
Bolus is 20 ml/kg (may need several)

maintenance fluids
When giving IV fluids to help with moderate to severe dehydration, we need to assess what? how often?
Check IV hourly, protect site
Reassess VS, CRT etc. regularly throughout administration to check response to tx
The infusion of IV fluids including bolus doses in replacing fluid loss in moderate to severe dehydration is used as a "fluid challenge" to check for response to treatment. The neonate will need a more subtle infusion, and the bolus is about ___ ml/kg
10
A _______ is a cylindrical device used to precisely control IV fluids. It is generally used for children less than __years of age and only gives ___ hours worth of fluid at a time. This prevents ____ ______.
volutrol
5
2
fluid overload
If hypernatremic, fluids need to be replaced more quickly or slowly?
The goal is to decrease serum sodium concentration by no more than __ mEq/L in 24 h.
slowly
12

(So, if the starting serum sodium level is 150, we don't want it less than 138. If it's less than this, solution is infusing too fast.
Isonatremic or hyponatremic dehydration needs fluids replaced over ____ h.
24
In calculating maintenance fluids, they are based on ____ and are over a ___ h period of time. This is in addition to the replacement and bolus fluids.
weight
24
What is the formula for calculating maintenance 24 h fluid needs?
1st 10 kg x 100 cc
2nd 10 kg x 50 cc
remaining weight if over 20 kg, x 20 cc

Divide by 24 to get hourly rate
The more hypertonic a solution, the more likely the IV is to _____.
infiltrate
Intraosseous lines are good for quick access if you can't get an IV in. Are they good for short term or long term? Why? What are some common sites?
short term (not for long term use, risk of infection-- osteomellitus)
lat. area, proximal tibia, distal end of femur
______ helps to heal infiltration if severe; it facilitates the healing process.
Wydase
Acute diarrhea is an increase in the number of stools ↓ in consistency. There may be mucus, or watery & greenish in color, possibly blood. It is related to the ________ process and may be a reaction to _______, _____ or _____. Acute diarrhea is termed lasts less than ____ days.
inflammatory
food, antibiotics, or poison
5
A common cause of acute diarrhea is ______ virus.
rota
Chronic diarrhea is loose stool over at least a ___ _____ period. It is usually related to what 4 causes?
2 week
malabsorption,
anatomic defects
hypersensitivity
Crohn's Disease
When infusing TPN or lipids, we usually use a ____ line.
central
Acute infectious gastroentreritis or acute infectious diarrhea are caused by what 3 things?
virus
bacteria
parasite
Viral acute infectious gastroentreritis or acute infectious diarrhea usually occurs in what season?
winter
Bacterial acute infectious gastroentreritis or acute infectious diarrhea usually occurs in what seasons?
summer and fall
Which is more common, Bacterial or Viral acute infectious gastroentreritis or acute infectious diarrhea?
Viral
The pathophysiology of acute infectious gastroentreritis or acute infectious diarrhea causes the production of ________ which involves direct invasion and destruction of ______ ________ cells. It causes local ________ and systemic invasion by the organisms.
enterotoxins
intestinal epithelial
inflammation
Gastroenteritis can lead to what 3 things?
dehydration
electrolyte disturbance/imbalance
shock
What is the treatment for Gastroenteritis?
Meds like antibiotics
ORS
normal diet or bland diet
Never give ________ to children who have gastroenteritis/diarrhea. Why?
antidiarrheals (such as immodium
because it effects the binding of enterotoxins, they can't get out and need to be excreted.)
In diagnosing gastroenteritis/ diarrhea, a stool culture and sensitivity is done. What are you looking for? (7)
ova & parasites
rotavirus
pH
RBC
PMNs (polymorphonuclear leukocytes)
glucose
blood guiac test
In diagnosing gastroenteritis/ diarrhea, a blood test is doneWhat are you looking for? (6)
differential
electrolytes
BUN
glucose
lumbar puncture
blood cultures (if an infectious agent is suspected such as C. Diff
What are some common causes of vomiting? (5)
obstruction (esp. in younger children)
infection (usually gastroenteritis)
motion sickness
metabolic alteration (Chron's Disease, IBS)
psychologic alterations (stress)
What are the 2 main types of obstruction that cause vomiting?
pyloric stenosis
intussception
_________ is an intestinal obstruction of bowel turned on itself like a telescope, usually in the ileum
usually 1 mo to 5 y of age
Intussusception
What is pyloric stenosis? What does it cause? When does it occur? What will you not see?
narrowing of pyloric sphincter, blocks food from emptying out of stomach. causes severe, projectile vomiting
usually 2-4 weeks after birth
No Bile, no diarrhea
When treating vomiting, it is important to treat the cause and prevent complications. Use ____ to rehydrate and assess for signs and symptoms of ______.
ORS
dehydration
A ______ burn is minor, the tissue is pink, the damage is minimal, it's painful, and it heals in 3-5 days. An example is a ______.
superficial- 1st Degree

sunburn, blister
In treating sunburns, use cool ____ and a moisturizing ____.
tap water
lotion
A _______ burn is superficial partial thickness (includes epidermis and part of dermis) or deep partial thickness (includes epidermis and dermis, the hair follicles, and sweat glands are intact)
It heals in ____ to ___ days depending on depth. It is painful and can become _____.
2nd degree (partial thickness)
14 - 30 days (2-4 weeks)
infected
A ______ burn is a full thickness burn. It includes the epidermis, dermis, and subcutaneous layer. The nerve endings are destroyed but the surrounding burn areas are usually what?
It will require removal of _____
...1st & 2nd degree burns and are painful

eschar (dead tisse area, debridement is needed for healing to occur)
Burns extending to fascia, muscle, and bone ?
4th degree
In contrast from how adults are assessed for extent of burn injury (rule of 9's), children are assessed by what? It is based on what?
the percentage of total body surface area

age
In assessing burns, we need to assess whether it requires burn unit treatment, which involves IV fluid _______ which usually with a central line.
resuscitation
In assessing burns, decide whether there are _____ injuries such as fractures and head injuries.
concomitant
Many burns that are greater than ___ degree or have a problem with the _____ require burn unit treatment, which is a very specialized area and infection control is very important.
2nd degree

airway
In assessing burns, it is important to determine if the burn is near the face or an airway. Also assess for fluid and _______
problems, an ______ response, previous or concurrent _____, and whether special care is needed such as for the hands and face. Infants will suffer more damage because they have thin ____.
electrolyte
immune
illness
thin
Systemic responses to burns include an increase/decrease of blood flow to brain, heart, and kidneys and blood flows away from/toward from GI. Systemic responses can lead to a______,a______, g_____ changes, and e_______.
increase
away from
anemia
acidosis
growth
edema
A prepubescent child with a severe burn may experience a decrease in ____ hormone secretion which can cause a growth stunt.
growth
What are 4 complications from burns
SWAG
Shock
Wound Sepsis
Asphyxia
G.I. problems
What causes asphyxia in burns?
hypoxia & CO2 poisoning
What types of GI complications can be caused by burns?
stress ulcer
paralytic illeus
It is very important to assess end organ perfusion in severe burns. How do we assess this?
urine output
What medication can be used to treat GI problems caused by burns? They may be ___ so the GI can rest. They can receive TPN and higher amounts of _____ via IV.
antacids
NPO
dextrose
Which type of IV line can you give higher amounts of electrolytes, a central line or a peripheral?
central
In treating burns, it is important to stop the burning process. Use ____ ____ if a minor burn. Remove burned ______ only if easily removable because you might tear away layers of skin. Cover the area with a ____, ___ sheet or cloth.
cold water
clothing
clean, dry
For a minor burn, clean the area with mild ______, ___ times a day and ____ water. An antiseptic or antimicrobial cream such as ______ can be used. The dressing should be wet/dry. For pain management, use ____ or something stronger. The patient may need _______ to prevent infection and may need a ______ shot if not current with this immunization.
For a minor burn, clean the area with mild SOAP, 2 times a day and TEPID water. An antiseptic or antimicrobial cream such as SILVADENE can be used. The dressing should be DRY. For pain management, use Tylenol or something stronger. The patient may need ANTIBIOTICS to prevent infection and may need a TETANUS shot if not current with this immunization.
For treating a severe burn, assess the involvement of the airway. Intubation needs to be done quickly before the airway _____. IV fluids are given in the first 24 - 48 hours due to drastic ____ ____. Usually these patients are NPO. Soaks and d______ are needed. The same creams are used as in a minor burn. The patient may have a ______ tube and a ___ catheter. Lab work will be done.
For treating a severe burn, assess the involvement of the airway. Intubation needs to be done quickly before the airway SWELLS. IV fluids are given in the first 24 - 48 hours due to drastic FLUID SHIFTS. Usually these patients are NPO. Soaks and DEBRIDEMENTS are needed. The same creams are used as in a minor burn. The patient may have an NG tube and a FOLEY catheter. Lab work will be done.
What are the 3 types of skin grafts for burns?
Allograft (homograft - human cadaver)

Xenograft (sythetic tissue covering)

Autograft- permanent skin covering, from the patient's own skin
Which is the most common type of skin graft?
allograft or homograft
A ______ is a type of graft used until tissue builds up and forms underneath as the skin heals.
xenograft
Autografts include what 2 types?
sheet graft

mesh graft
We often use ______ dressings to flatten out the scar. Elastic garments stabilize ______ changes.
pressure
pressure
In treating burns, it is important that the diet is rich in what nutrients to help with tissue repair and healing?
↑ protein
↑ carbohydrates
↑ Vit C, A, B
↑ Zinc & Iron