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90 Cards in this Set

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Why are children at higher risk for insensible losses?
-They have a much higher respiratory rate.
-when they have a fever it reaches higher temperatures than adults
-They play outside and for long periods of time
-They have a larger body surface area than adolescents and adults.
What portions of insensible losses are through the skin?
2/3
The respiratory tract is responsible for what fraction of insensible losses?
1/3
What are the sources of fluid loss?
Insensible, urinary and fecal
What are the 2 parts of the extracellular compartment?
-Intravascular fluid
-interstitial fluid
What is intravascular fluid?
Blood and plasma
What is interstitial fluid?
Fluid that lies between the cells and the outside of the blood and lymphatic vessels.
What compartment dominates the fluid volume in children under 2?
The extracellular compartment
WHy do neonates and young children have a high BSA?
Body surface area:
because their brain and skin, which is rich interstitial fluid occupy greater proportion of their body weight
Which compartment is fluid often lost from first?
The ECF
What makes the up the ECF?
Na, Cl, bicarb and calcium
The ICF is composed of?
K, Ca, Mg and Phosphorous
At what age does the ICF begin to predominate the fluid volume of the body?
age 2
In terms of fluid and electrolytes what does the rapid growth rate of children put them at risk for?
Fluid loss and thus require a larger amount of fluid intake
Describe the issues with kidney of a child and their fluid and electrolyte balance?
-Their glomeruli tubules and nephrons are immature and are unable to conserve H2O effectively.

-They have a greater amount of metabolic wastes to be excreted by the kidneys.

-Therefore they are even more at risk for dehydration
What are the daily fluid requirements for fluid mainenance?
1. pt wt in kg
2. 100ml/kg for first 10kg
3. 50ml/kg for second 10kg
4. 20 ml/kg for the remainder of the weight in kg
5. divide total amount by 24 hrs and obtain rate in ml/hr
What is the proper urine output for infants and toddlers?
>2-3ml/kg/hr
What urine output should be seen in preschool and young school age children?
> 1-2 ml/kg/hr
Older school age and adolescents have a normal urine output of?
0.5-1ml/kg/hr
How is dehydration classified?
according to serum Na concentration and osmolarity
What is the most common form of dehydration?
Isotonic
What is isotonic dehydration?
FLuid and electrolyte loss in equal portions
How will Na levels appear in a child with isotonic dehydration?
WNL because water is lost in equal proportions
What are the most common causes of isotonic dehydration?
Vomiting and diarrhea
What is the first treatment option for dehydration?
Oral rehydration: pedialite
What type of IV solution is most often given first for dehydration?
Isotonic IV solutions
What is the most common Isotonic solution given in the hospital for dehydratioin?
0.9% NS
What is the greatest threat related to isotonic dehydration>
SHOCK!!
What is hypotonic dehydration?
Where the ECF loses its electrolytes

Electrolyte loss > H2O deficits
Which compartment becomes more concentrated during hypovolemic dehydration?
The ICF
What are some common causes of hypovolemic shock?
running a marathon; drinking excess water without electrolytes; near miss drowning; diluting baby food to get more out of it.

-vomiting/diarrhea
What 2 disorders are often found to cause hypovolemic dehydration?
SIADH and meningitis

SIADH can be caused by tumor or head trauma
What are some interventions for hypotonic dehydration?
Restrict H2O

Take salt tablets

take fluids with electrolytes
What are the symptoms of hypotonic dehydration?
-Edema
-HTN
-confusion
-headache
-increase in urine specific gravity
-overall general weakness
What Na lab levels would indicate need for a HYPERTONIC solution?
less than 110meq/l
WHat is the most commonly used hypertonic solution in pediatrics?
10% dextrose
Why is administering a hypertonic solution dangerous?
If it is infused too quickly it can cause cell shrinking!

You will see rapid changes in LOC
What are the serum sodium levels commonly seen in hypotonic dehydration?
< 130 meq/l
Describe hypertonic dehydration.
H2O losses > electrolyte losses
Which compartment is most concentrated in hypertonic dehydration?
The ECF ore concentrated than the ICF
What are the causes of hypertonic dehydration?
Starts with diarrhea and vomiting

-excessive sweating
-excessive burns
-children who are not taking enough fluids
-problems with too little ADH
-renal diseases
-concentrating baby formulas
-antacids
-DM
What are the symptoms of hypertonic dehydration?
-Tachycardia
-fever
-hypotension
-decrease in cardiac output
-oliguria
-thirst
-agitation
What will occur if a hypotonic solution is pushed too quickly?
Cell swelling.

person will complain of headache as a result of cerebral edema
What are the general symptoms of dehydration?
-Changing LOC
-Response to stimuli
-Decreased skin elasticity & turgor
-Prolonged capillary refill
-Increased heart rate
-Sunken eyes & fontanels
-Dry mucus membranes
-Absent tears
-Decreased urine output
-weight loss
What are the symptoms that must be present for 5% dehydration to be diagnosed? How many are required?>
> capillary refill > 2 seconds
> absent tears
> dry mucus membranes
> ill appearance

At least 2 need to be present
What must the nurse monitor for a patient with dehydration?
-I & O: urine, vomiting, stool, IV fluids, sweating?
-Vital signs: changing?
-Skin: turgor, color, moisture?
-Mucus membranes: dry?
-Body weight: dropping?
-Fontanel: sunken 18 months
-Sensory: awake?
What are the common causes of increased K+ excretion?
-diuretics
-osmotic diuresis (DM type I)
-severe diarrhea
-renal disease
-elevation in aldosterone
What are the possible contributors to a decreased K+ intake?
-bulimia/anorexia
--NOP without K in IV
-vomiting
-NG tube suctioning
-metabolic alkalosis
Why does metabolic alkalosis cause hypokalemia?
The cells want to push H+ out of the cell with its concentration gradient, but it must be exchanged for K+ into the cell making the ECF appear hypokalemic
What % of K ingested is excreted in urine?
80%
What are some symptoms of hypokalemia?
-constipation
-muscle weakness
-leg cramps
-irregular, weak pulse
-numbness of extremities
-orthostatic hypotension
How do you treat hypokalemia?
First find the cause:

-Diet? then change it
-give fluids with K
What must a child be on if they are receiving IV fluids with K?
A Heart Monitor!!

They may become hyperkalemic and get arrhythmias
What is the serum concentration to be considered hyperkalemic?
Above 5.8mmol/l
What are the causes of hyperkalemia?
-Massive cell death
-excessive or too rapid K+ IV infusion
-metabolic acidosis
-diabetes
-Drop in K+ excretion
LIst the symptoms of hyperkalemia.
-abdominal cramping
-diarrhea
-nausea
-bradycardia
-irregular pulse
-muscle weakness (especially lower extremities)
-ELEVATED T wave on EKG
What 2 drugs can be given to expel K from the body?
Diuretics and Kayexalate
What are 2 drugs that can help to drive K into the cell when a pt is hyperkalemic?
Insulin and bicarbonate
If a patient has skin breakdown, the nurse should recommend ____ be incorporated into their diet to help prevent hyperkalemia.
Protein
____ may be a required treatment for a pediatric patient in renal failure who is hyperkalemic.
Peritoneal dialysis
The life span of acute diarrhea is usually less than ___ days.
14
Gastroenteritis is an infection that commonly leads to ___ ____?
Acute diarrhea
What is gastroenteritis?
Acute infectious diarrhea
What are the common causes of acute diarrhea?
-infection
-antibiotics
-upper respiratory tract infections
-laxatives
How long must diarrhea go on to be diagnosed as chronic?
More than 14 days
The two malabsorption syndromes associated with chronic diarrhea are ____ and _____?
Celiac disease
Cystic Fibrosis
What are the 2 inflammatory bowel disease that are common with chronic diarrhea?
Crohn's disease
Ulcerative colitis
What common food allergy has been found to cause chronic diarrhea?
lactose intolerance
____ diarrhea of ____ is chronic diarrhea that occurs in the first few months of life.
Intractable diarrhea of infancy
The most common reason for intractable diarrhea of infancy is?
the mismanagement of acute diarrhea
This type of diarrhea is associated with normal growth and nourishment and common in children 6-54 months of age?
What is...Chronic non-specific diarrhea?

Thank you Alex Trabec! hahahaha
These two dietary products have been found to cause chronic non-specific diarrhea in children
What are apple juice and diet coke?

You are welcome Mich and Sara! hahahaa
In chronic non-specific diarrhea, are blood and infection often found in the stool?
No
The most common virus associated with acute diarrhea is?
Rotavirus
Salmonella, Shigella and campylobacter are common ____ that have been found to cause ____ ____?
Bacteria; acute diarrhea
What is the most common route to obtain an infection leading to acute diarrhea?
Fecal-oral
The most common parasite to cause acute diarrhea is ____?
Cryptosporidium
When a child is on extensive antibiotics, ___ should be incorporated into their regimen to prevent the development of _ ___.
Probiotics; C. diff
List the general methods of diagnosis for acute diarrhea.
-History
-Lab data: stool samples
-Urine specific gravity
-CBC, serum electrolytes, creatinine, BUN
What lab values can show the degree of dehydration?
Creatinine and BUN
What is an essential question to ask the caretaker of a child presenting with acute or chronic diarrhea?
"Has the child traveled outside of the country recently?"
If a child vomiting can they be given oral rehydration?
yes, but in small frequent amounts
What dehydration signs warrant hospitalization for a child?
-No urine output after 2 hours of oral rehydration
-Crying but not producing tears
-Cannot tolerate pedialite because of vomiting
Can mothers breastfeed during oral rehydration?
Yes, but alternate feedings with pedialite
What type of feeding is appropriate for bottle fed babies on oral rehydration?
Pedialite ONLY!!!
Once a baby is rehydrated, what can breastfeeding mothers do?
Go straight back to breastfeeding solely!
Once rehydrated, ____ fed infants must be slowly increased to their previous form of nutrition.
Bottle
For an older child that is recently rehydrated, what foods are part of the protocol for re-feeding?
Start with low sugar and carb and high fat. ie Chicken, fish, rice

No burgers, candy, cookies
What nursing intervention for diarrhea is essential in infants? Which product can help this?
Skin integrity. Use BUTT PASTE
What are the components of butt paste?
Zinc Oxide, vasoline, and an antibiotic