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90 Cards in this Set
- Front
- Back
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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. |
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What portions of insensible losses are through the skin?
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2/3
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The respiratory tract is responsible for what fraction of insensible losses?
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1/3
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What are the sources of fluid loss?
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Insensible, urinary and fecal
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What are the 2 parts of the extracellular compartment?
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-Intravascular fluid
-interstitial fluid |
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What is intravascular fluid?
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Blood and plasma
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What is interstitial fluid?
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Fluid that lies between the cells and the outside of the blood and lymphatic vessels.
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What compartment dominates the fluid volume in children under 2?
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The extracellular compartment
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WHy do neonates and young children have a high BSA?
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Body surface area:
because their brain and skin, which is rich interstitial fluid occupy greater proportion of their body weight |
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Which compartment is fluid often lost from first?
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The ECF
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What makes the up the ECF?
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Na, Cl, bicarb and calcium
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The ICF is composed of?
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K, Ca, Mg and Phosphorous
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At what age does the ICF begin to predominate the fluid volume of the body?
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age 2
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In terms of fluid and electrolytes what does the rapid growth rate of children put them at risk for?
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Fluid loss and thus require a larger amount of fluid intake
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Describe the issues with kidney of a child and their fluid and electrolyte balance?
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-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 |
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What are the daily fluid requirements for fluid mainenance?
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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 |
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What is the proper urine output for infants and toddlers?
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>2-3ml/kg/hr
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What urine output should be seen in preschool and young school age children?
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> 1-2 ml/kg/hr
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Older school age and adolescents have a normal urine output of?
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0.5-1ml/kg/hr
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How is dehydration classified?
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according to serum Na concentration and osmolarity
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What is the most common form of dehydration?
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Isotonic
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What is isotonic dehydration?
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FLuid and electrolyte loss in equal portions
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How will Na levels appear in a child with isotonic dehydration?
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WNL because water is lost in equal proportions
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What are the most common causes of isotonic dehydration?
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Vomiting and diarrhea
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What is the first treatment option for dehydration?
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Oral rehydration: pedialite
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What type of IV solution is most often given first for dehydration?
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Isotonic IV solutions
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What is the most common Isotonic solution given in the hospital for dehydratioin?
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0.9% NS
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What is the greatest threat related to isotonic dehydration>
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SHOCK!!
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What is hypotonic dehydration?
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Where the ECF loses its electrolytes
Electrolyte loss > H2O deficits |
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Which compartment becomes more concentrated during hypovolemic dehydration?
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The ICF
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What are some common causes of hypovolemic shock?
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running a marathon; drinking excess water without electrolytes; near miss drowning; diluting baby food to get more out of it.
-vomiting/diarrhea |
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What 2 disorders are often found to cause hypovolemic dehydration?
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SIADH and meningitis
SIADH can be caused by tumor or head trauma |
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What are some interventions for hypotonic dehydration?
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Restrict H2O
Take salt tablets take fluids with electrolytes |
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What are the symptoms of hypotonic dehydration?
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-Edema
-HTN -confusion -headache -increase in urine specific gravity -overall general weakness |
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What Na lab levels would indicate need for a HYPERTONIC solution?
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less than 110meq/l
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WHat is the most commonly used hypertonic solution in pediatrics?
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10% dextrose
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Why is administering a hypertonic solution dangerous?
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If it is infused too quickly it can cause cell shrinking!
You will see rapid changes in LOC |
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What are the serum sodium levels commonly seen in hypotonic dehydration?
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< 130 meq/l
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Describe hypertonic dehydration.
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H2O losses > electrolyte losses
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Which compartment is most concentrated in hypertonic dehydration?
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The ECF ore concentrated than the ICF
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What are the causes of hypertonic dehydration?
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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 |
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What are the symptoms of hypertonic dehydration?
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-Tachycardia
-fever -hypotension -decrease in cardiac output -oliguria -thirst -agitation |
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What will occur if a hypotonic solution is pushed too quickly?
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Cell swelling.
person will complain of headache as a result of cerebral edema |
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What are the general symptoms of dehydration?
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-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 |
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What are the symptoms that must be present for 5% dehydration to be diagnosed? How many are required?>
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> capillary refill > 2 seconds
> absent tears > dry mucus membranes > ill appearance At least 2 need to be present |
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What must the nurse monitor for a patient with dehydration?
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-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? |
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What are the common causes of increased K+ excretion?
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-diuretics
-osmotic diuresis (DM type I) -severe diarrhea -renal disease -elevation in aldosterone |
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What are the possible contributors to a decreased K+ intake?
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-bulimia/anorexia
--NOP without K in IV -vomiting -NG tube suctioning -metabolic alkalosis |
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Why does metabolic alkalosis cause hypokalemia?
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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
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What % of K ingested is excreted in urine?
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80%
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What are some symptoms of hypokalemia?
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-constipation
-muscle weakness -leg cramps -irregular, weak pulse -numbness of extremities -orthostatic hypotension |
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How do you treat hypokalemia?
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First find the cause:
-Diet? then change it -give fluids with K |
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What must a child be on if they are receiving IV fluids with K?
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A Heart Monitor!!
They may become hyperkalemic and get arrhythmias |
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What is the serum concentration to be considered hyperkalemic?
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Above 5.8mmol/l
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What are the causes of hyperkalemia?
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-Massive cell death
-excessive or too rapid K+ IV infusion -metabolic acidosis -diabetes -Drop in K+ excretion |
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LIst the symptoms of hyperkalemia.
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-abdominal cramping
-diarrhea -nausea -bradycardia -irregular pulse -muscle weakness (especially lower extremities) -ELEVATED T wave on EKG |
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What 2 drugs can be given to expel K from the body?
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Diuretics and Kayexalate
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What are 2 drugs that can help to drive K into the cell when a pt is hyperkalemic?
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Insulin and bicarbonate
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If a patient has skin breakdown, the nurse should recommend ____ be incorporated into their diet to help prevent hyperkalemia.
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Protein
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____ may be a required treatment for a pediatric patient in renal failure who is hyperkalemic.
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Peritoneal dialysis
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The life span of acute diarrhea is usually less than ___ days.
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14
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Gastroenteritis is an infection that commonly leads to ___ ____?
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Acute diarrhea
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What is gastroenteritis?
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Acute infectious diarrhea
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What are the common causes of acute diarrhea?
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-infection
-antibiotics -upper respiratory tract infections -laxatives |
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How long must diarrhea go on to be diagnosed as chronic?
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More than 14 days
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The two malabsorption syndromes associated with chronic diarrhea are ____ and _____?
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Celiac disease
Cystic Fibrosis |
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What are the 2 inflammatory bowel disease that are common with chronic diarrhea?
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Crohn's disease
Ulcerative colitis |
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What common food allergy has been found to cause chronic diarrhea?
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lactose intolerance
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____ diarrhea of ____ is chronic diarrhea that occurs in the first few months of life.
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Intractable diarrhea of infancy
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The most common reason for intractable diarrhea of infancy is?
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the mismanagement of acute diarrhea
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This type of diarrhea is associated with normal growth and nourishment and common in children 6-54 months of age?
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What is...Chronic non-specific diarrhea?
Thank you Alex Trabec! hahahaha |
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These two dietary products have been found to cause chronic non-specific diarrhea in children
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What are apple juice and diet coke?
You are welcome Mich and Sara! hahahaa |
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In chronic non-specific diarrhea, are blood and infection often found in the stool?
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No
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The most common virus associated with acute diarrhea is?
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Rotavirus
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Salmonella, Shigella and campylobacter are common ____ that have been found to cause ____ ____?
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Bacteria; acute diarrhea
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What is the most common route to obtain an infection leading to acute diarrhea?
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Fecal-oral
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The most common parasite to cause acute diarrhea is ____?
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Cryptosporidium
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When a child is on extensive antibiotics, ___ should be incorporated into their regimen to prevent the development of _ ___.
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Probiotics; C. diff
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List the general methods of diagnosis for acute diarrhea.
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-History
-Lab data: stool samples -Urine specific gravity -CBC, serum electrolytes, creatinine, BUN |
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What lab values can show the degree of dehydration?
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Creatinine and BUN
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What is an essential question to ask the caretaker of a child presenting with acute or chronic diarrhea?
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"Has the child traveled outside of the country recently?"
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If a child vomiting can they be given oral rehydration?
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yes, but in small frequent amounts
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What dehydration signs warrant hospitalization for a child?
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-No urine output after 2 hours of oral rehydration
-Crying but not producing tears -Cannot tolerate pedialite because of vomiting |
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Can mothers breastfeed during oral rehydration?
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Yes, but alternate feedings with pedialite
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What type of feeding is appropriate for bottle fed babies on oral rehydration?
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Pedialite ONLY!!!
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Once a baby is rehydrated, what can breastfeeding mothers do?
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Go straight back to breastfeeding solely!
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Once rehydrated, ____ fed infants must be slowly increased to their previous form of nutrition.
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Bottle
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For an older child that is recently rehydrated, what foods are part of the protocol for re-feeding?
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Start with low sugar and carb and high fat. ie Chicken, fish, rice
No burgers, candy, cookies |
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What nursing intervention for diarrhea is essential in infants? Which product can help this?
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Skin integrity. Use BUTT PASTE
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What are the components of butt paste?
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Zinc Oxide, vasoline, and an antibiotic
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