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Nutrition and Hydrat

Peds

QuestionAnswer
Fluid Intake Formula 1st 10 kg = 100 ml/kg 2nd 10 kg = 50 ml/kg remainder = 20 ml/kg
Rickets Vitamin D deficiency leading to impaired absorption of calcium and phosphorus
S/S Rickets large head, protrubent frontal bone pigeon chest w/ horizontal groove kyphosis, lordosis, scoliosis bowing pot belly r/t weak muscles tetany constitpation
Sunlight and Vtamin D 10- 15 minutes needed 3-4 times a week Too much sun degrades the bodies absorption of D SPF 8 and above also blocks absorption Darker skin needs longer exposure
NX Interventions Rickets Maintain body alignment, prevent decubiti and infection seizure precautions handle gently and minimally Have 10% calcium gluconate on hand (tetany)
Celiac Disease malabsorption syndrome intolerance of gluten. villi atropy and results in decreased surface area for digestion in small intestine
S/S celiac disease occurs 3-6 mos after gluten introduced to diet anorexia weight loss irritable severe abdominal distension muscle wasting (esp butt) FTT
S/S Celiac disease cont pain and vomitting, anemia r/t decreased iron, folic acid and B12 Inc clotting time r/t decreased vit k production, osteomalacia,dependent edema r/t dec protein
Tests & Labs Celiac hypoproteinemia, anemia, hypothrominemia, serum iron levels, folic acid and b 12, sweat test r/o CF, small bowel biopsy (definitive), detects atropy of muscle wall.
Treatment Celiac Disease Gluten Free diet, omit wheat, rye, barley and oats. Substitute rice, corn and soy, inc claories and protein, fruits and vegs for carbs supplemental vitamins, read food labels
Special Infant Formulas Pregermil Portogen Nutramagen They have different protein and carb sources, more sodium, calcium and iron
Type 1 DM less than 20 yrs. Can self test @ 10 yrs meals and snacks need to be consistent each day food distribution pattern should be calculated to fit activity pattern inc food for inc activity to prevent hypoglycemia
Isotonic Dehydration most common. Water and electrolytes lost in equal amounts. Serum Sodium remains 130-150. Loss determined by preillness weight and current weight Mild 5% loss Moderate 10% Severe 15% Dead 20%
Mild Hypovolemic Shock R/T isotonic fluid loss <50 mg/kg less than 5% fluid loss skin color pale skin turgor slight tenting mucous membranes dry urine output decreased B/P normal to slightly inc cap refill < 2 secs fontanels normal
Pulse Rate one of first signs of shock mild normal or slightly increased moderate tachy severe rapid and thready
moderate hypovolemic shock R/T isotonic fluid loss 50-90 ml/kg skin color gray skin turgor tenting mucous membranes very dry uoliguria < 400 ml day pulse tachy cap refill 2-3 secs sunken fontanels B/P normal to slightly decreased
severe hypovolemic shock r/t isotonic dehydration 100 ml/kg or 15% skin color mottled skin trugor tenting mucous membranes parched marked oliguria B/P decreased pulse rapid and thready cap refill . 2-3 secs
Hypertonic Dehydration (Hypernatremia) serum sodium > 150 Caused by inc sodium intake, renal disease, increaqsed protein intake, TPN Shock is less apparent changes in LOC (1st sign) seizures lethargy hypereflexia irritability to stimuli
More S/S hypernatremia thirst, dry sticky mouth develops slowly, flushed skin, inc temp, hoarseness, oliguria, N/V
Hypotonic Fluid Loss(Hyponatremia) Serum sodium , 130 Electrolyte defecit in ECF exceeds water deficit Results in shift of ECF to ICF. Cells swell larger amount of sodium inside cell
Causes Hyponatremia fever/ perspiration esp if only replacing fluids with water not electrolyte solution, cystic fibrosis, burns and wounds, vomitting, renal disease
S/S Hyponatremia weakness, dizziness, naseau, abd cramps, dec B/P. Small losses result in more severe physiological signs than isotonic types of loss
Water Excess (Intoxication) excess intake or failure to excrete, incorrect preparation of formula
S/S H20 Intoxication pulomonary or generalized edema,hepatomegaly, weight gain, lethargy, Inc CSF fluid pressure (bulging fontanels), seizures, coma, dec urine specific gravity (dilute, less concentrated), dec HCT, varable urine volume, poor regulation.
Characteristics that result in vulnerability to F&E loss in children Until age 2 children maintain a larger ECF than older children and adults, daily exchange of ECF is greater and ECF losses greater during acute illnesses, Greater BSA for weight, longer GI tract for body size, high %age of body warer, higher metabolic,
TX Water Intoxication educate parents causes, eliminate cause, limit fluid intake, administer diuretics if ordered, carefully monitor iv pump for infiltration, strict I&O's
TPN must monitror carefully as it is a hypertonic solution and cssan cause hypertonic dehydration r/t to the solute concentration. Momitor labs daily and more often if needed
Predisposing Factors Diarhhea age- not previously exposed to pathogens, malnourishment - villi will atrophy, warm climate, crowded substandard living conditions
Acute diarhhea leading cause of death in children ,5 yrs r/t dehyddration
S/S acute diarrhea sudden onset, self limiting, ROTAVIRUS, bacteria, arsenic, lead, emotional stress, over eating esp carbs iron supplements, other infections such as UTI, URI,antibiotics,otitis media
Chronic Diarhhea more gradual onset, persists 2 wks or more malabsorption syndromes, cystic fibrosis, celiac disease
Kwashiokor sudden and recent deprivation of food, 18 mos -2yrs, large protruding abd, emancipated child, hepatomegaly r/t protein defiiciency, can be result of measles, muscle wasting, dec ability to maintain fluid balance, hair loss, patchy scaly skin, sores
Marasmus severe deprivation of food over long period of time, overpopulated urban slums, diluted cereal drinks, muscle wasting and weakness, decreased learning ability, GI tract deteriorates (lining)
other causes of diarhhea milk allergies, IBD, short gut syndrome r/t inadequate time for absorption
mild diarrhea ,5% dehydration, few loose stool sdaily, terminates in a few days, no other illness, often result of food or stress
moderate diarrhea 5-10% dehydration, several loose stools daily, fever, vomitting, irritability, usually result of infection,
Severe Diarrhea 10-15% dehydration, numerous stools, flaccid and expressionless, eyes lack luster, cry w/o vigor, high pitched cry
Stool dontent diarrhea undigested fat, CHO, small amounts protein large amnts H2O and electrolytes
Lab Values Diarrhea hct, hgb, BUN and creatinine al increase
When do you culture stool for c diff recent history of antibiotics accompanies diarrhea
ph of diarrhea <6
polymorphic leukocytes helps to distinguish bacterial vs viral causes of diarrhea
most common pathogen r/t diarrhea rotovirus
1 lb body wieght ='s how much fluid 2 cups
what foods supplement K+ banana, citrus, bran, legumes, peanut butter
what is most dangerous type of fluid loss hypertonic
FTT failure to thrive less than 5th percentile for height and weight
S/S FTT social, motor, language deficits, developmental delays, dislike touching and holding, avoid eye contact, minimal smiling, interest in inaminate objects, irregularity of ADL's,
Charecteristics parents FTT maritial discord, lonely & isolated, linited or no support systems, may have received poor parenting, multiple life crisises, and stress, may have difficulty assessing childs needs and wants, physical or health problems, may have drug dependency, immaturi
S/S poor parental bonding hold baby away from body, no enfacement, hold baby infrequently, repulsed by baby's body fluids, believes child doesn't love them
Nursing considerations FTT primary concern is nutritional improvement, maintain accurate I&O, daily weights, calories sufficient to support catch up growth , establishing routine of care, assign orimary and secondary nurse for consistency,
Nursing considerations FTT 2 maintain face to face contact to encourage eye contact, welcome and encourage parental involvement, praise parents when they are appropriate with child
Created by: margaretptz