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Fluid & Electrolyte

What is the maintenance fluid requirement for pts under 10kg? under 10kg =100ml/kg/day
Minimum urine output for all ages 1ml/kg/hr
Name the 4 factors that affect TBW (total body water) Age, Sex, Body fat content, and ECF (extracellular fluid)
The ____ surface area to body mass in infants contributes to fluid & electrolyte risk factors greater
____ basal metabolic rate in children (2-3X adult) contributes to fluid and electrolyte risk factors Higher
Immature ____ function contributes to fluid and electrolyte risk factor kidney
greater vulnerability to severe ____ losses contributes to fluid and electrolyte risk factors electrolyte
Risk factor for dehydration - body fluid loss in excess of fluid ____ gained
Risk factor for dehydration is that it is often associated with ____ imbalance sodium
Risk factor: Dehydration is to ____? diarrhea
Mild dehydration is less than ____ ml/kg TBW loss in 48hr period, Up to ____% loss of body weight, or____ water per kg in 24hr period loss Mild dehydration is less than 50ml/kg TBW loss in 48hr, up to 5% loss of body weight, and 15ml of water per kg loss in 24hr
Moderate dehydration is between ____ - ____ ml/kg TBW loss. Between ____% - ____% weight loss of body water. Moderate dehydration is between 50-90 ml/kg TBW loss and between 5-9% weight loss of body water
Severe dehydration is greater than ____ml/kg TBW loss or ____% or higher weight loss Severe dehydration is greater than 100ml/kg TBW loss and 10% or higher weight loss
mild dehydration manifestations include few ____ stools, ____ color complexion, ____ mucous membranes, ____ unchanged, and ____ behavior Mild dehydration manifestations include few loose stools, pale complexion, tacky mucous membranes, VS unchanged and normal behavior
moderate dehydration manifestations include ____ loose watery stool, irritability, ____ color complexion, ____ mucous membranes, ____ anterior fontanel, ____ pulse, BP ____, capillary refill ___ seconds. Moderate dehydration manifestations include several loose watery stool, irritability, grayish complexion, dry mucous membranes, sligt depression of anterior fontanel, increased pulse, BP normal or lower and capillary refill 2-3 seconds
severe dehydration manifestations include letargy, ____ skin, ____ mucous membranes, ____ anterior fontanel, ____ pulse, ____ BP, and capillary refill greater than ____ seconds. Severe dehydration manifestations include lethargy, mottled skin, parched mucous membranes, sunken anterior fontanel, rapid pulse, lower BP, capillary refill greater than 3 seconds
Sodium is normally between ____ - ____. Three classifications of dehydration are ____ ____ ____ Na 130 - 150. Isotonic, Hypertonic and Hypotonic
Isotonic dehydration is ____ loss of Na & Water Isotonic dehydration is EQUAL loss of Na & H20
Hypertonic dehydration is when water loss is ____ sodium loss? What is this seen in? Na level? Hypertonic dehydration is when water loss is greater than sodium loss. Seen in fever, burns, high protein with low water diet and not geting enough water. greater than 150 na level
Hypotonic dehydration is when water loss is ____ sodium loss. What is this seen in? Na level? less than, seen in renal failure or excessive water intake. less than 130 Na level
Other than sodium, what are three other imbalances associated with dehydration Potassium, metabolic acidosis and metabolic alkalosis
Therapeutic management of mild dehydration includes oraly rehydration solutions ____ ml/kg over ____ hours 50ml/kg over 4 hrs
Therapeutic management of moderate dehydration is ____ ml/kg over ____ hrs 100ml/kg over 4 hrs
A dehydrated child should not be given ____ to replace fluids because the sugar will cause extra ____ losses Gatorade extra electrolyte losses
Therapeutic management of severe dehydration includes IV fluids of ____ @ ____ml/kg/hr until ___ and ___ return to normal, then ____ ml/kg Therapeutic managment of severe dehydration includes IV ringer's lactate @ 40ml/kg/hr until pulse and behavior return to normal, then 50-100ml/kg
If urine specific gravity is over ____, need more fluid. greter than 1.20. Children don't consentrate urine well
With dehydration, which electrolyte is added to an IV after first void potassium
If a child has a hx of vomiting how often is 1 tsp of fluids given until vomiting stops 1 tsp every 2-3 minutes
Nursing interventions for dehydration: measurement of accurate ____, measurement of ____ gravity. Measurement of accurate I&O and specific gravity
Nursing interventions of dehydration: ____ fluid therapy, provide ____ intake, ____ care and ____ education parenteral fluid therapy, provide oral intake, skin care and parental education
Most common pathogen causing diarrhea in children, what color is the diarrhea, and is C. diff common in children? Rotovirus is the most common pathogen causing diarrhea and the diarrhea is bright green. C. diff not common in children
There are ____ million outpatient visits with diarrhea 1/5 million
____ hospitalizationa and approx ____ deaths due to dehydration 200,000 hospitalizations and approx - 300 deaths due to dehydration
What is the most common bacterial agent to cause diarrhea in children? Esherichia coli is the most common bacterial agent to cause diarrhea in children
T/F parasites can cause diarrhea True
A ___ infection outside GI tract can cause ___? systemic infection outside of the GI tract can cause diarrhea
The rotavirus cause ____ - ____% children hospitalized with diarrhea in US 50-88%
Worldwide there are about ____ million deaths worldwide due to diarrhea 11 million
typical age range for children to get diarrhea from rotavirus 6 months to 2 years
Adults have acquired ____ to the rotavirus acuired immunity
T/F the rotavirus is typically a year round infection. False - seasonal
Other than diarrhea, the rotavirus causes ___ & ____ Other than diarrhea, the rotavirus causes fever and vomiting
What are the vaccines for the rotavirus? Rotarix & Rotateq vaccine
Risk factor for diarrhea in young infants is a lack of ____ . Normal enteric flora
Risk factor for diarrhea in children is placing contaminated ____ in ____ contaminated fingers in mouth
Risk factor for children to get diarrhea is if they are on ____ therapy? Why? antibiotic therapy disrupts normal flora in GI
Therapeutic management for diarrhea includes assessment for ____ imbalance? If the pt is not vomiting whad diet can you use? Fluid and Electrolyte imbalance. As long as not vomiting can use regular diet
Therapeutic managment of diarrhea includes maintaining ____ therapy fluid & give adaquate diet
Why should antidiarrheal not be given to children? fluid loss in cells still going on even tough it stops diarrhea
Diahhrea nursing interventions include assess stool for ____, ____, ____ and ____. amount, color, frequency and consistency
Diarrhea nursing intervention includes monitor for signs of ____ and carefully assess ____ status? diarrhea nursing intervention includes monitor for signs of dehydration and carefully assess integument status
Diarrhea nursing interventions include monitor ____ studies and maintain adequate ____ & ____ requirement? diarrhea nursing interventions include monitor lab studies and maintain adequate fluid and caloric requirement
diarrhea nursing intervention includes parental teaching - call primary care provider if diarrhea has not improved in ____ hrs, ____ urine, ____ vomit. diarrhea nursing intervention includes parental teaching - call primary care provider if diarrhea has not improved in 24 hr period, decreased urine, or increased vomit.
If there is not improvement of diarrhea in 24hr period it may be caused by ____. bacteria
Nursing intervention of diarrhea is to education parents for signs and symptoms of ____ dehydration
What is the maintenance fluid requirement for pts between 10-20kg? 1000ml + 50 ml/kg for ea addl kg
What is the maintenance fluid requirement for pts over 20 kg? 1500ml + 20 ml/kg for ea addl kg over 20kg
_____is the largest, and is placed at the junction of the sagittal suture, coronal suture, and frontal suture; it is lozenge-shaped, and measures about 4 cm in its antero-posterior and 2.5 cm in its transverse diameter. anterior fontanelle (bregmatic fontanelle, frontal fontanelle)
_____ allows the skull to deform during birth to ease its passage through the birth canal & for expansion of the brain after birth? anterior fontanelle (bregmatic fontanelle, frontal fontanelle)
The younger you are the more water in the body. Therefore it is easier to get dehydrated. About ___ years old the TBW approaches that of an adult? 2 years old
Why do babies have difficulty to dilute and concentrate urine? immature kidney function
A 2 year old male arrive to ER with a Hx of Vomiting and diarrhea. The child weighed 40lbs (18.8 kg) 2 weeks ago. The present weight is 17 kg. What is the classification of this child's dehydration? 18.18-17 = 1.18 kg wt loss then 1.18/18.18 = 0.0649 or 6% wt loss
Where do you check skin turger on babies? Abdomen
Where do you check for perfusion? Top of hands & feet & ALWAYS check mucus membranes
With SEVERE Dehydration What do you as a nurse whant to do? Start an IV right away possibly the head, do not leave child,put baby on monitor. Get IV bag & tubing ready to go whilist they are trying to start IV. Have IV run by gravity, as fast as it can
What are the normal Na & K levels? Na 130-150 K 3.5-5.5
When is metabolic acidosis seen in a dehydrated pt? seen in vomitingand diarrhea, Ph will bedown also CO & Bicarbonates
When will metabolic alkalosis be seen in a dehydrated pt? Diuretics, if they are losing a lof of NG drianage
T/F Moderate dehydrateion theraputic management can only be given IV? False may be oral or thru IV
In a dehydrated pt when can they go back from IV to eating orally? What is normal maintenance therapy of this pt? normal fluid maintenance for wt (plus stool loss) continue breast feeding and/or regular diet AFTER rehydration is achived. So symptoms return to normal.
How much ORS would a 5kg infant with mild dehydration intially require per hour? 50/kg over 4 hrsso 50 x 5 = 250 ml over 4 hrs250/4 = 62.5 ml/hr
What is the daily fluid requirement for a 25 kg child? over 20 kg = 1500ml + 20 ml/kg foreach kg above 20kg1500 + (20 x 5) = 16001600/24hrs = 66.67
In severe dehydration if the pt is unable to take PO & ongoing replacement is need (___ replacement is given 1st ___ hrs, then remaining volume in the next ___ hrs)? If unable to take po & ongoing replacement is needed ( 1/2 replacement is given 1st 8 hrs, then remaining volume in the next 16 hrs)
What happens too the HR with excess fluid? bounding HR
How many days of vomiting before pt will be put on TPN? 3 days
Do you want to give a diarrhea pt a lot of juice and caffine? Why? Dont give concentrated juices because of sugar contenet will further dehydrate them and caffine causes increased water and sodium loss
What is the brad diet? it consists of bannas rice toast and tea. It is no longer recommened because it is high carb low protein
What is the minimum amount of wet dippers a pt should have? 5
T/F Child may be left on IV fluids for 3 days then they go to TPN True because you dont want their calories affected
Make sure the parents know to bring their child back in if they have ___ in stool or emesis? blood
Created by: cgwayland
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