Peds
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| Fluid Intake Formula | 1st 10 kg = 100 ml/kg
2nd 10 kg = 50 ml/kg
remainder = 20 ml/kg
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| Rickets | Vitamin D deficiency leading to impaired absorption of calcium and phosphorus
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| 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
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| 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
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| NX Interventions Rickets | Maintain body alignment,
prevent decubiti and infection
seizure precautions
handle gently and minimally
Have 10% calcium gluconate on hand (tetany)
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| Celiac Disease | malabsorption syndrome intolerance of gluten. villi atropy and results in decreased surface area for digestion in small intestine
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| 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
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| 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
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| 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.
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| 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
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| Special Infant Formulas | Pregermil
Portogen
Nutramagen
They have different protein and carb sources, more sodium, calcium and iron
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| 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
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| 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%
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| 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
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| Pulse Rate | one of first signs of shock
mild normal or slightly increased
moderate tachy
severe rapid and thready
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| 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
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| 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
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| 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
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| More S/S hypernatremia | thirst, dry sticky mouth develops slowly, flushed skin,
inc temp,
hoarseness,
oliguria,
N/V
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| 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
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| Causes Hyponatremia | fever/ perspiration esp if only replacing fluids with water not electrolyte solution, cystic fibrosis, burns and wounds, vomitting, renal disease
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| S/S Hyponatremia | weakness, dizziness, naseau, abd cramps, dec B/P. Small losses result in more severe physiological signs than isotonic types of loss
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| Water Excess (Intoxication) | excess intake or failure to excrete, incorrect preparation of formula
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| 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.
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| 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,
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| 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
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| 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
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| Predisposing Factors Diarhhea | age- not previously exposed to pathogens, malnourishment - villi will atrophy, warm climate, crowded substandard living conditions
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| Acute diarhhea | leading cause of death in children ,5 yrs r/t dehyddration
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| 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
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| Chronic Diarhhea | more gradual onset, persists 2 wks or more malabsorption syndromes, cystic fibrosis, celiac disease
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| 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
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| 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)
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| other causes of diarhhea | milk allergies, IBD, short gut syndrome r/t inadequate time for absorption
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| mild diarrhea | ,5% dehydration, few loose stool sdaily, terminates in a few days, no other illness, often result of food or stress
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| moderate diarrhea | 5-10% dehydration, several loose stools daily, fever, vomitting, irritability, usually result of infection,
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| Severe Diarrhea | 10-15% dehydration, numerous stools, flaccid and expressionless, eyes lack luster, cry w/o vigor, high pitched cry
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| Stool dontent diarrhea | undigested fat, CHO, small amounts protein large amnts H2O and electrolytes
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| Lab Values Diarrhea | hct, hgb, BUN and creatinine al increase
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| When do you culture stool for c diff | recent history of antibiotics accompanies diarrhea
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| ph of diarrhea | <6
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| polymorphic leukocytes | helps to distinguish bacterial vs viral causes of diarrhea
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| most common pathogen r/t diarrhea | rotovirus
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| 1 lb body wieght ='s how much fluid | 2 cups
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| what foods supplement K+ | banana, citrus, bran, legumes, peanut butter
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| what is most dangerous type of fluid loss | hypertonic
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| FTT | failure to thrive less than 5th percentile for height and weight
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| 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,
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| 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
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| 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
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| 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,
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| 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
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