CCC Pediatric Fluid and Electrolyte Imbalance
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| Types of GI disfunctions that affect fluid and electrolytes | vomiting/diarrhea; structural/obstructive defects; inflammatory processes; extremely vulnerable to infections
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| What is the cause of pediatric dehydration? | common body disturbance in infants and children, when output exceeds intake, regardless of the cause; result of sensible and insensible losses, lack of oral intake, diabetic ketoacidosis, burns
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| Factors affecting fluid imbalance in an infant/child | more vulnerable to alterations due to greater intake and output relative to size, body adjusts slower to imbalnces due to immature kidneys
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| ECF, infant to older child/adult | larger amount of ECF in an infant. 50% ECF, 50% ICF
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| Insensible loss | 2/3 through the skin, 1/3 respiratory
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| Body Surface Area (BSA) | new born has 2 to 3 times greater surface area than an older child/adult
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| Basal Metabolic Rate (BMR) | Higher than adults due to mass of active tissue
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| Three Types of dehydration | Isotonic, hypotonic, hypertonic
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| Isotonic Dehydration | primary form of dehydration, electrolyte and water deficits are approximately equal, may lead to hypovolemic shock. 0.90% NS
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| Hypotonic Dehydration | excess loss of electrolytes exceeds water deficit. Fluid moves from ECF to ICF. Physical signs are more severe. Na < 130 mEq/L. 0.90% NS and NPO
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| Hypertonic Dehydration | Water loss exceeds electrolyte loss. Fluid moves from ICF to ECF. Most dangerous type of dehydration. Na > 150 mEq/L. 0.45% NS
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| What happens with cerebral changes from shock? | They could be permanent
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| Early signs of dehydration | increased heartrate; postural hypotension, weight loss (mild <5%; moderate up to 10%; severe 10-15%)
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| Severe signs of dehydration | increased heartrate; decreased blood pressure; weak/thready pulse; shock; changes in consciousness; no tears; sunken fontanel; poor skin turgor, low urine output; capillary refill > 2 seconds; thirst; irratablity; dry mucous membranes; no visible pulse
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| Steps to Maintain Fluid Balance | Document accurate I/O on: IV therapy, CHF, major surgery, dehydration, diuretics, diabetes mellitus, corticosteroids, oliguria, renal disease or damage, respiratory distress, chronic lung disease, weigh diaper to determine urine output
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| PIV therapy site | site is associated with development; avoid sites over joints
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| Infant IV sites | hand, wrist, forearm, foot, ankle, scalp (up to 9m)
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| Child IV site | hand, wrist, forearm, avoid foot due to being ambulatory
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| Venous access site can be hampered by | hypovolemic shock or cardiopulmonary arrest
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| Intraosseus infusion | inserted into medullary cavity of the bone and provides rapid, safe and lif-saving alternate route for administration of fluids and medications until intravascular access can be obtained.
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| Complications of IV therapy | Infiltration and vessicant or sclerosing agents
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