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