Flashcards in Dehydration - Fluid & Electrolytes Deck (42)
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1
Difference between children & adults r/t fluid & electrolytes
children can enter into dehydration much quicker
2
what makes children more susceptible to dehydration - physiological differences (5)
larger body surface area in relationship to their weight
increased baso-metabolic rate
inability to concentrate urine (urine is very diluted)
higher respiratory rate - (child resp. rate = 40)
under 3, body fluids aren't stored as efficiently (stored in extracellular compartment) - insensible fluid lose
3
urine specific gravity increases or decreases in a child with dehydration
increases (eg: 1.020)
normal range of urine specific gravity (1.003-1.030)
***THE HIGHER THE DRYER***
4
what is an insensible fluid lose
fluid lost at the surface
5
infants
no
6
when does posterior fontanel close
8 weeks
7
when does anterior fontanel close
12-18 months
8
a sunken fontanel is consistent with dehydration, t or f
true
9
% of extracellular vs intracellular fluids by age (e/i)
infant 40/40
toddler (3 yr) 30/40
adult 20/40
10
water balance is regulated by
ADH - anti-diuretic hormone = acts on kidney tubules to reabsorb h20
11
formula for fluid bolus when dehydrated
20ml/kg of isotonic solution infused over 4 hours
reevaluate dehydration symptoms (diaper, eyes, fontanel)
12
what does ORS stand for?
oral re-hydration solutions (pedialyte)
13
Cardiac symptoms r/t dehydration
increase in pulse rate (hr); then a decrease with later stage of dehydration
weak/thready pulse
14
Blood pressure r/t dehydration
bp drops - late sign - severe dehydration
resp failure - hypo-volemic shock
15
fluid overload s/s
cough
moist breath sounds
water intoxication
16
fluid for children is a delicate balance, t or f
true
17
***95% of your potassium (k) is excreted via your***
***kidneys***
Don't add K to iv fluids until wet diaper if oliguria or anuria. Too much K can build up in intravascular fluid.
18
Too much K (hyperkalemia) can lead to
arrhythmia's
cardiac arrest
19
Potassium values
PANIC (7.0 mEq/L)
infant 3.6-5.8
child 3.5-5.5
adult 3.5-5.3
20
classified hyperkalemia with value above
5
can lead to heart arrhythmia (can be seen on ekg)
21
hypokalemia value k is less than
22
risk for hypokalemia
child on diuretics
ingesting lg amounts of ASA
23
A child w/an NG tube should have what monitored closely
potassium levels
24
Dehydration types (3)
hypertonic dehydration (hypernatremic) = more fluid loss than sodium (sodium >150)
isonatremic dehyrdation (isotonic) = lose equal parts water and sodium (sodium levels in norm. range)
hyponatremic/hypotonic = more sodium loss than water, generally sodium is
25
most frequent dehydration we will run into
isotonic/isonatremic dehydration
26
body weight and dehydration
10% body loss = severe dehydration
5% body loss = mild dehydration
5-9% body loss = moderate dehydration
27
norm sodium levels
135-148 mEq/L
28
kids with cystic fibrosis experience which type of dehydration - particularly in summer
hyponatremic/hypotonic - loose more salt than water; salt tablets given to replace the loss
taste salty
29
2 different ways to classify dehydration
weight
serum sodium levels
30
most abundant cation & chief base of blood
sodium
31
children with hypernatremia are almost always
dehydrated
32
re-hydration solutions are made up of what?
75-90 mEq Na+ per liter - electrolyte solution
33
for severely dehydrated patients bolus with what?
20ml/kg of isotonic solution over 20 minutes (bolus)
34
for re-hydration follow this formula (after bolus)
calc. maint. fluids add additional fluids based on weight loss as follows:
50ml/kg for mild
100ml/kg for moderate
150ml/kg for severe
2/3 of fluids within 8 hours of admission
35
BRAT diet is not recommended t or f
true
36
If no urine output teach parent to
call the Dr
37
if child is admitted to the hospital with dehydration what should be part of your care plan
daily weights - same time/scale each day
accurate i/o
38
daily weights is the best indicator of what
fluid status
39
never give k in an iv push, t or f
true
40
whats d5 1/2?
dextrose 5%, .45 Na+
41
whats d5 1/3?
dextrose 5%, .33 Na+
42
