Elimination pattern

Question 1

Content of Body fluids for an infant (%):

Answer 1

Infant- 70 - 80%
• Adult Female- 50 - 60%
• Adult Male- 50 - 70 %
• Older Adult- 45 - 55%

Question 2

3 compartments of BF:

Answer 2

intracellular fluid , extracellular fluid , transcellular fluid

Question 3

Diff between Intra vs Extracellular

Answer 3

Intra- 2/3 of Fluid within cells

Extra- 1/3 Fluid in blood or plasma,
and interstitial space

Question 4

Fluid in between cells (lymph)

Answer 4

interstitial

Question 5

Fluid within the blood vessels

Answer 5

intravascular

Question 6

Fluid in small and specialized cavities (synovium, CSF, pleura and peritoneum)

Answer 6

transcellular fluid

Question 7

diffusion of water/solvent molecule through a
selective permeable membrane (e.g.
cell membrane)

Answer 7

osmosis

Question 8

T or F
in osmosis, water moves to an area of low solute
concentration to a high solute concentration

Answer 8

T; salt goes; water follows

Question 10

___pressure exerted by proteins (mainly albumin) in blood to pull water into capillaries; has a capillary level of 25 mmHg

Answer 10

colloidal (proteins) osmotic pressure or oncotic pressute

Question 11

T or F
dec oncotic pressure moves water from intravascular space to interstitial space; fluid leaks into tissues, causing edema.

Answer 11

T

Question 12

Starling’s Law of Capillary Forces:

Answer 12

Hydrostatic Pressure (pushing out):
Created by the heart pumping.
Forces water out of capillaries into tissues.
Higher on the arterial end (e.g., 40 mm Hg).

Oncotic Pressure (pulling in):
Created by blood proteins.
Pulls water back into capillaries.
Higher on the venous end (e.g., 25 mm Hg)

Question 13

explain what happens in the arterial end and venous end

Answer 13

Arterial end: Hydrostatic pressure (40 mm Hg) > oncotic pressure (25 mm Hg) → fluid pushed out into tissue.

Venous end: Hydrostatic pressure drops (10 mm Hg) < oncotic pressure (25 mm Hg) → fluid pulled back into capillary.

Question 14

Proteins leak out into tissues → drops oncotic pressure in capillaries.

More fluid leaves capillaries and accumulates in tissues = interstitial edema

Answer 14

trauma induced interstitial edema

Question 15

which fluid spacing is this?

Normal distribution of fluid between:
Intracellular fluid (ICF) – inside the cells
Extracellular fluid (ECF) – outside the cells

Answer 15

1st fluid spacing

Question 16

which fluid spacing is this?

Abnormal accumulation of fluid in the interstitial space (between cells).

Answer 16

2nd spacing

Question 17

which fluid spacing is this?

fluid accumulates in a portion of the body; fluid is trapped and not available for functional use; e.g. ascites, sequestration of fluid
in abdomen, edema associated with burn

Answer 17

3rd spacing

Question 18

Ability of the solution to change
shape and size of cells

Answer 18

tonicity

Question 19

solution with a lower concentration of solutes and a higher concentration of water
• Less osmotic pressure
• Cause bursting of the cells (lysis)
• Examples:
- 1/4 % NS (25% salt)
- 1/8% NS (12.5% salt)

Answer 19

hypotonic

Question 20

• C o n c e n t r a t i o n o f solutes a n d w a t e r a r e t h e
same/equal on both sides of the cell membrane
• N o change in cells will be observed
• Examples:
• 0.9 NS solution
• Lactated Ringers (lactate converted as HCO3 in the liver)
• D5W

Answer 20

isotonic

Question 21

• solution has high concentration than solutes and lower concentration of water than cells
• for pump only and not run
• cells will shrink or “notch”
• examples: 3% or 5% NS sol, D10, D20, D30 (hypoglycemic)

Answer 21

hypertonic

Question 22

Burns - massive wound drainage
• High Fever more than 3 days
• Vomiting
• Diarrhea
• Failure to thrive
what does this condition cause…

Answer 22

dehydration

Question 23

loss of 10 ml/Kg body weight

Answer 23

diarrhea

Question 24

PARASITIC - AMOEBIASIS (Entamoeba Hystolitica)

Prevalence: 3% - 6%
• Ingested Cyst multiply; 2-4 weeks incubation
• S/S - Fever, abd cramps, watery or bloody stools
• Source: Fecal contaminated food & water
• Resistant t o Chlorine (Swimming pools)
• Recurrence- Liver abscess later life

what is the treatment?

Answer 24

T r e a t m e n t :
- O r a l M e t r o n i d a z o l e a n d Erceflora
Kiddie

Home Remedy:
- Lemon juice and probiotic yogurt
- Replace/Increase fluids PO

Question 25

Most common cause ECF depletion (dehydration)

Answer 25

gastroenteritis

Question 26

Reduces stool output by volume by 25% • Reduces vomiting by almost 30% • Reduces need for IV replacement therapy • Formula is hypoosmolar - Tri-sodium Citrate - Potassium Chloride - Sodium Chloride - Dextrose (sugar) - Water Ceralyte: One sachet per liter of safe w a t e r • Home made: 1 tsp salt + 6 tsp sugar/L • Administration: -< 2 years - 50 - 100 m L u p t o IL/day - 2-9 years - 100-200 mL up t o IL/day - ≥ 10 years - As tolerated up to 2L/da

Answer 26

ORS

Question 27

T or F D O N O T U S E H O N E Y T O C H I L D R E N O N E Y E A R O L D O R LESS - introduction of honey t o i n f a n t s c o u l d c a u s e C l o s t r i d i u m Botulinum b a c t e r i a infection f o u n d commonly found on soil and hone

Answer 27

T

Question 28

give the clinical manifestations of dehydration

Answer 28

• Weight Loss • Decreased sensorium (Irritability to Lethargy) • General appearance of being ill • Sunken Fontanels • No Tears and decreased diaper changes • Sunken eyeballs (late and severe sign)

Question 29

give the skin changes during dehydration

Answer 29

- loss of skin elasticity (wong) -Poor skin Turgor, pale, parched dry mouth (more than 5% loss) - Capillary refill >2 (mod) - Capillary refill >3 sec (severe) - Skin Mottling (severe, rare)

Question 30

WHO ASSESSMENT OF DEHYDRATION IN CHILDREN • Three best signs of Pediatric dehydration:

Answer 30

1. Prolonged Capillary refill >2 2. Abnormal skin turgor (+ skin tenting) 3. Abnormal respiratory pattern

Question 31

• Use Spoon, syringe or dropper • May insert NGT if patient is vomiting • U s e___ i n c a s e o f s e v e r e vomitin

Answer 31

ondansetron

Question 32

case of dehydration: When Patient is unstable with Symptoms of shock what treatment?

Answer 32

Give IV bolus with NS preferred or Lactated Ringer's

Question 33

MANAGEMENT OF DEHYDRATION - Replace total calculated fluids in____hrs -Recheck patient status every ____ hours for over hydration or under hydration -___ replacement therapy

Answer 33

24hrs; 8hrs; individualize

Question 34

i n c r e a s e s insensible water loss by approximately 7mL/kg 24 hours for each degree Fo rise in temperature above 37.2 C° (99 degrees F°)

Answer 34

fever

Question 35

Call the doctor for fever___ • Call the doctor if___ is not successful • Go to ER if the following symptoms occur (under 6 months) - Respiratory changes - - - Unusually sleepy/lethargic - Rash

Answer 35

> 3days; home ORS; Vomiting (12 to 24 hours) - Diarrhea (bloody stools) and abdominal pain

Question 36

Continue to__ your baby • Limit very sweet drinks • Give probiotics • Start O R S • Maintain___ • Maintain sanitation practices

Answer 36

breast feed; BRAT d i e t

Question 37

SHOCK STATES:

Answer 37

-Anaphylaxis -Sepsis -Fluid loss due to Burns, Trauma or Hemorrhage • Tachycardia (signs of Shock) • Age 0 to 1 yr # > 180/min • Age 2 t o 5 yrs = >|40/min • Age 6 -12 yrs = > |30/min • Hypotension (Orthostatic BP not done in peds)

Question 38

1 Gm wet diaper= 1 mL

Answer 38

remember mo lang

Question 39

"Given to severely ill children only. •Empirical coverage on certain strains of organism. •May be necessary in HIV, Crohn's Ds, malnutrition and immunocompromised children

Answer 39

ANTIBIOTIC TX