Exam 1: Fluid Balance And Imbalance Flashcards
(40 cards)
1
Q
Maintaining Water Balance: Increased requirements in
A
- Fever
- V/D
- Diabetes Insipidus
- DKA
- Burns, Shock, Tachypnea
- Warmer/Phototherapy
2
Q
Maintaining Water Balance: Decreased requirements in
A
- Congestive HF
- SIADH
- Mechanical ventilation
- Increased ICP
- Post-Op
3
Q
Fluid Balance/Imbalance: Differences in Children
A
- Infants and young children have greater need for water.
- Water and electrolyte disturbances occurs more frequently, more rapidly and adjust less promptly.
- Metabolism is higher -> higher rate of peristalsis.
- Kidney function is immature.
4
Q
Dehydration
A
Whenever the total output of fluids exceeds the total intake.
5
Q
What should the nurse monitor for dehydration?
A
- Monitor I&O closely: 1 g wet diaper = 1 mL urine
- Calculate fluid requirements! 100, 50, 20 rule.
6
Q
What are types of dehydration?
A
- Isotonic
- Hypotonic
- Hypertonic
7
Q
Isotonic Dehydration**
A
- Most common
- Reduces circulating blood volume
- Shock is the greatest threat to life.
8
Q
What are clinical manifestations of dehydration?
A
- No tears >3 months old**
- Tachycardia
- Dry mucous membranes
- Sunken eyes
- Sunken fontanel → anterior fontanel closes at 18 mo
- Loss of skin elasticity
- Prolonged capillary refill
- Decrease to no urine output (elevated urine SG >1.020)
- SHOCK
9
Q
Dehydration Symptoms: Shock
A
- Caused by severe depletion
- Preceded by tachycardia and signs of poor perfusion.
- BP alterations are a very late sign of shock
10
Q
Mild Dehydration: Signs and Symptoms
A
- <5% weight loss
- Normal VS
- Well alert
- Moist mucus membranes
- Capillary refill <2 seconds
- UO slightly decreased
11
Q
Management of Mild Dehydration
A
- Monitor amount of fluid lost
- Replace fluid orally: oral rehydration therapy aka pedialyte
- Continue age appropriate diet
12
Q
Moderate Dehydration: Signs and Symptoms
A
- 5-10% weight loss
- Weak pulse, fast RR
- Fatigued, thirsty and eager to drink
- Dry mucus membranes/sunken fontanel
- Decreased skin turgor, prolonged capillary refill
- Decreased, concentrated urine
13
Q
Management of Moderate Dehydration
A
- Oral rehydration solution; 50-100 ml/kg
- If can’t take oral, do IV bolus (20 ml/kg); evaluate after each bolus
- Can only bolus 3x’s max; After 3rd bolus give some sort of blood product.
- Resume age appropriate diet as soon as dehydration corrected.
14
Q
Severe Dehydration: Signs and Symptoms
A
- > 10% weight loss
- Tachycardia (bradycardia more severe)
- Decreased BP; increased RR
- Lethargic
- Drinks poorly, unable to drink
- Absent tears
- Minimal UO
- Depressed fontanel
15
Q
Management of Severe Dehydration
A
- IV therapy
- Bolus 20 ml/kg or NS or LR
- Evaluate after each bolus
- If able, also take oral rehydration
16
Q
How can you calculate percentage of weight loss?
A
- Old weight minus new weight
- Divide answer by old weight
- Multiply by 100
17
Q
Dehydration Management: What should not be given?
A
- Sports drinks make diarrhea worse, especially in children
- Do not give large amounts of water alone
- Do not give potassium if UO is not appropriate for age.
18
Q
Dehydration Treatment
A
- PO Replacement (if alert and awake): replacement of fluid loss over 4-6 hours with oral rehydration solution (i.e pedialyte)
- IV Rehydration (if unable to drink or drink adequate amounts): Administer isotonic solution (i.e 0.9% NS or LR)
19
Q
Dehydration: Administration of IV Bolus
A
- 20 ml/kg per bolus**
- Can only give 3 bolus because if you give a whole bunch of fluid, you are diluting the blood o oxygen rate will be low and pulse ox will go down.
- Will give blood after 3 bolus
20
Q
Urine Output by Age: Infant and Toddlers
A
> 2-3 ml/kg/hr
21
Q
Urine Output by Age: Preschool and Young school-age
A
> 1-2 ml/kg/hr
22
Q
Urine Output by Age: School-age and Adolescent
A
0.5-1ml/kg/hr
23
Q
Dehydration Management: What is particularly important to assess?
A
- I&O, UO, V.S.
- Daily weight
- Stools, Vomiting
- Sweating, behaviors
- Serum electrolytes
- Skin, mucus membranes, tears
- Anterior fontanel
24
Q
Water Intoxication
A
- Occurs less frequently than dehydration
- May occur after ingestion of large amounts of fluid.
- Decrease in serum sodium leads to CNS symptoms
- Could cause death
25
Symptoms of Water Intoxication
- Increased urinary output
- Irritable
- Headache
- Vomiting/diarrhea
- Seizures
26
Causes of Water Intoxication Include
- Outdoor activities
- Alteration in formula preparation in infants
- Excessive water ingestion
- Tap water enemas
27
Types of IV Access Include
- Peripheral IV
| - Central Lines
28
Central Line IV’s include
- PICC line
- Short-term Central Venous Catheter
- Broviac
- Portacath
29
Peripheral IV Guidelines
- Using a light to visualize the vein can be helpful
- Secure the IV site
- Keep fingers/toes accessible to check capillary refill
- Do not attach ID Band to the same extremities as IV (could act as a tourniquette)
30
How often should you check IV site?
Minimum q2h
31
How can you secure the peripheral IV site?
A “pillow” will help secure the site and keep it flat/straight, but only if needed.
32
What are the preferred peripheral IV sites?
...
33
Central Line
- Utilized for long term access
- Surgically placed
- An order is needed to discontinue
34
What is the most common complication of central line IV’s?
Blood stream infections
35
Management for Central Line IV’s
Dressing must be changed weekly.
36
PICC Line
- Done in arms and legs (NICU)
| - NOT sutured in so be careful with dressing changes!
37
Short-term Central Venous Catheter
- Neck or groin area
- 1-3 lumens
- Big catheter
38
Central IV: Broviac
- Comes out of the center of the chest
- Long term
- Surgical placed above heart on center of chest.
- Used for patients on TPN all the time.
39
What is important to remember about a Broviac IV line?
- Needs dressing on it so patient isn’t breathing on it.
- Needs to always be covered/sealed; needs to remain sterile!
- Sterile procedure to change the dressing
40
Central IV: Portcath
- Surgically placed under skin
- 1-2 lumens
- For chemotherapy and sickle cell therapy.
