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PHA 397 - Make-Up Therapeutics > Exam 1 - Outpatient Pediatric Fluid and Electrolytes > Flashcards

Exam 1 - Outpatient Pediatric Fluid and Electrolytes Flashcards

(104 cards)

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1
Q

Who has more TBW, Premature babies or Adults?

A

Premature babies

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2
Q

Which is higher in premature babies, ECF or ICF?

A

ECF

-50% in premature babies, while ICF is 35% in premature babies

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3
Q

What is the calculation for % of dehydration in peds pts?

A

% Dehydration = (Normal wt - Actual wt)/Normal wt

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4
Q

What are the 3 stages of dehydration?

A

1) Mild
2) Moderate
3) Severe

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5
Q

What is the % dehydration that is mild dehydration?

A

<5%

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6
Q

What are the s/s of mild dehydration?

A 
Normal to dry mucous membranes
Slight thirst
Tears present
Normal skin
Flat anterior fontanel
Slightly increased urine specific gravity
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7
Q

What is the % dehydration that is moderate dehydration?

A

6-9%

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8
Q

What are the s/s of of moderate dehydration?

A 
Irritable 
Moderate thirst 
Dry mucous membranes
With or without tears
Anterior fontanel may or may not be sunken in 
Skin +/-
Increased urine specific gravity
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9
Q

What is the % dehydration that is severe dehydration?

A

10-15%

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10
Q

What are the s/s of severe dehydration?

A 
Hyperirritable to lethargic
Intense thirst
Parched mucous membranes 
Absent tears 
Sunken anterior fontanel 
Tenting skin 
Significantly increased urine specific gravity
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11
Q

T/F: Clear liquids are always super helpful.

A

FALSE

-Misconception that they are helpful

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12
Q

Why are clear liquids not always helpful?

A

B/C they are hyper-osmolar and lack electrolytes

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13
Q

What should be used instead of clear liquids in dehydration?

A

Glucose-Sodium coupled transport mechanism

-Ration of 1 - 2:1 (glucose:Na)

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14
Q

What is the concern with more osmolar liquids?

A

DIARRHEA

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15
Q

When do you refer to MD for dehydration?

A 
Young age (<6 months, <8kg) 
High risk - DM
Fever >38 C for infants <3 months or >39 C for infants 3-36 months 
Visible blood in stool, high output
Persistent vomiting 
Change in mental status
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16
Q

When does mild to moderate dehydration begin?

A

AT HOME

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17
Q

What is the ORS dosage for rehydration in mild to moderate dehydration?

A

50-100 mL/kg over 4 hours

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18
Q

Over how many hours should ORS be given in mild to moderate dehydration?

A

OVER 4 HOURS

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19
Q

How many mL per kg of body weight or ORS should be given in mild to moderate dehydration?

A

50-100 mL/kg body weight

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20
Q

In mild to moderate replacement of losses, how many mL should pts weighing <10 kg receive?

A

60-120 mL ORS for each diarrheal stool or vomiting episode

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21
Q

How many oz is 60-120 mL ORS?

A

2-4 oz

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22
Q

In mild to moderate replacement of losses, how many mL should pts weighing >10 kg receive?

A

120-240 mL ORS for each diarrheal stool or vomiting episode

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23
Q

How many oz is 120-240 mL ORS?

A

4-8 oz

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24
Q

T/F: During oral rehydration you can consume lactose.

A

FALSE

-Avoid lactose

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25
During oral rehydration, what foods should older children avoid?
Foods high in simple sugars - Soft drinks - Undiluted apple juice - Jell-o - Presweetened cereal
26
Why is the BRAT diet not recommended for prolonged use?
Inadequate energy and protein content
27
What are the must use IV rehydration conditions?
Bloody diarrhea Severe dehydration (shock or near shock, >10% fluid deficit) If pt has an intestinal ileus Intractable vomiting High stool output (>10 mL/kg/hr) associated with lower rate of success with ORS
28
Who has the most maintenance caloric requirements?
Premature neonates | -The younger you are the more you get
29
What are the advantages of enteral over parenteral nutrition?
- Maintenance of structural and functional GI integrity - Decreased potential for bacterial translocation - Enhanced utilization of nutrients; improved glucose tolerance and decreased hyperinsulinemia - Greater ease and safety of administration - Decreased hepatobiliary complications associated with TPN - Decreased cost
30
Name the indications for Enteral Nutrition.
Diminished ability to ingest nutrients Failure to meet full nutritional needs orally Altered absorption or metabolism of nutrients (chronic diarrhea, short bowel syndrome, inflammatory bowel disease, GERD)
31
Name the contraindications to Enteral Nutrition.
``` Necrotizing enterocolitis GI obstruction Intestinal atresia Severe inflammatory bowel disease Acute pancreatitis ```
32
What macronutrient do you consider most important for the development of an infant?
PROTEIN
33
What minerals and vitamins become exceedingly important for a premature infant?
Ca Vitamin D Phosphorus
34
What is the gold standard feeding for babies?
Breast milk
35
T/F: Breast milk provides immunologic protection.
TRUE
36
How long does the American Academy of Pediatrics recommend breast feeding?
For the first 6 months of life and continuation for the second 6 months as optimum nutrition in infancy
37
Name the benefits of breast milk.
- Optimum nutrient for term and near term infants - Anti-infective properties reduce instances of bacterial and viral illnesses - Suggested to lower the risk of immune-mediated dx (Crohn's disease, DM, Eczema, Asthma, Allergic gastroenteritis) - Psychological and long-term cognitive advantages
38
Name the contraindications to breast feeding.
- Contagious lesions on the breast (syphillis or herpes) - Chickenpox or shingles - Pertussis - Cytomegalovirus - TB - HIV - Hep B if untreated - Infant intolerance to breast milk - Certain meds - Permaturity (<35 weeks gestation)
39
T/F: You still need to fortify and add protein to donor breast milk.
TRUE
40
T/F: Donor breast milk is un-pasteurized.
FALSE | -Donor breast milk is pasteurized
41
Who needs human milk fortifier?
Very low birth weight infants receiving breast milk
42
What does human milk fortifier contain?
Extra sodium, calcium, phosphorous, vitamins, and calories ALSO - protein and fat (iron)
43
Name the two hydrolyzed human milk fortifier products.
1) Enfamil Human Milk Fortifier - Mead Johnson | 2) Similac Human Milk Fortifier - Ross
44
Name the 100% donor human milk - human milk fortifier.
Prolacta
45
What is the concern with Prolacta?
It displaces volume of moms breast milk
46
What makes breast milk best?
Increased immunity Decreased autoimmune disease Higher IQ
47
Name the 2 pre-term infant formulas.
1) Similac Special Care | 2) Enfamil Premature Formula
48
What formula do low birth-weight infants requiring rapid growth need?
Pre-Term formula
49
What does Pre-Term formula contain?
Increased proteins, Calcium, and Phosphorous
50
T/F: Babies taking Pre-Term formula do not require supplemental iron.
FALSE | -Babies taking Pre-Term formula require supplemental iron
51
Name the two Transitional formulas.
1) Neosure | 2) Enfacare
52
What type of formula is Similac Special Care?
Pre-Term formula
53
What type of formula is Enfamil Premature Formula?
Pre-Term formula
54
What type of formula is Neosure?
Transitional formula
55
What type of formula is Enfacare?
Transitional formula
56
What formula do infants requiring increased caloric intake at discharge from hospital need?
Transitional formula
57
T/F: Pre-Term formula is OTC.
FALSE | -Pre-Term formula requires prescription
58
T/F: Transitional formula is OTC.
TRUE
59
Who needs Transitional formula?
Former premies, babies between 34-37 weeks
60
What does Transitional formula contain?
Increased protein, calcium, vitamins, and mineral | -Less than Pre-Term formula
61
Which type of formula can you ad lib feed?
Transitional formula
62
Name the 5 milk protein term formulas.
1) Similac 2) Enfamil 3) Enfamil Enspire 4) Enfamil AR 5) Similac for Spit-Up
63
Who needs milk protein term formula?
Normal full-term infants with no special nutritional needs | Supplement breast-fed infants
64
What type of formula is Enfamil Enspire?
Milk protein term formulas
65
What type of formula is Enfamil AR?
Milk protein term formula
66
What type of formula is Similac for Spit-Up?
Milk protein term formula
67
Which two formulas are good for spit-up and decrease the need for a PPI or H2RA?
Enfamil AR | Similac for Spit-Up
68
Name the partially hydrolyzed allergy formulas.
1) Similac Sensitive 2) Similac Total Comfort 3) Enfamil Gentlease 4) Enfamil Sensitive 5) Enfamil Reguline
69
Which two formulas can be used for opioid withdrawal babies?
1) Similac Sensitive | 2) Enfamil Gentlease
70
Which of the partially hydrolyzed formulas is lactose free?
Similac Total Comfort
71
What are partially hydrolyzed allergy formulas for?
Gassy, fussy babies
72
Name the soy allergy formulas.
1) Isomil | 2) Prosobee
73
Who would need a soy allergy formula?
- Children sensitive to cow's milk - Following diarrhea - Lactose intolerance - Lactase deficiency - Galatosemia
74
T/F: Some of the soy allergy formulas are lactose free.
FALSE | -Soy allergy formulas are all lactose free
75
What type of formula is Prosobee?
Soy allergy formula
76
Name the Casein Hydrolysate based formulas.
1) Nutramigen 2) Alimentum 3) Pregestimil
77
What type of formula is Alimentum?
Casein Hydrolysate based
78
What type of formula is Pregestimil?
Casein Hydrolysate based
79
What type of formula is Nutramigen?
Casein Hydrolysate based
80
Who needs Casein Hydrolysate based formulas?
Babies that can't tolerate cow's milk protein or soy protein
81
What are some additional additives to milk ("MLLPP")?
``` Milk Fat Globule Membrane Lutein Lactoferrin Prebiotics Probiotics ```
82
Name the elemental formulas.
1) PurAmino 2) Neocate 3) EleCare
83
What is in "Advance" and "NeurPro" formulas?
DHA & ARA | -Added fatty acids - helps with visual acuity and gives higher IQ in babies
84
Name the 2 older child formulas.
1) Pediasure | 2) Kindercal
85
Who needs older child formulas?
Older children not eating well, hospitalized, tube feedings, etc.
86
What formula is best for a premature infant with increasing bradys within 30 minutes of feeding?
Similac for Spit-Up | Enfamil AR
87
What formula is best for an infant with an intolerance to cow's milk protein?
Lactose free - Soy formula = "IP" I - Isomil; P - Prosobee Casein Hydrolysate formula = "NAP" N - Nutramigen; A - Alimentum; P - Pregestimil Free amino acid formula = "PEN" P - PurAmino; E - EleCare; N - NeoCate
88
What are the infant caloric needs?
100-120 kcal/kg/day
89
Do Pre-term or Term infants need more calories?
Pre-term infants need more calories (120 kcal/kg/day)
90
What are the infant fluid needs?
140-160 mL/kg/day
91
20 kcal/oz = ?
20 kcal/30mL
92
How many feedings is an infant getting if they feed every 3 hours?
8 feedings 24 hr/3 hr = 8
93
Who needs multivitamins?
Preterm infants | High risk infants for >6 months
94
Who needs vitamin D?
Preterm infants | Term breastfed infants
95
Who needs iron?
Preterm infants if NOT FULLY supplied in preterm formula or breast milk fortifier High risk infants Term infants at 4 months
96
What amount of iron do preterm infants <32 weeks gestation need?
Infants <32 weeks gestation need 4-6 mg/kg/day
97
What amount of iron do preterm infants >32 week gestation need?
Infants >32 weeks gestation need 2-4 mg/kg/day
98
When should infants receive fluoride?
Around 4 months, if exclusively breast fed
99
What is protein a good source for?
LENGTH
100
What labs are measured for bone mineralization?
- Ca - Phos - Alkaline phosphatase - X-ray/Skeletal survey
101
What is prealbumin a good indicator of/for?
As kids get older prealbumin helps tell if they are growing and getting enough protein
102
What macronutrient do you consider most important for the development of an infant?
PROTEIN
103
When is the composition of carbohydrates in infant formula a concern?
Lactose
104
What minerals and vitamins become exceedingly important for a premature infant?
Ca Vitamin D Phos

PHA 397 - Make-Up Therapeutics (15 decks)

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