What health care conditions would decrease fluid requirements?
- Heart failure
- Oligouric renal failure
- Increased ICP
- Mechanical ventilation
- SIADH
- Post operative
What health care conditions would increase fluid requirements?
- Fever
- Vomitting
- Diarrhea
- Diabetes insipidus
- Increased UOP in renal failure
- Burns
- Shock
- Tachypenia
Children have lower GFR than adults until age 2: Normal urine output
Newborn is 1/2 mL/kg/hour
Child is 1 mL/kg/hour
GU Possible problems: more susceptible to trauma
- Fluid status problems and fluids eqilibrium infants and children are more vulnerable to fluid and electrolyte imbalances
- Increased proportion of water content and greater surface area
- Increased metabolic rate which increases HR, so water must be replenished
- immature kidneys
- Immature homeostatic regulation system
- Inability to shiver/sweat control temp.
- Increased daily exchange of extracellular fluid.
Structures involved in GU system
Kidneys
Ureters
Bladder
Urethra
Dehydration Assessment
- Skin turgor
- Mucous membranes
- UOP & frequency
- Tears
- Tachycardia
- Lethargy
- Usual type and amount of fluid intake
- Stools: # and consistency
- Fontanels
- Sunken eyes
- Dry skin
- Rapid deep breathing
- Shock (tachycardia-earliest sign)
- Metabolic acidosis
- Diagnostics: Concentrated urine, blood in urine, increased BUN, altered electrolytes
Nursing considerations/interventions for dehydration
1) Weight (need that baseline)
2) VS I&Os (weigh diapers)
3) Oral fluids
4) No potassium
5) Correct metabolic acidosis
6) Monitor labs
Dehydration: What is it? Why does it happen?
1) Output>Intake
2) Excessive fluid loss
3) Inadequate intake
4) Mild 5% pre-illness weight, moderate: 5-10% pre-illness weight, severe: >10% pre-illness weight
Mild dehydrate S/S
- Slight thirst
- normal pulse, RR, BP, weight loss (3-5% in infants, 3-4% in children), normal behavior, normal mucous membranes
Moderate dehydration S/S
- Slightly increased pulse, RR, Normal to orthostatic BP
- Increased thirst
- dry mucous membranes
- weight loss (6-9% in infants, 6-8% in children)
- Irritable
Severe dehydration S/S
- Pulse is very increased
- Hyperpnea
- BP is orthostatic to shock
- Intense thirst
- Parched mucous membranes
- Weight loss (>/= 10% in infants, 10% in children)
UTI: What is it? Why does it happen?
- May involve upper or lower urinary tract
- Increased number of microogranisms
UTI Risk
- 2-6 years
- More often in girls than boys (except for infants) because of how they wipe
- Urinary stasis
UTI assessment
- Abdominal pain
- Flank pain
- Foul smelling urine
- Jaundice in newborns
- Poor feeding
- Flu-like symptoms
- Urinary incontinence
- Diagnostics: Urine C&S, BUN, Creatine, KUB
Nursing considerations/interventions for UTI’s
- Prevention
- Educate s/s
Medical management for UTI’s
- Antibiotics
- Hydration
- Treat underlying cause
Types of UTI’s
1) Recurrent: repeated episodes
2) Persistent: bacteriuria despite antibiotics
3) Febrile: typically indicates pyelonephritis
4) Cystitis: Inflammation of the bladder
5) Pyelonephritis: upper urinary tract and kidneys
6) Urosepsis: bacterial illness; urinary pathogens in blood
Acute Glomerulonephritis (AGN) What is it? Patho?
- Inflammation of glomeruli (kidney filtration system)
- May lead to acute renal failure and heart failure
- May be a primary or secondary event
- Think infection with no UOP
Acute Glomerulonephritis (AGN) Risks
- Most common after a post-strep infection
- May show after strep infection, pneumococcal infection or viral infection- shows up to 10-14 days after primary infection
Acute Glomerulonephritis (AGN) Assessment
- Oliguria
- HTN
- Cardiac congestion
- Peri-orbital and peripheral edema
- Hematuria, increased specific gravity, mild protenuria
