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Fall - Pediatrics > F&E and Respiratory > Flashcards

F&E and Respiratory Flashcards

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1
Q

What is the difference between dehydration and volume depletion?

A

Dehydration: Hypernatremia with water loss (losing water as sodium rises)

Volume depletion: Isotonic loss - water and sodium are lost equally

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2
Q

What is TBW mad up of?

A

Intracellular and extracellular fluids

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3
Q

What are intracellular fluids

A

Fluids in the cell

Remain constants at 35% throughout lifespan

No easily affected by fluid shifts

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4
Q

What are extracellular fluids? Are they affect by fluid shifts?

A

Intravascular plasma, cerebrospinal fluid, digestive secretions, pleural and pericardial fluids, synovial fluids, interstitial spaces, lymph fluids, collagen

Change throughout lfiespan

Susceptible to fluid shifts

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5
Q

When does the distribution of TBW become normal?

A

around 5 years old

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6
Q

What is the difference between the distribution of fluids in children under 5 and those over 5?

A

Under 5: More volume in the extracellular so unstable and can shift rapidly with changes in either metabolic or environmental facts causing F&E imbalances

Over 5: More volume in intracellular so their fluid is more stable

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7
Q

What is TBW maintained at? How do I&Os affect this? What is the percent of oral intake?

A

TBW is maintained at 0.2% of body weight over a 24 hour period

Intake should equal output

About 70% of intake is orally

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8
Q

What is the insensible water loss of an infant?

A

20-30%

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9
Q

What are pediatric risk factors for fluid and electrolyte imbalances?

A

Increase ECF –> rapid fluid shifts
Increased ISW loss –> rapid fluid shifts
Immature kidneys
Immature immune system
Cant express thirst (infant/toddlers, developmentally delayed)

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10
Q

What are examples of ISW loss that increase the risk for F&E imbalances?

A

Increase BSA vs. Wt
Increased metabolic demands
Inpatient interventions (suctioning, hyperventilation d/t inaccurate vent settings, radiant warmers, phototherapy)

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11
Q

How do immature kidneys put a child at increased risk of F&E imbalances?

A

Kidneys do not respond to ADH or aldosterone so they are unable to adjust to fluid shifts

Cant concentrate urine/acidify urine

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12
Q

How do immature immune system put a child at increased risk of F&E imbalances?

A

Fevers

React to any type of sickness with a high fever –> metabolic demands, transepidermal fluid loss, insensible fluid loss

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13
Q

What is shock?

A

condition that peripheral tissues and end organs (kidney, brain, skin, GI tract) do not receive adequate oxygen and nutrients

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14
Q

A child with fluid loss could lead to..

A

hypovolemic shock

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15
Q

What is the clinical assessment of mild (less than 5%) of body weight fluid loss?

A

Normal VS
Active and well appearing
Mildly decrease UO
Moist MM, AF flat, has tears, eyes not sunken
Cap refill and turgor are normal
No thirst

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16
Q

What is the clinical assessment of moderate (5-10%) of body weight fluid loss? (9)

A

VS slight increased
Irritable but consolable
Abnormal skin turgor
Cool extremities
Decrease UO/concentrated UA
Sunken eyes, decrease tears, dry MM
Depressed anterior fontanel
Cap refill 2-4 seconds
Thirsty

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17
Q

What is the clinical assessment of severe (over 10%) of body weight fluid loss? (11)

A

HR tachy to Brady
Thready pulse
Hypotension (late)
RR deep and rapid
Obtunded/coma
Cold, mottled extremities
Cap refill over 4 seconds
Oliguria/anuria
AF markedly depressed
MM parched, no tears
Skin tenting

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18
Q

What is the minimum UO for under 3? 3-10? over 10?

A

Under 3: 2-3mL/kg/hr

3-10 years: 1-2 mL/kg/hr

Over 10: 0.5-1 ml/kg/hr

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19
Q

Why do we expect more UO in infants/under 2

A

Can’t concentrate urine so still urinating despite volume depletion therefore UO is not on PEWS and is a late indicator

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20
Q

Why are tears not an accurate indicator of hydration in infants?

A

Tears do not form until 6 months old

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21
Q

What is AKI define by?

A

less than 1 mL/kg/hr

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22
Q

IV fluid resuscitation is indicated in..

A

Moderate to severe dehydration

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23
Q

How is IVF resuscitation given?

A

Given via two phases

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24
Q

What is phase one of IVF

A

Restores intravascular volume to prevent hypovolemic shock

Rapid and agressive

Initial bolus 20mL/kg of isotonic fluid (0.9% NS or LR) over 5-20 minutes

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25
How often should you assess after a bolus for phase one IVF resuscitation? Can you repeat?
Assess s/s of hydration and improvement after each bolus hourly Can be repeated based on % of BW loss
26
What is phase two of IVF
Ongoing deficit replacement Routine and less urgent 4-2-1 fluid calculation rules of ongoing losses
27
When is oral rehydration solutions indicated?
Mild to moderate dehydration
28
What is ORS? How can it be given?
Balanced F&E drinks for infants Orally, Gtube or NG tube
29
What is phase one in ORS? Phase 2?
Phase 1: 50-100 mL/kg bolus Phase 2: ORS after each stool 60-240mL based on weight. Should do small sips 5mL (teaspoon) every 2-5 minutes so that the stomach is able to handle it and not cause vomitting
30
Should you continue breast milk/formula with ORS? Should you dilute?
Yes you should Alternate between formula/breast milk and ORS DO NOT dilute milk with ORS because it is usually done incorrectly and can cause hypoNa or HyperNa seizures
31
What is appropriate oral rehydration for a 12 month old? Why?
Pedilyte Infalyte Both electrolyte balanced
32
What oral rehydration is inappropriate? Why?
Gatorade and apple juice is high in carbs/sugar which can cause an osmotic effect --> diarrhea Water and juice have no electrolytes so not replacing sodium Milk - lactose which can trigger diarrhea
33
What are gastroenteritis considerations?
1. Implement transmission based precautions 2. Assess and monitor F&E with strict I&Os, labs PEWS, daily weights 3. Maintain fluid balance - don't want to fall behind so stay on top of fluid losses and adjust accordingly 4. IV assessment every hour for complications 5. Avoid food and drinks high in sugar, avoid greasy foods, ORS 6. Probiotic: lactobacillus 7. Avoid pesto/immodium/ASA/NSAID
34
Why do you use a probiotic in patient with gastroenteritis?
To restore normal GI flora
35
Why do you avoid pepto/immodium in patients with gastroenteritis
These medications slow down the transit of stools and the most common cause of diarrhea in children is infections so want to get it out of the body not slow it down
36
What do popcorn and balloons have in common?
They are the leading cause of choking in children
37
What is a childs airway like?
SMALL Size of a straw Can easily be obstructed
38
What is the alveolar development in a child? When is it fully developed?
Lack surfactant Poor alveolar compliance (especially before 34 weeks old) Ari trapping 3-8 years fully developed
39
What are children's respiratory muscles like?
Weak Fatigue easily Poor reserves Accessory muscle use
40
Why does small airway, undeveloped alveoli and weak respiratory muscles matter?
Increases the risk of obstruction and aspiration especially with foreign objects, edema, and mucus Wheeze b/c you are able to hear more since less fat, CT and muscle Increased use of accessory muscles Fatigue easily --> Resp failure Air trapping d/t poor alveolar compliance (barrel chested)
41
What are upper respiratory disease? What is the problem they cause?
Croup Epiglottis Tonsilitis Choking Airway obstruction
42
What are lower respiratory diseases? What is the problem that they cause?
Pertussis Bronchiolitis (RSV) - pneumonia Chronic lung diseases like cystic fibrosis and asthma
43
How do you prevent respiratory diseases?
Vaccines Avoid second hand smoke
44
What is the defining point between upper and lower respiratory disease?
Trachea
45
What is included in the basic respiratory assessment?
Rate Effort (retractions, depth of resp, position) Air movement (coughing??) Breath sounds - upper vs. lower Need for oxygen
46
What does positioning look like for a child that is experiencing respiratory distress?
Tripod position Leaning on hands, mouth open, almost looks like sniffing
47
What are signs of early respiratory distress?
Increase RR Wheezing Coarse respirations
48
What are signs of moderate (9)
Retractions Grunting Wheezing Irritability/anxiety Tachycardia Tachypnea HTN Orthopnea Nasal flaring
49
What are signs of severe respiratory distress? (9)
Bradycardia Hypotension Decrease RR Quiet chest Cyanosis Stupor Coma See raw chest Tripod positioning
50
Why is a quiet chest not a good sign?
Misleading b/c think they are getting better but it is really quiet because there is no movement of air
51
What retractions are mild?
Isolated substernal and subcostal retractions
52
What retractions are moderate?
Substernal and subcostal retractions Suprasternal and supraclavicular retractions
53
What retractions are severe?
Substernal and subcostal retractions Suprasternal and supraclavicular retractions Use of accessory muscles in neck Sternal retractions
54
What is epiglottitis caused by? Is it serious?
Bacterial - haemophilus influenza LIFE THREATENING
55
On assessment of epiglottitis what would you expect?
4 D's Dyspnea Dysphagia Drooling Distress Tripod Inspiratory strider Sore throat High fever
56
What should you not assess with epiglottitis?
DO NOT assess oropharynx
57
What is the treatment for epiglottitis?
Urgent intubation IV antibiotics IVF HIB vaccination
58
What is croup caused by? What does it affect? Treatment?
Viral Larynx/trachea Usually self limiting
59
What would you expect to see on assessment of a patient with croup?
Barky cough Worse at night
60
What is the treatment for croup?
Symptomatic treatment Cool humidified air Racemic epinephrine Dexamethasone IVF
61
What is bronchiolitis caused by? Who is at high risk? Is hospitalization required?
Viral infection < 2 years 80% respiratory syncytial virus (RSV) Preemies high risk for hospitalization Under 2 months routinely hospitalized
62
How is bronchiolitis transmitted? Is it a seasonal disease?
Droplet b/c very contagious Winter and spring
63
Is pertussis preventable? How?
YES Tdap vaccine
64
What does upper airway disease cause? What is the goal for treatment?
Ineffectively airway clearance Goal is to clear the airway
65
What does a lower airway disease cause? What is the goal for treatment?
Impaired gas exchange Goal is to optimize gas exchange
66
What is a common complication of both upper and lower respiratory disease? Why?
Fluid volume deficit Especially if it is infectious and causes a fever which leads to ISWL
67
What are common respiratory interventions for both upper and lower respiratory diseases?
1. Reassess every 1-4 hours 2. Conserve energy by clustering care and small/frequent feeds 3. Oxygen 4. Suctioning 5. IVF 6. Strict I&Os 7. Infection control w/ precautions 8. Medications (antibiotics/antivirals, inhalers/nebulizers, steroids) 9. Evaluate for improvement
68
What is asthma? What causes it? What do you hear?
Inflammation of the airways Caused by environmental triggers, URIs Silent chest (not moving air)
69
What is the treatment for asthma? How do you prevent it?
Treated with SABA Prevent with an asthma action plan, avoiding triggers, and vaccines (annual flu)
70
What is cystic fibrosis?
Genetic autosomal recessive disorder Causes excessive loss of NaCl due to a defect in Cl receptors Slaty skin Thick/dehydrated secretions
71
Who does cystic fibrosis commonly affect?
Caucasian males
72
How do you diagnose CF?
Sweat test
73
What happens to the lungs with CF?
1. Airway obstruction (mucus) 2. Chronic infection 3. Chronic inflammation 4. Impaired gas exchange 5. Fibrosis
74
What are major clinical s/s of CF?
Salty tasting skin Chronic respiratory problems Lung infections Poor growth/weight loss Meconium ileus Chronic obstructions in GI d/t mucus Issue w/ gaining weight Delayed puberty
75
What respiratory care should patients with CF have?
Oxygen Mobilize secretions (vibration or percussion) Prevent infections with meticulous hand hygiene and vaccines Treat infections early with nebs, mucolytics, hydration, O2, antibiotics based on cultures Know baseline cough
76
What should the diet and exercise for a patient with CF look like?
High fat, High protein Supplemental enzymes w/ meals High salt and adequate hydration Exercise balanced with rest
77
What organ systems could you see complications in with a patient with CF?
Cardiac Endocrine GI complications
78
How should a patient with CF get airway clearance?
Increase pressure Huff cough TID - QID Postural drainage
79
Does O2 requires an order?
Yes, considered a medicine
80
What are the types of oxygen devices? What are the allowed LPM?
NC - 2L for infants - 4L small children Mask: over 6L to clear CO@ (10-15L), needed for higher flow Oxygen hood for infants that need high flow CPAP
81
What are two non-invasive ways to assess O2?
Pulse ox End tidal CO2 - attached to nasal prongs
82
What is an invasive way to assess O2? What can this also assess?
Atrial blood gas Acid-base balance
83
What is the goal for pulse ox? What conditions can it not be used in?
90-95% based on their baseline 95% for completely healthy Cant be used with cardiac child that normally has decreased distal perfusion and CF (clammy skin)
84
How long does it take for bronchiolitis to resolve?
can take 2 weeks
85
What is the treatment for bronchiolitis?
Treat the s/s
86
When can an infant be vaccinated against pertussis?
at 2 months
87
What is an OK SpO2 for children?
88-100
88
Why are you extra worried about ISWL in children that have respiratory diseases?
B/C there breath so fast which increases their ISWL
89
Should you suction before or acter the patient eats?
before
90
What are medications like antibiotics/antivirals, inhalers/nebulizers and steroids be used for?
Chronic conditions
91
What are the s/s of hypernatermia?
Na above 150 THIRST Flushed Oliguria CNS alterations
92
What are the s/s of hyperkalemia?
K+ above 5.5-6 Cardiac arrhythmia/arrest Often asymp
93
What are the s/s of hyponatremia?
Na less than 130 Cool Clammy Irritable Weak N/V Hypotension
94
What are the s/s of hypokalemia?
K+ less than 3 Muscle weakness Cramps N/V Hypotension
95
How do you are for an IV site in an child/infants?
Touch to IV section to see if it is soft, warm, dry and pain free Look to see if the IV insertion site is dry and without redness Compare the IV insertion site with the opposite extremity to look for swelling
96
What will you determine if ORS is working?
Focused perfusion and hydration assessment after every bolus UOP increases/returns to normal PEW score normalizes Daily weight returns to baseline Strict I&O

Fall - Pediatrics (15 decks)

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