Fluid and Electrolytes (Exam 2) Flashcards
(45 cards)
Most the of the body is made up of what type of fluid?
Intracellular (where potassium is located)
Why do kids become dehydrated more often?
-Increased body surface area to body mass
-Higher metabolic rates
-Higher body water content
-Increase fluid intake and output relative to size
-Larger quantities of extracellular fluid
-Immature kidney function
Holliday Segar Formula (Daily Fluid Management)
need to have memorized
-first 10kg times 100 ml/kg/d
-next 10kg times 50 ml/kg/d
->20kg time 20 ml/kg/d
ex) 7kg child would get 700 ml
ex) 12kg (10x100)+(2x50) = 1100 ml
ex) 30kg (10x100)+(10X50)+(10x20) = 1700 ml
divide by 24 to get per hr
Factors Increasing Fluid Requirements (When kids need extra fluids)
-Fever over 99
-Tachypnea
-Increase temperature of the environment (hot outside)
-Burns
-Ongoing losses-diarrhea, vomiting, NG tube output, high kidney failure
-Diabetic ketoacidosis / Diabetes insipidus
-Shock
-Radiant warmer - phototherapy
-Post Bowel Surgery
Factors Decreasing Maintenance Fluid (When kids do not need as much fluid)
-Skin: Mist test - Incubator - swamp bed
-Lungs: Humidified ventilator
-Renal: Oliguria / anuria
-Hypothyroidism
-Congestive heart failure
-Increased intracranial pressure
-SIADH
Fluid Excess:
Intake Causes
Exretion Failure Causes
Intake:
-Excessive oral intake
-Hypotonic overload
-Plain water enemas
Excretion Failure:
-Renal failure
-CHF
-Malnutrition
Fluid Excess: Symptoms
Edema
Slow bounding pulse
Crackles in lungs
Lethargy
Hepatomegaly
Weight gain
Seizures / coma
Fluid Excess: Management / Nursing Care
Limit intake
Diuretics
Monitor vital signs
Monitor neurologic status
Seizure precautions
Fluid Depletion: Etiology
Diarrhea
Vomiting
Hyperventilation
Burns
Hemorrhage
Three types of dehyration
Isotonic
Hypertonic
Hypotonic
Isotonic Dehydration
Electrolytes = Water
Serum Na 135 - 145 (KEY)
80% of all dehydration patients
Hypertonic Dehydration
Water loss > Electrolyte loss
Serum Na > 145 mEq/L (KEY)
15% of dehydration patients
Hypotonic Dehydration
Electrolyte loss > Water loss
Serum NA < 135 (KEY)
5% of patients
We only bolus children with what type of fluids?
NS or LR
Clinical Manifestation of Mild Dehydration:
Weight loss
Appearance
Capillary Refill
Pulse
Respiration
Blood pressure
Mucous membrane
Tears
Eyes
Skin
Fontanel
Urine flow
-3/5%
-Active / alert
-Normal
-Normal
-Normal
-Normal
-Moist
-Present
-Normal
-Spring back
-Normal
-Normal (6/8 wet diapers)
Clinical Manifestations of Moderate Dehydration:
Weight loss
Appearance
Capillary Refill
Pulse
Respiration
Blood pressure
Mucous membrane
Tears
Eyes
Skin
Fontanel
Urine flow
Weight loss: 6-9%
Appearance: Irritable Thirsty
Capillary Refill: > 3 seconds
Pulse: Slightly increased
Respiration: Slightly Tachypnea
Blood pressure: Normal / low orthostatic
Mucous membrane: Dry
Tears: Less than expected
Eyes: Normal
Skin: Tents
Fontanel: Normal / slight sunken
Urine flow: Reduced
Clinical manifestations of severe dehydration:
Weight loss
Appearance
Capillary Refill
Pulse
Respiration
Blood pressure
Mucous membrane
Tears
Eyes
Skin
Fontanel
Urine flow
Weight loss: > 10%
Appearance: Lethargic
Capillary Refill: > 4 seconds
Pulse: Tachy
Respiration: Fast / deep
Blood pressure: Orthostatic to shock
Mucous membrane: Parched
Tears: Absent
Eyes: Sunken
Skin: Prolong teneting
Fontanel: Sunken
Urine flow: Severely reduced (no wet dippear in 12/16 hours)
Best Clinical Signs of Dehydartion
Abnormal skin turgor
Abnormal RR pattern
Prolong cap refill
Oral Rehydration Solution Therapy
When child is alert, awake, and not in shock
Replace over 4-6 hours
Pedialyte
If child is not alert and awake, how do we rehydrate?
IV fluids
What is oral rehydration solution?
Pedialyte
Sugar can worsen dehydration (like gatoraid)
Mild Dehydration: Rehydration Therapy
ORS 50ml/kg over 4 hrs + add fluid for each stool (10ml/kg) and emesis (5-10 ml every 5 min)
Moderate Dehydration: Rehydration Therapy
ORS 100 ml/kg within 4 hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)
If still having ongoing losses ORS might not help
Start IV fluids instead
Severe Dehydration: Rehydration Therapy
IV fluids 40ml/kg/hr until pulse & consciousness return (after kidney function verified may add K+) then 50-100 cc/kg of ORS
