fluid, electrolyte, acid base balance (1) Flashcards
(108 cards)
1
Q
what fraction of total body water is extracellular and what fraction is intracellular?
A
1/3 is extracellular
2/3 is intracellular
2
Q
What are the two types of extracellular fluid
A
intravascular and interstitial
3
Q
What type of extracellular fluid is in blood vessels
A
intravascular
4
Q
what makes pediatrics more vulnerable to dehydration?
A
- High daily food requirement with little fluid volume reserve
- small stomach size
- more dependent on intake, lose greater proportion of fluid
5
Q
children of which age have greater body surface area, more skin surface
A
infants and children under two years old.
6
Q
Why does having a greater body surface area increase dehydration
A
there is greater insensible water loss through the skin, can’t be measured
7
Q
Describe respiratory and metabolic rates in childhood
A
- high during early childhood
- Greater water loss from the lungs
- Greater water demands to fuel the body’s metabolic processes
8
Q
What parts of the kidney are immature under two years old
A
glomeruli, tubules, and nephrons
9
Q
why do pediatric kidneys lead to increased dehydration
A
- unable to conserve or excrete water and solute effectively
- More water is excreted
- Difficulty regulating electrolytes
10
Q
what is the term for dehydration?
A
Extracellular fluid volume deficit
11
Q
What is extracellular fluid volume defecit, dehydration, usually caused by
A
The loss of sodium containing fluid from the body
12
Q
what kind of fluid lack is dehydration
A
not enough extra cellular fluid, intravascular and interstitial
13
Q
What are sodium levels like during extracellular fluid volume deficit
A
can be normal, low, or high depending on the cause
14
Q
what are the physical causes of extracellular fluid volume deficit
A
prolong vomiting and diarrhea!, nasogastric suction, hemorrhage and burns
15
Q
what is the leading cause of death among children less than three years old
A
Dehydration
16
Q
what days during dehydration have the highest loss of extracellular fluid
A
First 3 days
17
Q
What are symptoms of mild dehydration?
A
- Hard to detect
- Infants may be irritable
- older children are thirsty
- moist mucous membranes
- No vital sign changes
18
Q
What is the main indicator of mild dehydration
A
Up to 5% weight loss
19
Q
What are signs of moderate dehydration
A
- drive mucus membranes
- flirt, thirsty, restless
- anterior fontanel sunken
- Cap refill >3 sec
- Poor turgor
- Eyes sunken
- urine output less than one milliliter / kilogram / hour, dark color
20
Q
what percent of weight loss is during moderate dehydration
A
6 to 9%
21
Q
what are vital sign changes during dehydration
A
- blood pressure is normal or low with postural hypotension
- tachycardic, usual respirations or tachypneic
22
Q
What state is a child with severe dehydration in?
A
Hypovolemic shock
23
Q
what changes that are not vital signs appear in kids with severe dehydration?
A
- Lethargic to comatose
- parched mucus membranes
- Very decreased or absent to urine output
- Increased thirst
- Sunken fontanel
- Extremity school, discolored, and delay capillary refill
24
Q
what vital sign changes occur during severe dehydration
A
- low to undetectable blood pressure
- rapid, weak or non palpable pulse
- Respirations change rate and regularity
25
Case study:
chloe is a 2 month old admitted at 8 PM today with a two day history of diarrhea and vomiting. She weighs 4 kilograms. As a temperature of 38.9 degrees Celsius. Her heart rate is 188. The resp rate is 62. urine output since 0800 is 20 milliliters.
her anterior fontanel Is sunken and she has decreased tears when she cries. She is lethargic.
What symptoms of dehydration does she have?
What level of dehydration does she have?
Symptoms:
* high heart rate
* high respiratory rates
* urine output 20 milliliters in two hours
* anterior fontanel sunken
* decreased tears, mucus membranes dry
* lethargic
Type: Moderate? Severe?
26
what is the bicarbonate level like with dehydration?
low
27
Case study:
chloe is a 2 month old admitted at 8 PM today with a two day history of diarrhea and vomiting. She weighs 4 kilograms. As a temperature of 38.9 degrees Celsius. Her heart rate is 188. The resp rate is 62. urine output since 0800 is 20 milliliters.
her anterior fontanel Is sunken and she has decreased tears when she cries. She is lethargic.
Would she require oral or IV rehydration?
IV rehydration because of her symptoms
28
what kind of Bolus (and amount) should be given for rehydration
normal saline or lactated ringers (20 ml/kg over 20")
29
What maintenance fluids are used for dehydration
Isotonic solutions:
D5 1/2 NS with 20 mEq of KCl/L
OR
D5 NS with 20 mEq KCl/L
NO POTASSIUM UNTIL AFTER THEY PEE
30
what fluid should never be used as a bolus
dextrose, will cause fluid shifts
31
how do you calculate maintenance fluid needs in children
weight based:
up to 10 kg: 100 ml/kg/day
11-20 kg: 1000 ml + 50ml/kg / day
Above 20 kg: 1500 ml + 20ml/kg / day
32
Case study:
susie is a 12 month old with a one day history of diarrhea. Heart rate is 190. Respiratory rate of 54. Her temperature is 38. Alert and playful and irritable at times. She has three wet diapers today. She has tears when she cries. Her fontanel Is soft and flat. Her mucus membranes are tacky. Capillary refill is less than three seconds. Skin turgor is brisk.
Oral or IV rehydration?
Oral
33
in what amount do you give pedialyte to a kid
one to three teaspoons every 10 to 15 minutes
34
What is the term for too much fluid in extracellular compartment
extracellular fluid volume excess (overhydration)
35
what are causes of extracellular fluid volume excess
conditions that cause retention of sodium or water
36
What conditions cause overhydration, or retention of sodium and water
* Adrenal tumors which cause extra aldosterone secretion, retaining saline
* congestive heart failure
* chronic renal failure
* Infant or child who has been given an overload of sodium containing isotonic IV fluid
37
1 kg = __ L of fluid
1
38
What are clinical manifestations of extracellular fluid volume excess
* weight gain
* Edema
* Tight clothes/shoes
* Bounding pulse
* Respiratory difficulty
39
How much weight gained in one day is due to fluid accumulation
0.5 kg in a day
40
What is the clinical therapy for extracellular fluid volume excess
Determine cause and treat
41
describe what edema looks like in infants and children with extracellular fluid volume excess
Infants: genrealized over body
Children: Dependent areas of body
42
What pulses do you assess in children with over hydration
Radial and pedal
43
What condition increases the osmolality of blood and had the body fluids too concentrated
Hypernatremia
44
Describe hypernatremia
Too much sodium compared to water
45
What are causes of hypernatremia
* breast fed infants who are poorly feeding with normal diuresis at two to three days old
* limited water intake
* excessive concentration of formula
* diarrhea
* vomiting
* diabetes insipidus
46
Clinical manifestations of hypernatremia
* Inc thirst
* Dec urine output
* Confusion
* Seizures
* Lethargy
* Coma
* Dec LOC
47
Treatment of hypernatremia
* Serum sodium levek
* Hypotonic fluid; more dilute than normal body fluid
* .45 NS
* D5W: Once Dextrose is absorbed it acts on the body as hypotonic, only plain water left
48
Nursing management of hypernatremia
* monitor lab values, monitor IV infusion, intake and output
* Education for prevention
* 4-6 wet diapers per day
* Formula prep
49
what is when osmolality of the blood is decreased, body fluids are too dilute
hyponatremia
50
describe water and sodium in hyponatremia
body fluids contain more water relative to sodium
51
what are causes of hyponatremia
* water intoxication (pool water)
* dilute formula
* exercise
52
clinical manifestations of hyponatremia?
* brain edema
* dec. LOC (from swelling)
* HA
* anorexia
* muscle weakness
* seizures
* lethargy
* confusion
* coma
53
clinical therapy for hyponatremia
* serum sodium level
* correct cause
* hypertonic IV solution
54
what types of IV fluid are used for hyponatremia
hypertonic
* D5 .45 NS
* D5 .9 NS
55
nursing management of hyponatremia
* monitor sodium levels
* monitor I&O, IV infusions
* assessments
* NS rather than distilled water for irrigation
* no tap water enemas
56
which electrolyte has a huge role is muscle function?
potassium
57
causes of hyperkalemia
* renal insufficiency
* too much potassium in IV
* blood transfusions
* crush injuries
* sickle cell anemia crisis
58
clinical manifestations of hyperkalemia
* hyperactivity of GI smooth muscle causing intestinal cramping & diarrhea
* weak skeletal muscle
* lethargy
* arrythmias
59
clinical therapy of hyperkalemia
* potassium level, 12 lead EKG, treatment of cause
* potassium removed via dialysis, potassium wasting diuretics, kayexalate
60
nursing management of hyperkalemia
* monitor potassium levels
* assessment
* monitor HR and arrythmia
61
how can potassium be falsely elevated?
if a person drawing blood takes too long, RBCs burst releasing potassium
62
what kind of children are at risk for hyperkalemia
ones receiving IV therapy
63
what should be checked before implementing potassium in IV fluid
check urine output
64
what are causes of hypokalemia
* diarrhea/vomiting (also self-induced like bulemia)
* NG suction
65
clinical manifestations of hypokalemia
* GI smooth mucle slowed, distention, constipation/ileus
* skeletal muscle weak/unresponsive
* cardiac arrythmias
* respiratory muscles affected
* polyuria from kidney damage
66
clinical therapy of hypokalemia
* serum potassium level, 12 lead EKG, identify cause adn treat
* potassium replacement
67
management of hypokalemia
* monitor potassium
* assess muscle weakness
* all assessments
* potassium replacement: diet high in potassium/IV fluid
68
accululation of carbon dioxide in blood; carbon dioxide and water combined into carbonic acid
respiratory acidosis
69
what causes respiratory acidosis
anything that interferes with lung excretion of CO2
70
describe pH and PCO2 in respiratory acidosis
PCO2 increased, pH decreased
71
describe the compensatory mechanism in respiratory acidosis
nonbicarb buffers; additional hydrogen excreted by kidneys, formation and decreased bicarb excertion of kidneys
72
causes of respiratory acidosis
* decreased aeration
* resp muscle injury
* head injury
* cardiac/resp arrest
73
clinical manifestations of respiratory acidosis
* CNS depression
* confusion
* lethargy
* HA
* inc. intracranial pressure
* tachycardia
* arrythmias
74
clinical therapy of respiratory acidosis
treatement of cause
75
nursing management of respiratory acidosis
* assessment
* interventions speciic to correcting cause
76
what is when blood contains too little CO2; CO2 and water are combined into carbonic acid (PCO2)
respiratory alkalosis
77
describe PCO2 and pH in resp alkalosis
dec. PCO2, pH elevated
78
causes of resp alkalosis
hyperventilation, hypoxia, sepsis
79
clinical manifestations of resp alkalosis
* neuromuscular irritability and paresthesia is extremities and around mouth
80
clinical therapy of resp alkalosis
treatment of cause
81
nursing management of resp alkalosis
* assessments
* interventions specific to correcting cause
82
what is excess of any acid other than carbonic acid
metabolic acidosis
83
what is metabolic acidosis caused by (chemically, patho)?
imbalance in production and excretion of acid or by excess loss of bicarbonate
84
what happens to the chemoreceptors int eh brain when pH of the blood decreases below normal
they are stimulated caausing respiratory compensation
85
conditions/problems that cause metabolic acidosis
* DM
* ingestion of antifreeze
* ingestion if ASA
* renal failure
* diarrhea
* starvation
86
clinical manifestations of metabolic acidosis
* dec. pH, dec. HCO3, normal PCO2
* resp compenation causes Kussmaul respirations (inc. rate/depth)
87
clinical therapy of metabolic acidosis
treat cause
88
nursing management of metabolic acidosis
* assessment
* intervention specific to correcting cause
89
what occurs with loss of metabolic acid or too much bicarb
metabolic alkalosis
90
what neutralizes bicarb to return pH to normal
carbonic acid
91
pH, HCO3, and PCO2 in metabolic alkalosis
* pH elevated
* HCO3 elevated
* PCO2 normal
92
physical causes of metabolic alkalosis
* prolonged vomiting
* NG suction
* antacids
* diuretics
* reconstruction of powder formula
93
clinical manifestations of metabolic alkalosis
* hypokalemia
* neuromuscular irritability
* resp rate and depth decrease
94
clinical therapy and management for metabolic alkalosis
* treat cause
* assessment
* interventions to correct cause
95
assessment for infiltration
edema, cool, discomfort
96
assessment fro phlebitis
red, warm, irritated, pain, red streak
97
Case scenario:
Johnny is a four month old you are currently admitting to the emergency department. The mom gives you the following history: two days of diarrhea, temperature of 39, sleepy and difficult to wake up
What questions do you need to ask?
* What does the diarrhea look like
* when was the last time he had a bottle
* how many wet diapers has he had today
* When he cries does he have tears
* When did he begin to get sleepy
98
Case scenario:
Johnny is a four month old you are currently admitting to the emergency department. The mom gives you the following history: two days of diarrhea, temperature of 39, sleepy and difficult to wake up
What would the assessment include?
vital signs, head to toe assessment
99
Case scenario:
Johnny is a four month old you are currently admitting to the emergency department. The mom gives you the following history: two days of diarrhea, temperature of 39, sleepy and difficult to wake up
assessment data:
Heart rate 200, respirations 50, blood pressure 84/54, 39.5 temp, Difficult to arouse, PERRLA, sunken fontanel, dry, pink, decreased tears, tachycardia, no edema, resp good, hyperactive BS, soft round and, brown watery stool. Diaper rash, 0 pain.
What information would you give to the HCP?
What orders would you expect?
* Labs, electrolytes
* IV fluid bolus, maintenance
* I&O
* Assess and vitals evey 4 hours
* Stool culture
* Regular diet
* Contact precautions
* Daily weight
100
Case scenario:
Johnny is a four month old you are currently admitting to the emergency department. The mom gives you the following history: two days of diarrhea, temperature of 39, sleepy and difficult to wake up
lab results:
High sodium, high potassium, high chloride, low carbon dioxide, good urine nitrogen, good glucose
What is the significance?
* Hypovolemia
* Low co2 is metabolic acidosis
101
Case scenario:
Johnny is a four month old you are currently admitting to the emergency department. The mom gives you the following history: two days of diarrhea, temperature of 39, sleepy and difficult to wake up
mom stayes he lost .45 kg, almost a pound
What is your plan of care?
* initiate IV fluid bolus, then maintenance
* reassessment when fluid is complete
* assess output hourly
* take additional labs and reweigh in the morning
* stool culture, virus?
* contact precautions
* safety
102
Infants and children under two years old lose a greater proportion of fluid each day and are more dependent on which of the following?
1. IV fkuid intake
2. Oral liquid intake
3. Oral food intake
4. Urine output
Oral liquid jntake
103
choose all the symptoms that apply for a one year old with moderate dehydration?
1. Lethargy, poor turgor
2. Cap refill <2-3 sec
3. Urine output <1 ml/kg/hr
4. eyes slightly sunken and decreased tears
1, 3, and 4
104
an infant ways 10.2 kg, Hourly urine output for this infant needs to be what?
1. 10 ml/hr
2. 11 ml/hr
3. 10.2 ml/hr
4. 10.5 ml/hr
10.2
105
IV fluid bolus rehydration would be which type of IV fluid?
1. NS
2. D5LR
3. .45 NS
4. D5NS
NS
106
A child with extracellular fluid volume access will need which of the following nursing interventions. choose all that apply
1. Daily weights on the same scale
2. Edema assessments
3. education on skin care with family
4. Diuretics
1,2,3
107
Hyperkalemia may occur in infants and children due to which of the following?
1. diet
2. Blood draw technique
3. Overhydration
4. Urine output
Blood draw technique
108
respiratory acidosis could occur in which diagnosis?
1. Asthma
2. Gastroenteritis
3. Dehydration
4. Vomiting
A
