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peds > fluid, electrolyte, and acid/base > Flashcards

fluid, electrolyte, and acid/base Flashcards

1
Q

describe how percentage of body weight composed of water varies with age

A
  • kids and infants are at a much higher risk of imbalance with fluid
  • % is the highest at birth and increases in premature infants compared to full term
  • decreases with age
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2
Q

do infants have a high or low daily fluid requirement?

A

high requirement with little fluid volume reserve
- vulnerable to dehydration
- stomach size limits ability to rehydrate

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3
Q

infants and children under 2 years lose greater proportion of fluid each day, this makes them more dependent on…

A

adequate intake

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4
Q

infants and childrne inder 2 years have greater body surface area (BSA)… what does this lead to

A

greater insensible water loss through skin

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5
Q

what is insensible water loss

A

cant be directly measured, loss through respiration and the skin

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6
Q

describe respiratory and metabolic rates in pediatrics

A
  • high during early childhood
  • greater water loss from lungs r/t higher resp rate
  • greater demand to fuel body’s metabolic processes

all this puts em at higher risk for dehydration

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7
Q

under two years, glomeruli, tubules, and nephrons of kidneys are immature, what does this cause?

A
  • unable to conserve or excrete wtaer and solutes effectively
  • more water excreted
  • difficulty regulating electrolytes (may have more loss through urine), ie sodium and calcium
  • become dehydrated more quickly
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8
Q

describe extracellular fluid volume deficit (dehydration)

A
  • occurs when not enough fluid in extracellular compartment (intravascular and interstitial)
  • usually caused by the loss of sodium-containing fluid from the body
  • depending on cause, sodium may be normal, low, or high
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9
Q

what are some causes of extracellular fluid volume deficit (dehydration)

A
  • prolonged vomiting and diarrhea, NG suction, hemorrhage, and burns
  • vomiting and diarrhea lead frequently to dehydration
  • worldwide diarrhea related dehydration is one of the leading causes of death among children < 3yrs old
  • first 3 days of dehydration relfects a high loss of extracellular fluid
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10
Q

what are some symptoms of mild dehydration

A
  • hard to detct
  • infants may be irritible
  • older children thirsty
  • mucous membranes are moist
  • urine output normal
  • no change in vital signs
  • fontanel no change in infants
  • cap refill <2-3secs, extremities warm and pink
  • turgor brisk
  • up to 5% weight loss
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11
Q

whats a major indicator of degree of dehydration

A

% weight loss

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12
Q

what are some symptoms of moderate dehyration

A
  • irritable or lethargic (infants and young children)
  • alert, thirsty, restless (older children)
  • BP normal or low; postural hypotension
  • tachycardic; usual RR or tachypneic
  • mucous membranes dry
  • urine output less than 1ml/kg/hr, dark color
  • anterior fontanel sunken
  • cap refill >3 secs
  • turgor poor
  • eyes slightly sunken, decreased tears
  • 6-9% weight loss
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13
Q

what are some signs and symptoms of severe dehydration

A
  • 10% or more weight loss
  • lethargic to comatose for infants and young children
  • often conscious, apprhensive for older children and adolescents
  • BP low to undetectable
  • pulse rapid, weak to nonpalpable
  • skin tugor very poor
  • mucous membranes parched
  • thirst greatly increased unless lethargic
  • fontanel sunken
  • extremities cool and discolored
  • cap refill >3-4 seconds
  • resp rate change and regularity
  • eyes deeply sunken, absent tears
  • severe CV compromise, hypovolemic shock
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14
Q

describe dehydration diagnosis

A
  • clinical observations best identifies dehydration and the level of dehydration
  • history of illness
  • a major indicator to the degree of dehydration is percent of weight loss
  • serum electrolyte balance: increased electrolytes
  • bicrab level decreased
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15
Q

describe clinical therapy for dehydration

A
  • IV fluids: NS or LR fluid bolus (20ml/kg over 20mins) then maintenance fluids (may be dextrose containing)
  • dextrose never used for bolus d/t r/f rapid fluid shift and complications
  • isotonic fluids for increased fluid volume w/o causing electrolytes to shift
  • calculation of Iv fluid needs
  • identify cause
  • probiotics
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16
Q

describe oral rehydration

A
  • pedialyte or infalyte
  • frequent small amounts
  • 1-3tsp every 10-15min
  • educate on signs and symptoms of worsening dehydration
  • no cola or full strength juice
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17
Q

describe dehydration nursing management

A
  • daily wghts
  • meds to control vomiting
  • strict I+O
  • check urine, color, amount
  • vital signs
  • assessments
  • monitor IV therapy
  • safety
  • education with fam for future prevention
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18
Q

what is extracellular fluid volume excess (overhydration)

A

too muhc fluid in extracellular space

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19
Q

what are soe causes of extracellular fluid volume excess (overhydration)

A
  • a condition that causes retention of sodium and water
  • adrenal tumors which cause excessive aldosterne secretion (aldosterone causes kidney to retain saline)
  • CHF
  • chronic renal failure
  • infant or child who has been given an overload of sodium containing isotonic IV fluid
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20
Q

what are some clinical manifestations of extracellular fluid volume excess (overhydration)

A
  • weight gain: .5kg suddenly gained in one day due to fluid accumulation
  • edema: infants will be generalized and children will be dependent
  • tight clothes, shoes
  • bounding pulse
  • resp difficulty: dyspnea, tachypnea, use of accessory muscles, crackles
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21
Q

whats the clinical therapy for extracellular fluid volume excess (overhydration)

A

determine cause and treat it

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22
Q

describe nursing management of extracellular fluid volume excess (overhydration)

A
  • daily weights - rapid weight gain most sensitive inidcator (.5kg suddenly gained in one day due to fluid accumulation)
  • strict I+O - successful treatment causes output to be greater than intake
  • assess pulse
  • resp assessment
  • assess neck veines and edema
  • education with fam
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23
Q

what are some causes of hypernatremia

A
  • breast fed infants who are poorly feeding with normal diuresis at 2-3 days old
  • limited waer intake
  • excessive concentration of formula
  • diarrhea
  • vomiting
  • diabetes insipidus
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24
Q

what are some clinical manifestations of hypernatremia

A
  • increased thirst
  • decreased UO (except for DI)
  • confusion
  • seizures
  • lethargy
  • coma
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25
Q

whats the treatment for hypernatremia

A
  • serum sodium level
  • hypotonic fluid: more dilute than normal body fluid
  • .45 NS
  • D5W: once dextrose is absorbed act on body as hypotonic (only plain water is left)
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26
Q

describe nursing management of hypernatremia

A
  • monitor lab values, IV infusion, intake and output
  • education for prevention
  • 4-5 wet diapers a day
  • formula preparation
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27
Q

what are some causes of hyponatremia

A
  • water intoxication
  • dilute formula
  • exercise
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28
Q

what are some clinical manifestations of hyponatremia

A
  • decrease LOC due to swelling of brain cells
  • headache, anorexia, muscle weakness, sizures, lethargy, confusion, coma
29
Q

what are some treatments of hyponatremia

A
  • serum sodium level
  • correct cause
  • administer hypertonic IV solution
30
Q

decribe nursing management of hyponatremia

A
  • monitor serum sodium levels
  • monitor intake and output, IV infusions
  • assessments
  • NS rather than distilled water for irrigations
  • no tap water enemas
31
Q

what does potassium have a vital role in

A

heart and skeletal muscle function

32
Q

what are some causes of hyperkalemia

A
  • renal insufficiency
  • too much K+ in IV
  • blood transfusions
  • crush injuries
  • sickle cell crisis
33
Q

what are some clinical manifestations of hyperkalemia

A
  • hyperactivity of GI smooth muscle causing intestinal cramping and diarrhea
  • skeletal muscles become weak
  • lethargy
  • arrythmias
34
Q

whats the treatment for hyperkalemia

A
  • serum potassium
  • 12 lead
  • treatment of cause
  • potassium removed by dialysis
  • potassium wasting diuretics
  • kayexalate
35
Q

describ nursing management of hyperkalemia

A
  • monitor potassium levels
  • assessments
  • monitor HR and arrythmias
36
Q

any child receiving IV therapy is at risk for…

A

hyperkalemia

37
Q

what should you check prior to implementing potassium in IV fluid

A

urine output

have to void recently in hospital setting before administering

38
Q

what are some causes of hypokalemia

A
  • diarrhea and vomiting are major causes
  • self induced vomiting
  • excessive stooling in bulimia
  • NG suction
39
Q

what are some clinical manifestations of hypokalemia

A
  • GI smooth muscle slowed causing abdominal distention, constipation, and ileus
  • skeletal muscle weak and unresponsive
  • cardiac dysrhythmias
  • resp muscles may be affected
  • polyuria from kidney changes
40
Q

whats the treatment for hypokalemia

A
  • serum potassium level
  • 12 lead
  • identify cause and treat
  • potassium replacement
41
Q

describe nursing management of hypokalemia

A
  • monitor potassium levels
  • assess for muscle weakness
  • all assessment
  • potassium replacement: diet high in potassium/IV fluids
42
Q

describe respiratory acidosis

A
  • accumulation of CO2 in blood; carbon dioxide and water are combined into carbonic acid
  • caused by anything that interferes with lungs excretion of CO2
  • increased PCO2 and pH decreased
  • compensatory mechanism begin in the form of nonbicarbonate buffers; additional hydrogen ion excretion by kidneys, formation and decreased bicarbonate excretion by kidneys
43
Q

what are some causes of respiratory acidosis

A
  • decreased aeration
  • resp muscle injury
  • head injury
  • cardiac/resp arrest
44
Q

what are some clincial manifestations of respiratory acidosis

A
  • CNS depression
  • confusion
  • lethargy
  • HA
  • increased ICO
  • tachycardia
  • arrhythmias
45
Q

whats the treatment for respiratory acidosis

A

treat the cause

46
Q

describe nursing management of respiratory acidosis

A
  • assessments
  • interventions specific to correcting cause
47
Q

describe respiratory alkalosis

A
  • blood contains too little CO2, carbon and water combined into carbonic acid
  • often only lastsfor several hours
  • decreased PCO2 and pH is elevated
48
Q

what are some causes of respiratory alkalosis

A
  • hyperventilation
  • hypoxia
  • sepsis
49
Q

what are some clinical manifestations of respiratory alkalosis

A
  • neuromuscular irritability and parasthesias in extremities and around mouth
50
Q

whats the treatment for respiratory alkalosis

A

treat the cause

51
Q

describe nursing management of respiratory alkalosis

A
  • assessments
  • interventions specific to correcting the cause
52
Q

describe metabolic acidosis

A
  • excess of any acid other than carbonic acid
  • caused by imbalance in production and excretion of acid or by excess loss of bicarb
  • when pH of the blood decreases below normal, the chemoreceptors in brain and arteries are stimulated causing resp compensation
  • rate and depth of resp increases and carbonic acid is remvoed from the body
53
Q

what are some causes of metabolic acidosis

A
  • DM
  • ingestion of antifreeze
  • ingestion of ASA
  • renal failure
  • diarrhea
  • starvation
54
Q

what are some clinical manifestations of metabolic acidosis

A
  • decreased pH, decreased HCO3 and norm PCO2
  • resp compensation causes kussmaul respirations
55
Q

what the treatment for metabolic acidosis

A

treat cause

56
Q

describe nursing management for metabolic acidosis

A
  • assessments
  • interventions specific to correcting cause
57
Q

describe metabolic alkalosis

A
  • occurs with loss of metabolic acid or too much bicarb
    • chemoreceptors in brain and arteries detect rising pH of metabolic alkalosis and respirations decrease, carbonic acid is retained in the body
  • carbonic acid neutralizes bicarb and returns pH to norm
  • pH and HCO3 elevated and pCO2 in normal
58
Q

what are some causes of metabolic alkalosis

A
  • prolonged vomiting (pyloric stenosis)
  • NG suction
  • antacids
  • diuretics
  • reconstitution of powder formula
59
Q

what are some clinical manifestations of metabolic alkalosis

A
  • hypokalemia
  • neuromuscular irritability
  • resp rate and depth decrease
60
Q

whats the treatment of metabolic alkalosis

A

treat cause

61
Q

describe nursing management of metabolic alkalosis

A

assessments and interventions specific to correcting cause

62
Q

describe parenteral fluid therapy

A
  • IV fluids ordered by health care provider
  • DO NOT ADD KCL UNTIL CHILD HAS VOIDED
  • IV site assessed hourly and documented, check hospital policy
  • assess for infiltration/phlebitis hourly
  • lots of tape used in peds: assess above and below tape, warmth of finger, pulse; do not take off tape or armband; may take off house to assess
63
Q

infants and children under two years lose a greater proportion of fluid each day and are more dependent on which of the following:

  1. IV fluid intake
  2. oral liquid intake
  3. oral food intake
  4. urine output
A

oral liquid intake

64
Q

choose all the symptoms that apply for a 1 year old with moderate dehydration:

  1. lethargy, poor turgor
  2. cap refill less than 2-3 seconds
  3. urine output less than 1ml/kg/hr
  4. eyes slighly sunken and decreased tears
A

lethargy, poor turgor
urine output less than 1ml/kg/hr
eyes slightly sunken and decreased tears

65
Q

an infant weighs 10.2kg. hourly urine output for this infant needs to be…

  1. 10ml/hr
  2. 11ml/hr
  3. 10.2 ml/hr
  4. 10.5 ml/hr
A

10.2ml/hr

66
Q

Iv fluid bolus rehydration would be which type of IV fluid?

  1. NS
  2. D5LR
  3. 0.45 NS
  4. D5NS
A

NS

67
Q

a child with extracellular fluid volume excess will need which of the following nursing interventions? choose all that apply

  1. daily weights on same scale
  2. edema assessments
  3. education on skin care with family
  4. diuretics
A
  1. daily weights on same scale
  2. edema assessments
  3. education on skin care with family
68
Q

hyperkalemia may occur in infants and children due to which of the following?

  1. diet
  2. blood drw technique
  3. overhydration
  4. urine output
A

blood draw technique

69
Q

respiratory acidosis could occur with which diagnosis?

  1. asthma
  2. gastroenteritis
  3. dehydration
  4. vomiting
A

asthma

peds (15 decks)

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