Fluid & Electrolyte Balance

Question 1

What are the physiologic characteristics of infants and young children that affect fluid and electrolyte balance?

Answer 1

Increased body surface area, higher metabolic rates, higher body water content, immature kidney function, larger quantities of extracellular fluid.

Question 2

Define dehydration and list its three types.

Answer 2

Dehydration is the loss of body fluids. Types: * Isotonic * Hypotonic * Hypertonic.

Question 3

What is isotonic dehydration?

Answer 3

Equal losses of Na and Water; serum Na 135-145 mEq/L.

Question 4

What are the clinical manifestations of isotonic dehydration?

Answer 4

No significant change between fluid compartments; most common type of dehydration.

Question 5

What is hypertonic dehydration?

Answer 5

Water loss > Electrolyte loss; serum Na > 145 mEq/L.

Question 6

What are the physical findings of hypertonic dehydration?

Answer 6

Dry doughy skin, increased muscle tone, child appears less ill but very thirsty.

Question 7

What is hypotonic dehydration?

Answer 7

Electrolyte loss > Water loss; serum Na < 135 mEq/L.

Question 8

What are the clinical signs of hypotonic dehydration?

Answer 8

Child appears more ill, less intravascular volume, signs include cerebral edema, seizures, and coma with Na < 120.

Question 9

How is dehydration assessed in children?

Answer 9

By evaluating weight loss, appearance, capillary filling, pulse, respiration, blood pressure, mucous membranes, tears, eyes, skin, and urine flow.

Question 10

What is the Holliday-Segar Method for calculating maintenance fluid requirements?

Answer 10

Add ml/kg/day: * First 10 kg: 100 ml/kg * Next 10 kg: 50 ml/kg * >20 kg: 20 ml/kg.

Question 11

What factors increase maintenance fluid requirements?

Answer 11

• Fever * Tachypnea * Increased environmental temperature * Burns * Ongoing losses (diarrhea, vomiting) * Diabetic ketoacidosis.

Question 12

What factors decrease maintenance fluid requirements?

Answer 12

• Mist tent * Humidified ventilator * Oliguria * Anuria * Congestive heart failure.

Question 13

What are the symptoms of fluid excess?

Answer 13

• Edema * Slow bounding pulse * Crackles in lungs * Lethargy * Weight gain.

Question 14

What is the management for fluid excess?

Answer 14

• Limit intake * Diuretics * Monitor vital signs * Monitor neurologic status.

Question 15

What are the signs of mild dehydration?

Answer 15

Thirst, slightly dry mucous membranes.

Question 16

What is the initial treatment for mild dehydration?

Answer 16

ORS 50 ml/kg within 4 hours plus additional fluids for each stool or emesis.

Question 17

What is hyponatremia?

Answer 17

Sodium depletion; Na+ concentration < 130 mEq/L.

Question 18

What are the clinical manifestations of hyponatremia?

Answer 18

• Behavior change * Irritability * Lethargy * Increased heart rate * Decreased blood pressure.

Question 19

What is hypernatremia?

Answer 19

Sodium excess; Na+ concentration > 150 mEq/L.

Question 20

What are the clinical manifestations of hypernatremia?

Answer 20

• Intense thirst * Oliguria * Agitation * Flushed skin.

Question 21

What is hypokalemia?

Answer 21

Potassium depletion; K < 3.5 mEq/L.

Question 22

What are the clinical manifestations of hypokalemia?

Answer 22

• Muscle cramps * Weak or irregular pulse * Tachycardia * CNS symptoms.

Question 23

What is hyperkalemia?

Answer 23

Potassium excess; K > 5.5 mEq/L.

Question 24

What are the clinical manifestations of hyperkalemia?

Answer 24

• Irritability * Weakness * Bradycardia * Cardiac arrest.

Question 25

What is hypocalcemia?

Answer 25

Calcium depletion; Ca < 8.5 mEq/L.

Question 26

What are the clinical manifestations of hypocalcemia?

Answer 26

* Numbness * Tingling * Hyperactive reflexes * Muscle cramps.

Question 27

What is hypercalcemia?

Answer 27

Calcium excess; Ca > 10.2 mEq/L.

Question 28

What are the clinical manifestations of hypercalcemia?

Answer 28

Nausea, vomiting, lethargy, confusion.

Question 29

What are common clinical manifestations of hypercalcemia?

Answer 29

* Lethargy * Weakness * Anorexia * Thirst * Itching * Behavior changes * Confusion * Stupor * Nausea * Vomiting * Constipation * Bradycardia * Cardiac arrest ## Footnote Hypercalcemia is defined as calcium levels greater than 10.2 mg/dL.

Question 30

What is the definition of hypercalcemia?

Answer 30

Calcium excess with levels greater than 10.2 mEq/L. ## Footnote Hypercalcemia can have various causes and clinical implications.

Question 31

What are some etiologies of hypercalcemia?

Answer 31

* Milk alkali syndrome * Excessive IV or oral calcium * Acidosis * Prolonged immobilization * Hypoproteinemia * Renal disease * Hyperparathyroidism * Hyperthyroidism ## Footnote Each of these conditions can contribute to elevated calcium levels.

Question 32

What is the most appropriate nursing action for an infant with moderate dehydration?

Answer 32

Schedule the child to be seen as soon as possible since he is moderately dehydrated. ## Footnote This decision is based on the child's assessment findings.

Question 33

What is the normal urine output in children?

Answer 33

1-2 ml/Kg/hr. ## Footnote Accurate measurements are critical for assessing fluid balance.

Question 34

What is the best method for measuring urine output in non-potty trained children?

Answer 34

Weighing diapers (1 gram weight = 1 ml urine). ## Footnote This method helps in accurately assessing fluid output.

Question 35

What are common IV solutions used in pediatric maintenance?

Answer 35

* 0.9% normal saline solutions * Lactated Ringer's * 5% dextrose in water * 10% glucose in water ## Footnote These solutions are chosen based on tonicity and electrolyte content.

Question 36

What should the nurse recommend for a 2-year-old child with diarrhea who is refusing solid food?

Answer 36

Recommend that the child be allowed to self-regulate. ## Footnote Allowing self-regulation can be beneficial during recovery from gastrointestinal disturbances.

Question 37

What should a nurse do if signs of IV infiltration are observed?

Answer 37

Immediately discontinue the line. ## Footnote Signs include erythema, pain, edema, and blanching along the vein.

Question 38

Fill in the blank: The composition of IV solution is selected based on _______.

Answer 38

[tonicity (osmolarity) and electrolyte content].

Question 39

What action should a nurse take for a child 3 hours post tonsillectomy who is swallowing frequently?

Answer 39

Perform a focused assessment on the child. ## Footnote Frequent swallowing may indicate bleeding or discomfort.

Question 40

What is the role of the nurse in measuring intake and output (I & O)?

Answer 40

Accurate measurements are essential to the assessment of fluid balance. ## Footnote I & O is critical in various clinical situations, including dehydration and IV therapy.

Question 41

True or False: An IV shield is used to protect the IV site after insertion.

Answer 41

True.

Question 42

What is the preferred gauge for IV catheters in most children?

Answer 42

22- to 24-gauge over-the-needle catheter. ## Footnote Smaller needles may be used for small scalp veins.

Question 43

What should the nurse monitor for a child receiving IV therapy?

Answer 43

* Infusion rate * Amount infused * Signs of infiltration * EKG if applicable ## Footnote Regular monitoring is crucial to ensure patient safety and effective treatment.