MedU Clipp 15 and 16 Flashcards
(30 cards)
1
Q
What is the most accurate method of determine
dehydration status?
A
- Subtract teh Patient’s current weight from his or her weight immediately prior to the illness
- Convert the difference into a “Percent Dehydration”
2
Q
What aspects of the physical exam can help you determine dehydration status?
A
- Weight
- Vital Signs (HR and BP)
- HEENT exam (Fontanel, eyes sunken, mucous prod.)
- Skin Turgor, Temp, Perfusion
- Mental Status / Level of Activity
3
Q
What are the (3) lvls of Dehydration?
A
- Minimal ( 0 - 3% )
- Mild to Moderate ( 3 - 9% )
- Sever ( > 10% )
4
Q
Why is Oral Rehydration better than IV therapy?
A
- Cheaper
- Done at Home
5
Q
What is the best prevention against the spread of Gastroenteritis?
A
Good Handwashing
6
Q
What is the preferred therapy for Sever Dehydration?
A
- IV Bolus Therapy
- 20 mL/kg of Normal Saline or Lactated Ringer’s
7
Q
DDx for Recurrent Emesis in the Infant?
A
- GERD
- Viral Gastroenteritis
- Malrotation and/or Volvulus
- Inborn errof of Metabolism
- Pyloric Stenosis
- Intussusception
- CNS disease
- UTI
8
Q
What provides Spanish speaking patients with an interpreter?
A
- Title VI of the Civil Rights Act of 1964
9
Q
What are the factors in the
Glasgow Coma Scale (GCS)?
A
- Eye-Opening Response
- Verbal Response
- Motor Response
10
Q
How is the Eye Opening Response of the GCS scored?
A
- NO EYE opening
- Eyes open w/ PAIN
- Eyes open w/ VERBAL command
- Eyes open SPONTANEOUSLY
11
Q
How is the Verbal Response of the GSC scaled?
A
- NO VERBAL response
- INCOMPREHENSIBLE sounds
- INNAPROPRIATE words
- CONFUSED but able to answer QUESTIONS
- ORIENTATED
12
Q
How is the Motor Response of teh GCS scaled?
A
- NO MOTOR response, flaccid
- Extensor response, DECEREBRATE posture
- Abnormal flexion, DECORTICATE posture
- WITHDRAWS from Pain
- LOCALIZES Pain
- OBEYS Commands
13
Q
A GCS score of XX requires aggressive intervention?
A
8
14
Q
Why do Children have a Higher Risk of
Dehydration than Adults?
A
- Higher Surface Area to Body Mass ratio
- relative area of evaporation is increased
- Higher Basal Metabolic Rates
- Generates Heat, Expends Water
- Higher % of Body Mass that is Water
- Infants 70%
- Children 65%
- Adults 60%
15
Q
(8) DDx of Vomiting and Altered Mental Status?
A
- DKA
- Toxic Ingestion
- Gastrointestinal Obstruction
- Increased Intracranial Pressure (ICP)
- Gastroenteritis
- Appendicitis
- Bacterial pneumonia
- Pyelonephritis
16
Q
(4) Diagnosing Diabetes Mellitus?
A
- Symptoms of Diabetes (Polyuria, Polydipsia, Unexplained Weight Loss) plus Random Plasma Glucose > 200 mg/dL
- Fasting Blood Glucose > 126 mg/dL (no caloric intake for at least 8 hours)
- 2-hour Postload Glucose > 200 mg/dL during an Oral Glucose Tolerance Test (GTT)
- HbA1c > 6.5% in an Adult is diagnostic of Diabetes
17
Q
Diagnosing Diabetic Ketoacidosis (DKA)?
A
- Vomiting
- Tachypnea
- Mental Status Changes
- Dehydration
- DDx
- Random Glucose > 200 mg/dL
- Venous pH < 7.3 or Serum Bicarbonate < 15 mEq/L
- Moderate / Large Ketonuria or Ketonemia
18
Q
How do you treat DKA?
A
- Insulin and Fluid Resuscitation
- Insulin 0.1 units/kg/hour after initial volume expansion
- 1 hour after fluids push insulin
- BiCarb should not be given because of Paradoxical CNS Acidosis and Hypokalemia and BiCarb is associated w/ increased risk of Cerebral Edema, the most common DM a/ death in children
- Only add Potassium after serum lvl evaluated
- Admit
19
Q
Signs and Symptoms of DKA?
A
- Vomiting
- Weight Loss
- Dehydration
- Shortness of Breath
- Abdominal Pain
- Change in the Level of Consciousness
20
Q
Lab Values a/w DKA?
- pH
- Sodium
- Potassium
- Bicarbonate
- Creatinine
- Glucose
- Serum Ketones
- Urine Ketones
A
Lab Values a/w DKA?
- pH - Decreased - Acidodic
- Sodium - Decreased - Hyponatremia
- Potassium - normal
- Bicarbonate - Decreased - Acidodic
- Creatinine - Elevated - PreRenal Azotemia
- Serum Glucose - Elevated - DKA
- Serum Ketones - Elevated -
- Urine Ketones - Elevated - Spill Over
21
Q
Isotonic / Isonatremic?
A
- Na = 130 - 150 mEq/L
- Loss of both sodium and water
- Acute Gastroenteritis and Diarrhea
- 12 hour replacement
22
Q
Hypotonic / Hyponatremic
A
- Na < 130 mEq/L
- Consumption of Diluted Fluids or Water w/ Dehydration
- A/w Adrenal Insufficiency
- 24 hours to replace
- Rapid Correction –> Central Pontine Myelinolysis
- -> dmg to myelin sheath of nerve cells
- -> dmg to pons
23
Q
Hypertonic / Hypernatremic
A
- Na > 150 mEq/L
- Loss of water exceed Na losses
- High Mortality
- A/w Breastfeeding failure, Innapropriate use of Rehydration Solutions (Boiled milk), Diabetes Insipidus
- 48 hours to Replace
- Too-rapid of a Correction –> Cerebral Edema
24
Q
(3) Methods for Calculating Maintenance Fluids?
A
- Caloric Expenditure
- Body Surface
- Holliday-Segar method (easiest)
- 100 mL/kg/day x the first 10 kg body weight
- 50 mL/kg/day x the second 10 kg body weight
- 20 mL/kg/day x each additional 1 kg body weight
25
What are signs of Cerebral Edema
and Increased Intracranial Pressure?
* Slowing of HR
* Increasing BP
* A/w DKA mgmt - before mgmt begins and up to 24 hours after initiation of treatment
* Risk Factors:
* High BUN
* Prolonged Acidosis w/ Hypocapnia
* Attenuated measured Serum Sodium
* Administration of Bicarbonate
26
Components of Admission Oders:
ADC VANDISMAL?
* A - admit
* D - Diagnoses
* C - Condition
* V - Vital
* A - Activity
* N - Nursing
* D - Diet
* I - IV
* S - Studies
* M - Medications
* A - Allergies
* L - Labs
27
Potential Rx Managment of DM?
* Metformin
* Primary for DM2
* Alternative for DM1
* Pramlintide
* Adjunctive for DM1
28
Admission Orders for Patient in DKA?
* Continuous Monitoring of Vitals
* Hourly Neuro Checks
* Monitor Fluid INs and OUTs
* Insulin Orders
* Serum Glucose every 60 minutes
* Serum Calcium, Magnesium, and Phosphorus now
* Check Serum pH (VBG) every 60 minutes
* Urine dipstick for Ketones
29
What are the signs of Cerebral Edema in DKA?
* Irregular Respirations
* Headache
* Vomiting
* Third Nerve Palsy
* High Blood Pressure
30
What is Cushing's Triad of Increased
Intracranial Pressure?
* HTN
* Inappropriate Slowing of HR
* Irregular Respirations (Cheyne-Stokes respirations)
* Increased ICRP
- -\> Vagal Stimulation
- -\> Gastric Acid Secretion
- -\> Followed by Epigastric Discomfort, Headaches, and Non-bilious Vomiting.
