T2-Fluid and Electrolyte PPT Flashcards Preview

Pediatrics-MJ > T2-Fluid and Electrolyte PPT > Flashcards

Flashcards in T2-Fluid and Electrolyte PPT Deck (87):
1

What is the largest single cause of death to children in 3rd world countries?

Gastroenteritis

2

Do children have large or small stomach capacity?

Small

3

Is GI motility slower or faster in younger children?

Faster

4

When are digestive enzymes present in children?

4-6 months

5

What is the infant susceptible to since digestive enzymes aren't present till 4-6 months?

Gas and abdominal distention

6

What are 4 factors responsible for fluid and electrolyte differences between adults and children?

1. % an distribution of body water
2. BSA
3. Rate of basal metabolism
4. Status of kidney function

7

Infants and young children have a greater ____ in relation to body mass.

Surface area

8

Infants and young children have greater fluid loss in insensible loss. How?

Skin-perspiration
GI track

9

Infants have a significantly higher ____ rate than adults---so that causes an increase in what?

Higher metabolic rate...causes an increase in HEAT PRODUCTION and PRODUCTION OF METABOLIC WASTE (insensible fluid loss, increase need for water for excretion)

10

Are infants kidneys functionally mature or immature at birth?

Immature

11

Since infants have kidneys that are functionally immature at birth, what happens? (3)

1. Urine concentration and dilution
2. Sodium retention and excetion
3. Urine acidity

12

T/F: Infants ingest and excrete a greater amount of fluid

TRUE

13

Infants have an immature immune system. What does this mean?

More vulnerable to pathogens--cause alterations in fluid and electrolytes

14

For infants and young children, how do we want intake and output to be?

Almost equal!

15

Infants and children have increased _____ and rapid emptying of the ______.

Increased motility

Rapid emptying of intestinal contents

16

Rapid excretion interfere with the absorption of ______

Nutrients, electrolytes, and water

17

What are normal routes of fluid excretion in infants and children?

Lungs
Urine
Feces
Skin

18

What are signs and symptoms of dehydration r/t fluid excretion via lungs, urine, feces, and skin?

-Decreased urine output
-Hard feces
-Diphoresis of skin
-Tachypnea (losing fluid from lungs)

19

What is formula for calculating output?

1-2 mL/kg/hr

20

What is formula for intake for 10kg?

100ml/kg

21

What is formula for intake for child 10-20 kg?

1000 ml + 50ml/kg for anything over 10 kg

22

What is formula for intake for child 20kg+?

1500 mL plus 20ml/kg for each kg over 20 kg

23

Causes of diarrhea: Composition. What types of food?

High carbohydrate formula or food intake as osmotic pull of water into GI lumen--Diarrhea

24

Causes of diarrhea: Introducing new food?

This may cause child to have difficulty digesting the new food

25

Causes of diarrhea: Allergy?

Allergy to formula, food, and ESP. MILK can cause diarrhea

26

Why would antibiotics cause diarrhea?

Alters normal flora causing increase growth of organisms

27

What kind of emotional disturbances can cause diarrhea?

Anxiety
Tension
Fatigue

28

What are some malabsorption syndromes that may cause diarrhea?

-Lactose intolerance
-Impaired disaccharide activity
-CF

29

What kind of stool do CF patient who have diarrhea have?

Fatty, frothy stool

30

What is starvation diarrhea?

History of decreased intake over last several days (N,V; NPO)

31

If a patient has had N/V or been NPO the last few days and experienced starvation diarrhea, how will their first PO intake be following all that?

First PO intake is not well accepted by the body and moves quickly though GI tract

32

When is the only time you put cereal in milk for babies?

GER/GERD

33

Why don't we want to put food in bottles for babies without GER/GERD?

Babies learn speech by giving them a spoon, so thats why you don't want to put their food in the bottle

34

What is the most common cause of diarrhea in children less than 5 years...(6-12 months=higher risk)?

Rotavirus

35

T/F: E.Coli is always in stool

True

36

What common organism that causes gastroenteritis mimics appendicitis?

Yersinia

37

Loss of ____ leads to metabolic acidosis

HCO3

38

Monitor ___ for acidosis

pH

39

What shows effect of dehydration?

BUN

40

If patient vomits, are they losing acid or retaining acid?

Loosing

41

If patient vomits, do they have metabolic alkalosis or metabolic acidosis?

Metabolic ALKALOSIS (they lost acid)

42

If patient has diarrhea, do they loose acid or retain it?

Acid stays

43

If patient has diarrhea do they have metabolic alkalosis or metabolic acidosis?

Metabolic ACIDOSIS (the acid stays)

44

What does this lab result mean: elevate WBC (mostly bands)

Infectious diarrhea

45

What does eosinophilia mean?

A parasitic infection

46

If a patient comes in with vomiting, what do we ask?

1. How much have you urinated?
2. How many times have you vomited?
3. Have you had any diarrhea?

[ask this for the last 24 hours]

47

Oral rehydration:
What can they have? What can they not have?

CAN have:
-Ricelytes
-Pedialytes
-Unsweetened jello

CANT have:
Fruit juice

48

Oral rehydration: How do they progress in foods?

Progress to soft complex CHO foods

*no greasy or spicy foods and progress as tolerated for older adults

49

Diet for vomiting and diarrhea general guidelines for infants?

-No milk or milk products for _____ (unless ordered by doctor)

24-48 hours

50

Diet for vomiting and diarrhea general guidelines for infants?

Day 2?

-May have SOY formula for 2 days, then return to regular formula
-May begin with 1/2 strength formula for 24 hours and then back to regular

51

Diet for vomiting and diarrhea general guidelines for infants?

Day 3?

Infant full strength formula

52

***For test and ATI, continue to ____ or ____ UNLESS they are on an oral rehydration diet!

Breast feed or formula feed

53

Where do we check skin turgor for infants?

Inner thigh or abdomen

54

Severe diarrhea management: If we start an IV and they haven't urinated, should we put potassium in?

NO

55

What is the most common type of dehydration in children? Why?

ISOTONIC---you catch it early enough before it progresses to hypo or hyper

56

Calculation of percentage weight loss?

1. Subtract childs present weight from original weight to get the loss
2. Divide loss by childs original weight


57

Present weight: 28 lbs

Original weight: 31 lbs

31 (original)- 28 (presnet)= 3 lbs

3 (loss) / 31 (original)= 0.09

9% weight loss

58

If V/D continue and progresses to severe dehydration, what do we do?

Admit for IV therapy

59

When pt comes in with severe dehydration, we need to admit them for IV therapy. What happens in ED before they are admitted?

10-20 ml/kg of normal saline boluses are give and repeated 2-3 times, then IV fluids are begun

60

We DO NOT add potassium to IV until patient has voided. Why?

Initial therapy is used to expand ECF volume quickly and improve circulatory and renal function .......Potassium is WITHHELD until kidney function (renal) is restored and circulation has improved!

61

If circulation does not improve, what happens?

SHOCK

62

What is a late sign of shock?

Low BP

63

What is blood loss shock?

Hypovolemic

64

What is pump failure shock?

Cardiogenic

65

What is septic shock?

Change is distrubution

66

What is anaphylaxic shock?

Allergy

67

Regardless of type of shock, what do we do?

ABC

68

If child has shock, and is not breathing do we do ABC or CAB?

CAB

69

What is shock patho?

Lose blood= diminished venous return= decreased CO and BP

70

Shock signs?

-Cool, cold, clammy skin
-Poor cap refill
-Reduced urine output
-Anaerbobic metabolism= ACIDOSIS
-Tachycardia, tachypnea
-LOC changes (parent tells this)

71

Early or late signs of shock:

-Tachycarida
-Delayed cap refill
-Fussy, irritable

Early

72

Early or late signs of shock:

-BRADYcardia
-Change in LOC
-Hypotonia
-Cheyne stokes
-HYPOtension

Late

73

Early or late shock: tachycardia

Early

74

Early or late shock: bradiacardia

Late

75

Stages of shock: What happens in compensated?

-Mild tachycardia

*this is when we want to catch shock

76

Stages of shock: Uncompensated

What happens?

-Pronounced tachycardia, prolonged cap. refill, BP maintained, somnolence

77

Where will you prob end up with uncompensated shock?

ICU

78

Stages of shock: Irreversible..What happens?

Thready pulse, BP decreases

Can cause COMA or DEATH

79

Septic shock can cause SIRS (systemic inflammatory response syndrome). What happens here? (3)

-Response to certain infections

-Capillaries dilate---lets out ALBUMIN

-3rd spacing of fluids

80

What may we find in assessment with septic shock?

-Fever
-Tachypnea
-Tachycardia
-Petechia

81

What are the body temp stages of shock?

Warm
Cool Cold

82

What is the best chance of survival in shock stages: warm, cool, or cold?

Warm

83

Will we always see all temp stages of shock?

NO--it progresses so quickly so we may not always see all stages

*these stages don't necessarily have to be in a sequential order

84

Shock: Ventilation is first, then treat underlying cause. How is fluid administration done?

Crystalloid FIRST, then colloid

85

What happens with the release of histamine for anaphylaxis shock? (4)

-Vasodilation
-Increased cap. permeability
-Fluid leak into interstitial spaces
-Decreased venous return

86

What is one of the first signs of anaphylaxis shock?

Warmth

87

Is it ABC or CAB for anaphylaxic shock?

ABC

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