T2 - Fluid & Electrolyte (Josh)

Question 1

A Popsicle is —- mL

Answer 1

45 mL (half)

the double is 90 mL

Question 2

—- is second to URI as a cause of illness in children.

Answer 2

Gastroenteritis

Question 3

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

Answer 3

Gastroenteritis

Question 4

GI Motility is —- in younger children.

Answer 4

faster

Question 5

Digestive enzymes are not present until —-

Answer 5

4-6 mths

• infant is susceptible to gas and abdominal distention

Question 6

What is one reason that infants and young children are more vulnerable to alterations in Fluid & Electrolytes?

Answer 6

They have greater surface are in relation to body mass

Question 7

Infants have a significantly higher —- than adults, leading to…

Answer 7

metabolic rate

increased heat production

increased fluid loss

increased need for water excretion

Question 8

Infants’ kidneys are —

Answer 8

functionally immature

Question 9

Infants —- a greater amount of fluid.

Answer 9

ingest and exrete

Question 10

Urine Volume/24 hrs

Answer 10

• Neonate (30-60)
• Week old (100-300)
• 10-60 days (250-450)
• 2-12 mths (400-500)
• 1-3 yrs (500-600)
• 3-5 yrs (600-700)
• 5-8 yrs (650-1000)
• 8-14 yrs (800-1400)
• Adults (600-1600)

Question 11

Normal routes of fluid excretion from infants and children?

Answer 11

Lungs
Urine
Feces
Skin

Question 12

Formula for Calculating I’s and O’s

Answer 12

Output: 1-2 mL/kg hr
Intake:
- up to 10kg = 100mL/kg
- 10-20 kg = 1000mL + 50mL/kg for anything over 10kg
- >20 kg = 1500mL + 20 mL/kg for anything over 20kg

Question 13

Child weighs 8 kg. Calculate I and O.

Answer 13

Intake = 100 * 8 = 800mL
Output = 1*8 or 2*8 = 8-16 mL/hr

Question 14

Child weighs 16 kg.

Calculate I and O.

Answer 14

Intake = 1000mL + 50*6 = 1300 mL

Output = 116 or 216 = 16-32mL/hr

Question 15

Child weighs 24 kg.

Calculate I and O.

Answer 15

Intake: 1500 + 20*4 = 1580 mL

Output: 124 or 224 = 24-48 mL/hr

Question 16

Viruses that cause Fluid/Electrolyte Imbalances:

Answer 16

Rotavirus

Norwalk Virus

Question 17

Bacteria that cause Fluid/Electrolyte Imbalance:

Answer 17

• E. Coli
• Salmonella
• Shigella
• Yersinia Enterocolitica
• Campylobacter jejuni
• Vibrio Cholera
• C. diff

Question 18

Most common cause of diarrhea in children less than five years old?

Answer 18

Rotavirus (unless they get RV vaccine)

• 6-12 mths greatest risk

Question 19

Appropriate diet for Oral Rehydration from diarrhea.

Answer 19

• Ricelytes
• Pedialyte
• Unsweetened Jello
• NO FRUIT JUICE
• progress to soft complex carb foods, no greasy/spicy foods and progress as tolerated for older child

Question 20

General Diet Guidelines for Infants w/ vomiting/diarrhea.

Answer 20

No milk or milk products for 24-28 hours
unless ordered by doctor

Day 2:
infants 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

Day 3
infant–full strength formula

Question 21

Calculate percentage of weight loss

Answer 21

• subtract child’s present weight from original weight

- divide the loss by the child’s original weight

Question 22

Shock Stages:

Answer 22

Warm (fever)

Cool (skin)

Cold (extremities)

Question 23

Why is an infant more susceptible to gas and abdominal distention?

Answer 23

smaller stomach and digestive enzymes not present until 4-6 mths

Question 24

T/F: Infants/Young Children have greater surface area in relation to body mass.

Answer 24

True

Question 25

Can babies concentrate urine well?

Answer 25

no, they have immature kidneys

Question 26

Infants excrete a --- amount of fluid per kg of body weight.

Answer 26

greater

Question 27

With children, we want --- to be almost equal.

Answer 27

Intake and Output

Question 28

Minimum fluid output is ---

Answer 28

1-2 mL/kg/hr

Question 29

Infant is ---- fluid 1 yr old is --- fluid Adult is --- fluid

Answer 29

70-80% 60% 60%

Question 30

Infants have more fluid in --- 1 yrs and up have more fluid in ---

Answer 30

ECF ICF

Question 31

---- become dehydrated faster because...

Answer 31

infants higher amts of ECF

Question 32

Why can high carb foods cause diarrhea?

Answer 32

pulls water into GI tract

Question 33

---- ---- causes malabsorption syndrome.

Answer 33

Cystic Fibrosis

Question 34

Starvation Diarrhea is...

Answer 34

If they've had NV or been NPO... then, first PO intake is not well accepted by the body and moves quickly through the GI tract

Question 35

Formula too diluted or too concentrated can cause...

Answer 35

diarrhea

Question 36

Which virus mimics appendicitis?

Answer 36

Yersina eneroclitica

Question 37

Sodium is --- Potassium is ---

Answer 37

ECF ICF

Question 38

If dehydrated, sodium levels ---

Answer 38

rise

Question 39

Stool Description:

Answer 39

Color Consistency Odor Frequency

Question 40

Instead of BRAT diet for diarrhea, give them...

Answer 40

- Ricelytes - Pedialyte - Unsweetened Jello - NO FRUIT JUICE - NO GREASY/SPICY FOOD

Question 41

Check skin tugor where?

Answer 41

inner thigh abdomen

Question 42

If patient is not voiding, avoid what when hanging IV?

Answer 42

KCl

Question 43

--- dehydration is most common in kids.

Answer 43

Isotonic

Question 44

---- dehydration is when electrolyte deficit exceeds water deficit.

Answer 44

Hypotonic

Question 45

--- dehydration is when water loss exceeds electrolyte loss.

Answer 45

Hypertonic

Question 46

---- dehydration is when electrolyte and water losses are in balanced proportions.

Answer 46

Isotonic - most common in children

Question 47

Child weighed 12 kg. he was weighed again and was 11 kg. What is his percentage weight loss? Mild/Moderate/Severe?

Answer 47

``` 12-11 = 1 1/12 = 0.83 ``` 8.3% weight loss Moderate (6-9%)

Question 48

Mild Dehydration = Moderate Dehydration = Severe Dehydration =

Answer 48

3-5% 6-9% 10% or more

Question 49

Cap refill for dehydration?

Answer 49

Mild = >2 secs Moderate = 2-4 secs Severe = >4 secs

Question 50

Diarrhea causes...

Answer 50

metabolic acidosis b/c you lose bicarb

Question 51

Blood Pressure for CV assessment.

Answer 51

Lower limit of SBP = 70 + (2*age in years) ex: SBP lower limit of 8 yr old should be 86

Question 52

Renal Perfusion should be minimally ---

Answer 52

urinary output > 1mL/kg/hr

Question 53

Shock signs

Answer 53

- Skin – cool, to cold, clammy - Mottling - Poor capillary refill - Reduced urinary output - Anaerobic metabolism –acidosis - Increased blood viscosity - Tachycardia, tachypnea - Level of consciousness changes