Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > The Child with Fluid & Electrolyte Alterations > Flashcards

The Child with Fluid & Electrolyte Alterations Flashcards

1
Q

ECF Total birth weight at birth

A

45-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ECF Total birth weight at 2 years

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ECF Total birth weight at maturity

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cerebral changes in hypertonic dehydration

A

Disturbances of consciousness
poor ability to focus attention
lethargy
increased muscle tone with hyperreflexia
hyperirritability to stimuli (tactile, auditory, bright light)
Decorticate posturting
unable to talk
Unresponsive to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment of hypernatremia

A

treat by IV hypotonic fluids -> dilutes body fluids back to normal
If dehydrated, may give isotonic first to replenish volume then hypotonic to correct osmolality. Careful monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

S&S of hypernatremia

A

will be thirst, decreased urine output
decreased LOC -> confusion, lethargy, coma from shrinking of brain cells; seizures if rapid or severe; can be fatal
Increased osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Special consideration with hypertonic solutions

A

Interstitial IV burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Manifestations of Dehydration

A

Thready, rapid pulse
Dry skin & mucous membranes
Sunken fontanel
Coolness & mottling of extremities
Decreased skin turgor
Delayed capillary refill
Increased small vein filling time
Dizziness, syncope
Oliguria
Weight loss
Postural BP drop (older children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical manifestations are a result of

A

Decreased fluid
Body’s response to decreased fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Earliest detectable sign of dehydration

A

Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how is magnitude of fluid loss described?

A

described as a % (5,10,15) & ascertained by comparison of pre-illness weight & current weight.
However, water is only 60-70% of infant weight, & adipose tissue, which contains very little water is highly variable.
More accurate to reflect acute loss in mL/kg of body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical signs:

A

provide clues to extent of dehydration. Earliest detectable sign is usually tachycardia, followed by dry skin & mucous membranes, sunken fontanels, signs of circulatory failure (coolness & mottling of extremities), loss of skin elasticity, & delayed capillary filling time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dehydration caused by loss of Na+ containing fluid form body

A
  • vomiting
  • diarrhea
  • NG suction
  • hemorrhage
  • burns
  • LBW infants under radiant warmers, adrenal insufficiency
  • overuse of diuretics
  • third space accumulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Etiology ECF deficit: decreased fluid volume

A

Manifestation: weight loss, sunken fontanel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Etiology ECF deficit: inadequate circulating blood volume to offset

A

Manifestation: postural BP drop, dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Etiology ECF deficit: decreased intravascular volume

A

delayed cap refill, flat neck veins when supine (older children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Etiology ECF deficit: Inadequate circulation to brain

A

dizziness, syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Etiology ECF deficit: Inadequate circulation to kidneys

A

oliguria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Etiology ECF deficit: Cardiac reflex response to decreased intravascular volume

A

Thready, rapid pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Decreased interstitial fluid volume

A

decreased skin turgor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Early Compensation

A

Interstitial fluid moves to vascular compartment; vasoconstriction maintains pumping pressure.
When BP is involved it is usually a late sign and more significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Compensatory mechanisms

A

attempt to maintain fluid volume by adjusting to these losses. Interstitial fluid moves into vascular compartment to maintain blood volume in response to hemoconcentration & hypovolemia, & vasoconstriction of peripheral arterioles helps maintain pumping pressure.

23
Q

Late Compensation

A

BP falls - tissue hypoxia & metabolic acidosis (accumulation of lactic acid, pyruvate)
Renal compensation impaired due to reduced blood flow; urine output decreased
- ADH to conserve fluid
- Renin-angiotensin -> vasoconstriction
- Aldosterone -> Na retention & water conservation.

24
Q

Shock

A

Tachycarida, poor perfusion (skin cool & mottled, decreased cap refill), oliguria & azotemia (nitrigenous waste esp. urea), low BP (late sign & may herald onset of cardiovascular collapse)

25
Q

Degrees of dehydration: Mild

A

Up to 5% weight loss
Irritable (infants); thirsty

26
Q

Degrees of dehydration: Moderate

A

6-9% weight loss
- lethargic & sleepy; restless & irritable
- decreased skin turgor; dry mucous membranes; urine dark & decreased
- pulse increased & BP normal or decreased

27
Q

Degrees of dehydration: Severe

A

> 10% weight loss
lethargy or non-responsive, decreased BP, rapid pulse, poor skin turgor, dry mucous membranes, decrease or absent urine output

28
Q

ECF Deficit (Dehydration)

A

occurs when total output of fluid exceeds total intake, regardless of underlying cause.
may result from lack of intake but more often result of abnormal losses (vomiting, diarrhea), when oral intake only partially compensates for the abnormal losses. Other significant causes of dehydration are DKA & excessive burns.
Dehydration - not enough fluid in ECF compartment (vascular & interstitial). Na+ generally lose with water, therefore may be hyponatremia
Signs vary with severity or degree of body water deficit.
Signs are result of: decreased fluid (turgor, dry mucous membranes), body’s response to fluid deficit (increased HR, decreased BP) Mild -> hard to detect

29
Q

Increased Fluid Requirements

A

Fever (add 12% per rise of 1 degree C)
Vomiting
Diarrhea
High-output kidney failure
Diabetes insipidus
Diabetic ketoacidosis
Burns
Shock
Tachypnea
Radiant warmer
Phototherapy
Post-op bowel surgery

30
Q

Normal Urine Output: Infant

A

2 ml/kg/h

31
Q

Normal Urine Output: Child (>1 yr)

A

1 ml/kg/h

32
Q

Normal Urine Output: Adolescent (10-19)

A

0.5 ml/kg/h

33
Q

Diarrhea

A

Caused by abnormal intestinal water & electrolyte transport which results
- dehydration
- electrolyte imbalance
- metabolic acidosis
Intestinal mucosa of young infant is more permeable to water than that of older child, therefore, more fluids & electrolytes are lost in infant with diarrhea

34
Q

Dehydration caused by diarrhea: patho

A

voluminous losses of fluid in frequent, watery stools
losses with vomiting
reduced fluid intake from nausea or anorexia
increased insensible water losses from fever, hyperpnea
continued (although diminished) renal losses

35
Q

Electrolyte imbalance cause by diarrhea

A

losses of Na, Cl, K & sometimes bicarb
inadequate replacement of electrolytes when hypotonic or hypertonic solutions used

36
Q

metabolic acidosis caused by diarrhea

A

increased absorption of short-chain fatty acids produced in colon from bacterial fermentation of unabsorbed dietary CHO
lactic acid from tissue hypoxia secondary to hypovolemia
loss of bicarb in stools
ketosis from fat metabolism when glycogen stores are depleted in untreated diarrhea dehydration or inadeqaute CHO intake; may result in malnutrition

37
Q

Acute Diarrhea

A

Leading cause of illness in children < 5 years
often caused by infectious agent (rotavirus, norwalk-like organisms, E. coli, Salmonella)
may be associated with URTI or UTI, antibiotic therapy, or laxative use
Usually self-limited (< 14 days)
- no specific treatment occurs usually required unless dehydration occurs
Spread through fecal-oral route, through contaminated water or close contact
Major risk factors: lack of clean water, crowding, poor hygiene, nutritional deficiency, poor sanitation

38
Q

Chronic Diarrhea

A

> 14 days
Often caused by malabsorption causes, IBD, immunodeficiency, food allergy, lactose intolerance, radiation, motility disorders, endocrine causes, parasitic infestations
Increase in stool frequency & increased water content
Malabsorption: celiac, short bowel, lactose intolerance
Motility: hirschusprung disease
Parasites: Giardia

39
Q

Factors that Predispose to Diarrhea

A

Age: the younger the child, the greater the susceptibility & the more severe the diarrhea
Impaired health: malnourished or immunocompromised child
Environment: crowding, substandard sanitation, poor facilities for preparation & storage of food, inadequate health care education

40
Q

Therapeutic Management Goals of Acute Diarrhea

A

Assessment of fluid & electrolyte imbalance
Rehydration
Maintenance fluid therapy
Reintroduction of adequate diet
First-line treatment is oral rehydration therapy (ORT)
- more effective, safer, less costly, & less painful than IV rehydration

41
Q

Therapeutic Management

A

Oral rehydration solutions (ORS)
- enhance & promote reabsorption of sodium & water
- reduce vomiting, volume loss from diarrhea & duration of illness
Continued feeding or reintroduction of normal diet (when child is dehydrated we want to promote eating normally and whatever they can tolerate)
- lessens severity & duration of illness
- Continue with BF & use ORS for replacement
- lactose-free formula if usual formula not tolerated
IV therapy for severe dehydration & shock (usually use saline solution with 5% dextrose. may add bicarb.
Antibiotics - maybe

42
Q

ORS

A

ORT is first line treatment.
After rehydration, use ORS during maintenance fluid therapy by alternating ORS with water, breastmilk, lactose-free formula, or ½ strength lactose-containing formula.
In older children, continue regular diet with ORS
Replace ongoing stool losses 1:1 with ORS
If vomiting, give small amounts of ORS frequently (5-10 mL q 1-5 mins.); may give with NGT or GT
If no clinical signs of dehydration in infants, they do not need ORT

43
Q

Diarrhea Treatment “no-nos”

A
  • Do not encourage po clear fluids, such as fruit juices, carbonated soft drinks & jello (high in CHO & low electrolyte, high osmolality
  • Do not drink caffeinated pop or other drinks (caffeine is mild diuretic)
  • Do not give chicken or beef broth (excessive sodium & inadequate CHO)
  • Do not use BRAT diet (bananas, rice, applesauce, & toast or tea) - little nutritional value (low in energy & protein), high in CHO, low in electrolytes
44
Q

What should you do when you have diarrhea

A

eat to what is tolerated with oral rehydration therapy

45
Q

Nursing Care Management of Diarrhea

A

Education re: treatment & prevention
Accurate weight
Accurate intake & output
Monitor IV therapy
Specimen collection (sometimes they are not making urine it just looks like it)
Skin care

46
Q

Hypovolemic Shock

A

Complex clinical syndrome
Circulatory failure (shock)
- tissue perfusion that is inadequate to meet metabolic demands of body
- results in cellular dysfunction & eventual organ failure

47
Q

Physiological consequences of hypovolemic shock

A
  1. hypotension (later sign)
  2. tissue hypoxia
  3. metabolic acidosis
48
Q

Pathophysiology of Hypovolemic Shock

A

If hemorrhage reduces the circulating blood volume sufficiently then the compensatory mechanisms support blood circulation by increasing the heart rate and constricting the peripheral blood vessels. This response shifts the remaining blood to larger blood vessels so that the vital organs continue to be perfused. When the blood loss exceeds 20% to 25%, the child’s body can no longer compensate; blood pressure falls and circulatory collapse is imminent.
Very fatal in little kids

49
Q

Hypovolemic shock: etiology

A

Most common type in children
Reduction in circulating blood volume beyond child’s physiological ability to compensate related to:
- blood loss (trauma, major bleeding)
- plasma losses (burns)
- ECF losses (diarrhea, dehydration)

50
Q

Hypovolemic Shock Clinical Manifestation - Early Compensated
Cardiac
Respiratory
Neurologic
Skin Renal

A

mild tachycardia, weak distal pulses, strong central pulses, normal BP
Mild tachypnea
Normal, anxious, irritable
Mottled; cap refill > 2 sec; cool, clammy extremities
Renal: decreased urine output; increased SG

51
Q

Hypovolemic Shock Clinical Manifestation - Moderate Uncompensated
Cardiac
Respiratory
Neurologic
Skin Renal

A

Mod tachycardia; thready distal pulses, weak central pulses, decreased systolic BP
mod tachypnea
confusion, agitation, combative behaviour, lethargy, decreased pain response
pallor, cap refill > 3 sec, dry extremities, sunken eyes
Oliguria, increased SG

52
Q

Hypovolemic Shock Clinical Manifestation - Severe Uncompensated shock
Cardiac
Respiratory
Neurologic
Skin Renal

A

Extreme tachycardia, decreased BP, absent distal pulses, thready central pulses
Severe tachypnea
Comatose state
pale, cold skin, cyanosis, cap refill > 5 sec
no urine output

53
Q

Principal differentiating signs at all stages of shock are

A

degree of tachycardia & perfusion to extremities
level of consciousness
blood pressure
Compensated: vital organ function maintained by intrinsic mechanisms & child’s ability to compensate is effective
Subtle signs initially
In decompensated, signs become more obvious

54
Q

Therapeutic Management of Hypovolemic Shock

A
  1. Ventilation
  2. Fluid administration
  3. Improvement of pumping action of heart (vasopressor support)
    - first priority is to establish airway & administer oxygen
    - place one or more multi-lumen central lines or cutdown or intraosseous needle
    - preferably place central line above diaphragm to deliver drugs closer to heart & limit tissue injury from caustic meds
    - lines needed for rapid volume replacement, administration of drugs, and hemodynamic monitoring.

Pediatrics (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions