n304 fluid & electrolytes

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n304 fluid & electrolytes
2012-10-15 12:05:24
peds fluid electrolytes

n304 fluid & electrolytes
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  1. why are children more susceptible to f/e imbalance?
    • higher portion of water content
    • inable to shiver or sweat
    • greater proportion of fluid in teh ECF
    • higher metabolic rate
    • immature kidneys and GFR
  2. urine output in infants?
    1 - 2 ml/kg/hr
  3. anterior fontanel palpable up until what age?
    16 - 18 months
  4. why does tachypnea increase fluid needs?
    insensible loss via lungs
  5. heart failure, renal failure, increased ICP, inappropriate secretion of ADH... fluid needs?
    less than average.  fluid restriction.
  6. why is urinalysis ineffective in determining F/E balance?
    infants cannot concentrate urine appropriately
  7. K+
    • intracellular.
    • 3.5 - 5
  8. Na+
  9. Cl -
    follows sodium - extracellular
  10. K+ affected by what?
    intenstinal losses.  diarrhea, NG drng, vomiting
  11. when do you NOT give K+ to a child?
    if they are not urinating
  12. causes of hypokalemia?
    diuretics, meds, CHF, GI losses, nephrotic syndrome
  13. causes of hyperkalemia?
    hemolysis, reduced kidney fx, acidosis, blood transfusions
  14. danger of hyperkalemia?
    cardiac symptoms, possible cardiac arrest
  15. what serum replacement should never be pushed IV?
  16. treatments for hypo/hyperkalemia?
    • hypo - replacement
    • hyper - diuretics, regular IVF (increased extracellular volume)
  17. most abundant electrolyte in ECF? levels?
    • Na+
    • 130 - 145
  18. hyponatremia? causes?
    • < 130
    • water moves from intra to extracellular, dilutes ECF, decreased Na+
    • most common cause: dilute formula
  19. hypernatremia? causes? 
  20. calcium normal values
    8.5 - 11
  21. hypocalcemia?  causes?
    • decreased intake/absorption, increased excretion
    • causes: inadequate diet, vit D deficiency, cow's milk given inappropriately
  22. hypercalcemia?  causes?
    increased absorption or intake, shift from bones to ECF, decreased excretion
  23. treatment for hypo/hyper calcemia?
    • hypo: oral or IV calcium gluc
    • hyper: increased fluids, lasix
  24. glucose needs of infants?
    higher than adults due to higher BMR
  25. acidosis results from
    accumulation of an acid OR a loss of a base
  26. alkalosis results from..
    accumulation of base OR loss of an acid
  27. can evaluate acid-base balance by what tests?
    ABG, electrolytes, protein/albumin, urine pH
  28. components of blood gas?
    • pH, pCO2, paO2, BE, HCO3
    • ph, carbon dioxide, oxygen, base excess, bicarb
  29. normal pH range?
    7.35 - 7.45
  30. three mechanisms that operate to keep pH in normal range?
    • chemical buffers
    • respiratory control of CO2
    • renal regulation of bicarb and secretion of H+ ions
  31. which mechanism usually used first in children to regulate ph?
  32. chemical buffers used for ph maintenance?
    bicarb, proteins
  33. respiratory acidosis?
    • pH < 7.35
    • high CO2
  34. respiratory alkalosis
    • high pH, low CO2.
    • over-ventilating.
  35. metabolic acidosis
    • decrease in pH
    • decrease in bicarb
    • high lactic acid
  36. metabolic alkalosis
    high pH, high bicarb, base excess
  37. tachypnea does what to compensate?
    faster breathing = blowing off CO2 = trying to correct acidosis
  38. where is the fluid loss in early dehydration?
    extracellular fluid loss
  39. where is fluid loss in late dehydration?
    intracellular fluid loss
  40. first compensatory mechanism to dehydration?
    increased HR
  41. dehydration is defined according to what electorlyte
  42. isotonic dehydration
    losing water and Na+ same rate
  43. hypotonic dehydration
    • losing salt faster than fluids.
    • Na+ will be low
  44. hypertonic dehydration
    • losing fluid faster than salt.
    • Na+ will be high
    • most dangerous. prone to seizures & neuro damage
  45. treatment of mild - moderate dehydration?
    oral rehydration solutions (pedialyte, etc)
  46. treatment for severe dehydration?
    • parenteral rehydration
    • deficit + maintenance + ongoing losses >> fluid rate
    • LR, NSS.  adminstered until pulse, perfusion, mental status return to baseline
  47. fluid types for rehydration?
    NS or LR.
  48. possible causes of acute diarrhea?
    infectious.  eg, gastroenteritis
  49. possible causes of chronic diarrhea?
    malabsorption, food allergies, lactose intolerance, parasites
  50. we look at diarrhea by what characteristics?
    frequency, fluidity, volume
  51. treatment/diagnosis of diarrhea?
    stool cx, ova/parasites, give abx if bacterial, assess for dehydration
  52. most common virus causing gastroenteritis?
    Norovirus.  fecal-oral route, person-to-person via contaminated food/water
  53. rotavirus?
    • leading cause of infx in children
    • common in winter months. 50% of diarrhea cases
  54. adenovirus
    usually respiratory illness, but can also cause gastroenteritis
  55. Giardiasis
    • most common parasite seen in daycare-age children
    • spread in water
    • stool cultures over several weeks
  56. enterobiasis (pinworms) manifestations
    • anal itching, no diarrhea
    • hand-mouth ingestion from environment
    • scratching causes reinfestation
  57. enterobiasis (pinworms) dx and treatment?
    • tape test.  tape on anus overnight, scrape onto slide.
    • medication can stain stool/emesis red
  58. common interventions for parasite infections?
    • monitor other family members
    • handwashing
    • cut fingernails
    • diaper hygience, wash diaper area
    • wash fruits and vegs
  59. interventions for impaired skin integrity
    • diaper changes and cleansing
    • protective ointment
    • expose to air
    • avoid wipes
  60. why are anti-diarrheals contraindicated?
    want to get infection out
  61. rapid replacement of fluids for what types of dehydration?
    • isotonic, hypotonic
    • *want rapid expansion of intravascular space
  62. rapid replacement contraindicated in what type of dehydration?
    hypertonic (hypernatremic)