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Why children are more at risk for fluid
and electrolyte imbalances
- percentage of body weight is water
- fluids are extracellular
- prone to gastrointestinal infections
What are the two compartments where water is located in the body?
Extracellular fluid is located in teh interstitial spaces ( surrounding the cells)
intracellular space- this more difficult to dehydrate.
What are symptoms of dehydration?
- from 4-5% losses, child will be fussy, thirsty, and vital signs are stable.
- from > 10% fluid loss—at risk for impending hypovolemic shock
What percentage of body water is located in the extracellular compartment in neonates?
40% compared to 20% in adults
Assessment of the child with fluid losses
- of nausea, vomiting, diarrhea
- in tears, salivation
- indicators of impending shock
Therapeutic management of dehydration
- according to child’s
- preparations such as pedialyte
- SPORTS DRINKS, WATER, OR SUGARY DRINKS
- therapy—solution depends on sodium needs
Level for hyponatremia?
sodium < 135 meq/l
Level for Hypernatremia?
sodium >150 meq/l
level for hypokalemia?
Potassium <3.5 meq/L
Oral replacement guidelines
- evidence of dehydration—replace up to 10ml/kg for ongoing losses—continue AAD
- dehydration—10-50 ml/kg over a 4 hour period + replace estimated losses*
- dehydration—10-100 ml/kg over 4 hours + replace estimated losses*
- dehydration—IV therapy bolus of 20ml/kg of solution*
*start age-appropriate diet once dehydration is corrected
Guidelines when administering potassium
Maximum dose is 40meq/liter.
- is 1 meq/kg/hour
- or less
- well into IV bag—upright position
- solution is > 30 meq/liter
- do not give in peripheral
- sure of age-appropriate dose
- if urinary output inadequate
What is the maximum dose of potassium IV given?
What do you not do if the potassium solution is >30 meq/L?
Do not give in peripheral vein.
Why would you DC IV potassium?
In urinary output is inadequate
What is the treatment goal in acid base imbalance?
- The treatment of metabolic acid-base distrubance is oriented towared correcting the underlying problem.
- The treatment of respiratroy imbalanc is directed toward reestablishing alveolar ventilation.
Nursing care—parent education about
symptoms of dehydration
- wet diapers within 6-8 hours
- tears if older than 2-4 months
- in mucous membranes
- high-pitched cry
- respiratory rate or difficulty breathing
- mottled, unusual color, or cool to touch
- common childhood disorder
- million cases annually
- hospitalizations yearly
- with dehydration, changes in stool patterns
Levels for hyperkalemia?
Levels for hypocalcemia?
- Calcuim <8.5 mg/dl
- ionized calcuim <4.5 mg/dl
Levels for hypercalcemia?
- Calcium >11.0 mg/dl
- ionized calcium >5.5 mg/dl
Etiology of diarrha
- due to bacterial or viral—rotavirus
- food intolerance
- bowel disorders, IBS
Management of diarrhea
- use of BRAT (banana-rice-applesauce-toast) diets—not preferred since this diet
- is low in energy, density, fat, and protein
- management--rehydration solutions, then resume formula or breast feeding—age
- appropriate diet
- on frequent feedings
- medications are contraindicated
Do they still use BRAT to treat diarrhea?
Not preferred since this diet is low in enegy, density fat and protein.
- ejection of stomach contents
- up” or
- GER due to overfeeding
- form is “projectile”
Expected findings in vomit?
- food or formula
- of bile, fecal odor, or blood
- projectile---indicates obstruction, tumor, pyloric stenosis, or increased
- intracranial pressure
Nursing management of vomiting
- oral replacement therapy per formula
- re-introduction of food