The child with a fluid and electrolyte atlertation.

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  1. Why children are more at risk for fluid
    and electrolyte imbalances
    • Higher
    • percentage of body weight is water

    • More
    • fluids are extracellular

    • Higher
    • metabolic rate

    • Faster
    • peristalsis

    • ¢Can’t
    • communicate thirst

    • ¢Cannot
    • concentrate urine

    • ¢More
    • prone to gastrointestinal infections
  2. 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.
  3. What are symptoms of dehydration?
    • Mild—suffering
    • from 4-5% losses, child will be fussy, thirsty, and vital signs are stable.

    • Severe—suffering
    • from > 10% fluid loss—at risk for impending hypovolemic shock
  4. What percentage of body water is located in the extracellular compartment in neonates?
    40% compared to 20% in adults
  5. Assessment of the child with fluid losses
    • History
    • of nausea, vomiting, diarrhea

    • Sunken
    • fontanels

    • Dry
    • mucous membranes

    • Decreased
    • urinary output

    • Changes
    • in tears, salivation

    • Weight
    • loss

    • Abnormal
    • electrolytes

    • Changes
    • in

    • Heart
    • rate

    Sensorium

    Skin

    • (early
    • indicators of impending shock
  6. Therapeutic management of dehydration
    • Correct
    • underlying cause

    • Replace
    • fluids/electrolytes

    • Rehydrate
    • according to child’s
    • weight

    • Recommend
    • preparations such as pedialyte

    • AVOID
    • SPORTS DRINKS, WATER, OR SUGARY DRINKS

    • IV
    • therapy—solution depends on sodium needs
  7. Level for hyponatremia?
    sodium < 135 meq/l
  8. Level for Hypernatremia?
    sodium >150 meq/l
  9. level for hypokalemia?
    Potassium <3.5 meq/L
  10. Oral replacement guidelines
    • No
    • evidence of dehydration—replace up to 10ml/kg for ongoing losses—continue AAD

    • Mild
    • dehydration—10-50 ml/kg over a 4 hour period + replace estimated losses*

    • Moderate
    • dehydration—10-100 ml/kg over 4 hours + replace estimated losses*

    • Severe
    • dehydration—IV therapy bolus of 20ml/kg of solution*

    *start age-appropriate diet once dehydration is corrected
  11. Guidelines when administering potassium
    IV
    Maximum dose is 40meq/liter. 

    • Rate
    • is 1 meq/kg/hour
    • or less

    • Mix
    • well into IV bag—upright position

    • If
    • solution is > 30 meq/liter
    • do not give in peripheral
    • vein

    • Be
    • sure of age-appropriate dose

    • DC
    • if urinary output inadequate
  12. What is the maximum dose of potassium IV given?
    40 meq/L
  13. What do you not do if the potassium solution is >30 meq/L?
    Do not give in peripheral vein.
  14. Why would you DC IV potassium?
    In urinary output is inadequate
  15. 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.
  16. Nursing care—parent education about
    symptoms of dehydration
    • No
    • wet diapers within 6-8 hours

    • No
    • tears if older than 2-4 months

    • Change
    • in mucous membranes

    • Irritable
    • high-pitched cry

    • Difficult
    • to rouse

    • Increased
    • respiratory rate or difficulty breathing

    • Skin
    • mottled, unusual color, or cool to touch

    • Skin
    • very dry

    • Decreased
    • turgor
  17. Diarrhea
    • Most
    • common childhood disorder

    • 25-30
    • million cases annually

    • 200,000
    • hospitalizations yearly

    • Presents
    • with dehydration, changes in stool patterns
  18. Levels for hyperkalemia?
    Potassium >5meq/L
  19. Levels for hypocalcemia?
    • Calcuim <8.5 mg/dl 
    • ionized calcuim <4.5 mg/dl
  20. Levels for hypercalcemia?
    • Calcium >11.0 mg/dl
    • ionized calcium >5.5 mg/dl
  21. Etiology of diarrha
    • Acute
    • infections

    • >50%
    • due to bacterial or viral—rotavirus

    • Parasitic
    • infections

    • Fungal
    • infections

    • Malabsorption,
    • food intolerance

    Medications

    • Obstructions,
    • bowel disorders, IBS
  22. Management of diarrhea
    • Restore
    • fluid/electrolytes

    • Past
    • use of BRAT (banana-rice-applesauce-toast) diets—not preferred since this diet
    • is low in energy, density, fat, and protein

    • Current
    • management--rehydration solutions, then resume formula or breast feeding—age
    • appropriate diet

    • Emphasis
    • on frequent feedings

    • Anti-diarrheal
    • medications are contraindicated
  23. Do they still use BRAT to treat diarrhea?
    Not preferred since this diet is low in enegy, density fat and protein.
  24. Vomiting
    • Forceful
    • ejection of stomach contents

    • Not
    • “spitting
    • up” or
    • GER due to overfeeding

    • Severe
    • form is “projectile”
  25. Expected findings in vomit?
    • Undigested
    • food or formula

    • Free
    • of bile, fecal odor, or blood

    • Not
    • projectile---indicates obstruction, tumor, pyloric stenosis, or increased
    • intracranial pressure
  26. Nursing management of vomiting
    • Treat
    • underlying cause

    • Prevent
    • dehydration

    • Use
    • oral replacement therapy per formula

    • Prevent
    • aspiration

    • Proper
    • positioning

    • Gradual
    • re-introduction of food

Card Set Information

Author:
jessem30
ID:
204680
Filename:
The child with a fluid and electrolyte atlertation.
Updated:
2013-03-03 23:01:42
Tags:
Child electrolyte SPC nursing
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SPC nursing pedi Child with electrolyte alteration.
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