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Distribution of Body Fluids
ICF/ECF changes during our lifetime...
- Fetus= 100% water
- Babies at Birth= 80% water
- Normal Adult= 70% water
- Elderly Person= 50% water
(ECF is greatest in newborns)
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Fluid within the cells
Intracellular Fluids (ICF)
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Fluid outside the cells
Extracellular (ECF)
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Intracellular Electrolytes
- Potassium
- Phosphate
- Magnesium
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Extracellular Electrolytes
- Sodium +
- Chloride -
- Calcium +
- Bicarbonate -
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Amount of water necessary to maintain normal health
- Obligatory Water Loss
- (Skin, Respiratory tract, Transcutaneous Evaporative, Urine, Stool)
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Sensible water loss
What you can sense and what can be measured (urine, stool)
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Insensible water loss
Can't be perceived/measured (Resp. Tract, Transcutaneous Evaporative)
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Transcutaneous evaporative water loss (TEWL) depends on:
BSA (Body Surface Area)-- highest in new borns; lowest in adults
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Obligatory urine is ____ in infants
Higher (they cannot concentrate urine to the same extent as adults)
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The rate of water loss from all 3 routes is highest in _____ and does not rise in direct proportion to increase in body weight
Smallest Children
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Respiratory losses are dependent on:
- Respiratory Rate
- Tidal Volume
- (unless ambient humidity is 100%)
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Transcutaneous Evaporative is dependent on:
BSA
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The amount of fluid a child's body needs is influenced by:
Growth Changes (fluid distribution shifts between ICF and ECF)
Water Balance (greater risk for fluid/electrolyte imbalances)
Body Surface Area (children have larger BSA than adults)
Basal Metabolic Rates (they breathe faster)
Kidney Function (because of larger BSA they have greater production of waste that must be eliminated by the immature kidneys)
Fluid Requirements
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Fluid Volume Requirements are INCREASED when:
- Fever
- Vomiting/Diarrhea
- High-Output Kidney Failure
- Diabetes Insipidus
- Diabetic Ketoacidosis
- Burns
- Shock
- Tachypnea
- Radiant Warmer
- Phototherapy
- Postoperative Bowel Surgery
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Fluid Volume Requirements are DECREASED when:
- Congestive Heart Failure
- SIADH
- Mechanical Ventilation
- After Surgery
- Oliguric Renal Failure
- Increased Intracranial Pressure
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Daily Maintenance Fluid Requirements is calculated by:
Calculating child's weight in kilograms
- 100 mL/kg for first 10kg
- 50 mL/kg for second 10kg
- 20 mL/kg for remaining kg of weight
***No appropriate for neonates <1month
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Fluid volume excess...intake of fluid exceeds output
- Water Intoxication
- (occurs less often than dehydration)
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Most common cause of Water Intoxification
Stretching formula by adding water; giving fluids too fast
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Fluid volume depletion...output exceeds intake
Dehydration
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Most common cause of dehydration:
Vomiting/Diarrhea
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Treatment of dehydration
- Parenteral Fluids (boluses)
- Oral rehydration
- Administer antiemetics
- V/S and I/Os
- Monitor Skin
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Treatment of water intoxification
- Limit Fluid Intake (IV/PO)
- Administer diuretics
- Monitor VS
- Neurochecks
- Seizure precautions
- Treat underlying cause
- Monitor Lab Results
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Clinical Manifestations of GI Dysfunction
Impaired functional integrity (failure to thrive, spitting up, regurgitation, constipation)
- GI losses of fluid; Absorption Disorders
- (nausea, vomiting, diarrhea, GI track anomalies)
Inflammatory Disorders (Crohn's Disease, Liver failure, Fever)
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Leading cause of illness in children >5 years of age
Acute Diarrhea
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In developing countries, ____% of all deaths are related to diarrhea and dehydration
20%
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Acute infectious diarrhea has a variety of causative organisms:
Viral, Bacterial, Parasitic
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Acute Diarrhea lasts:
<14 days
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Chronic diarrhea lasts:
>14 DAYS
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Oral Rehydration Therapy for minimal diarrhea
50 ml/kg over 4 hours
(5-10 mls every 2-3 min)
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Oral Rehydration therapy for moderate diarrhea
100 ml/kg within 4 hours
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Oral Rehydration for sever diarrhea
IV fluids 20ml/kg bolus over 30 min and repeat until pulse and state of consciousness returns to normal; Maintenance of fluids with dextrose and .45NS...add K+ after renal function is adequate
Give 50-100 ml/kg ORS
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Nursing care for diarrhea
Education -- s/s to look for, when to seek medical attention, change diapers often, use creams on skin, NO rectal temp
- I&Os
- Skin care
- Hand Hygiene
- Pedialyte
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Function of ORT (oral rehydration therapy)
Effectively enhances and promotes reabsorption of sodium and water
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Most common forms of ORT (oral rehydration therapy)
Pedialyte and Enfalyte
(given orally or ng tube)
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First line of treatment of fluid and electrolyte losses caused by diarrhea
Oral Rehydration Therapy
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