14174472
Descripción
Fichas por Elizabeth Then, actualizado hace más de 1 año
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Creado por Elizabeth Then
hace casi 6 años
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| Pregunta | Respuesta |
| Fluid and electrolyte balance | large percentage of body if fluid Contains electrolytes Two main compartments: Intra and extracellular Intravascular fluid and interstitial fluid |
| Paediatric physiology differences | percentage of body weight is composed of water and is higher in infants neonates and infants have larger extracellular fluid because brain and skin have greater proportion to their body weight =greater dependence on adequate intake and greater risk of fluid loss |
| When fluid and electrolyte imbalances occur | body tries to shift fluid and electrolytes to balance fluid losses kidneys - conserve water and electrolytes * children under 24 months have - immature kidneys, unable to conserve water and electrolytes effectively, greater risk of acidosis |
| when fluid volume imbalances | extra cellular volume deficit causes: phototherapy increased RR fever vomiting and diarrhea fistulas, blood loss drainage tubes renal disease |
| Dehydration (extracellular fluid volume deficits | dehydration occurs when there is not enough fluid in the extracellular space (vascular and interstitial) sodium may be elevated, low, or normal levels |
| Isotonic dehydration (Isonatremic dehydration) | sodium and fluid loss is the same- therefor sodium concentration is within normal limits caused by: vomiting and diarrhea |
| Hypotonic dehydration (Hyponatremic dehydration) | - sodium is greater than fluid loss Therefore concentration of sodium is lower than normal levels -body compensation: Fluid shifts from extracellular to intracellular to achieve normal proportions leading to greater extracellular dehydration causes: severe and prolonged vomiting and diarrhea, burns, renal disease, administration of intravenous fluids without electrolytes |
| Hypertonic dehydration (hypernatremic dehydration) | occurs when sodium loss is less than fluid loss therefore sodium levels are higher than normal levels fluid shifts occur from intracellular to extracellular causes: diabetes insipidus and administration of intravenous fluid or tube feedings with high electrolytes |
| Nursing assessment | history: frequency of vomiting and diarrhea, fluid in and out, pain, recent abx, bile stained vomit, blood stained stool, weight loss nursing observations: GCS, AVPU, HR,BP, oedema, resp rate and depth, gastro, renal, BSL, temp, muscle weakness, skin dry/moist, turgor |
| Calculating percentage of of body weight loss | subtract the child's weight from previous healthy weight to find loss divide the loss by original weight |
| Management of minimal to no dehydration | - may be d/c home with plan providing adequate fluids and normal diet - normal fluid intake plus 10ml/kg per watery bowel action - pts who may require admission for 4-6 hours - when dx unconfirmed if pt at high risk infant less than 3 months old co-exist illness living in isolated area no transport to return |
| moderate dehydration two methods: | rapid - child must be over 6 months old, illness present for less than 48 hours, nil chronic illness rehydrate by giving - 50ml/kg (12mls/kg/hr) over 4 hours either oral or NG for IV 0.9% NS + G at 10ml/kg/hr for 4 hours reassess and weight slow rehydration -do not meet rapid hydration criteria, require hydration over 24 hours, calc sum of deficit + maintenance + ongoing losses % dehydration X weight in kg X 10 - over 8 hrs ongoing loss - 2mls/kg/hr - reassess at 4 hours continue maintenance fluids + ongoing losses |
| Severve dehydration and shock | medical emergency - DRABS - secure airway, high flow oxygen - IV access and bloods, EUC, venous bloods, BSL - consider causes for shock and manage - give fluid once circulation has been restored continue hydration |
| Fever | temp measured at axilla, ear, rectal, orally - rectal temp is considered gold standard for children under 2 - tympanic temp correlates with rectal temp for children over than age of 2 - defined as rectal temp above 38 degress or tympanic/axillary temp over 37.5 |
| Diagnostic test for child presenting with fever | -CBE, CRP, blood cultures, urinalysis and culture, LP CXR, stool culture |
| Medications to consider | Ondasetron, antibiotics only if fever or bacterial infection present * Not recommended, metoclopramide, anti-diarrhoel agent or anti- motility agents |
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