Fichas
4 - Responding to fever and dehydration in infants and children
Fichas del conjunto (16)
- 1Fluid and electrolyte balancelarge percentage of body if fluid
Contains electrolytes
Two main compartments:
Intra and extracellular
Intravascular fluid and interstitial fluid - 2Paediatric physiology differencespercentage 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 - 3When fluid and electrolyte imbalances occurbody 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 - 4when fluid volume imbalancesextra cellular volume deficit causes:
phototherapy
increased RR
fever
vomiting and diarrhea
fistulas, blood loss drainage tubes
renal disease - 5Dehydration (extracellular fluid volume deficitsdehydration occurs when there is not enough fluid in the extracellular space (vascular and interstitial)
sodium may be elevated, low, or normal levels - 6Isotonic dehydration (Isonatremic dehydration)sodium and fluid loss is the same- therefor sodium concentration is within normal limits
caused by: vomiting and diarrhea - 7Hypotonic 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 - 8Hypertonic 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 - 9Nursing assessmenthistory: 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 - 10Calculating percentage of of body weight losssubtract the child's weight from previous healthy weight to find loss
divide the loss by original weight - 11Management 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 - 12moderate 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 - 13Severve dehydration and shockmedical 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 - 14Fevertemp 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 - 15Diagnostic test for child presenting with fever-CBE, CRP, blood cultures, urinalysis and culture, LP CXR, stool culture
- 16Medications to considerOndasetron, antibiotics only if fever or bacterial infection present
* Not recommended, metoclopramide, anti-diarrhoel agent or anti- motility agents
Información
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- El usuario ha eliminado su información de asignaturas Fichas sobre 4 - Responding to fever and dehydration in infants and children, creado por Usuario eliminado el 15/06/2018.
- Creado por
- Usuario eliminado · jun 2018
- Actualizado
- 15 jun 2018
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- 16
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- Creado por Elizabeth Then · 15 jun 2018
- Copiado por Elizabeth Then · 15 jun 2018
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