Dehydration and Gastroenteritis PEDs Exam Solution Manual Already Passed

Dehydration and Gastroenteritis PEDs Exam Solution Manual Already Passed Past medical history - Answers - why did they come into the office? what are the symptoms? vomiting, diarrhea, fever? - what does the vomit look like? how old is the child? are they experiencing growth problems? Physical examination - Answers - might be pale, fontanel might be sunken in if less than 18 months, assess bowel sounds - urine output should be asked about and try ti quantify it: how many times did they go and how wet are their diapers Fluid balance principles - Answers - your body is made up of both intracellular and extracellular fluid - these together equal total body water where are these fluids ECF located - Answers - ECF is located between cells and in the lymph and plasma ECF compared to ICF - Answers - ECF is lost more readily than ICF and because there is more ECF to lose, dehydration occurs commonly especially in younger children Sodium and chloride - Answers - since these predominate in ECF, with fluid loses comes electrolyte imbalances - if you lose a lot of water you are losing a lot of sodium Body surface area in children - Answers - they have a larger body surface area leading to more insensible fluid loss by 2/3 vaporation and 1/3 respiration from breathing and RR GI tract in children - Answers - children also have an abnormally large GI tract leading to increased sensible fluid loss via vomiting and sweating Pediatric basal metabolic rate - Answers - the metabolism the body has in order for it to function is much higher to promote growth in children because they use their calories much faster What does the higher BMR then lead to? - Answers - increased insensible fluid losses and more water is needed to excrete increased metabolic waste, needing the kidneys to work hard Immature kidneys - Answers - they are inefficient at excreting waste products, concentrating and diluting urine, and conserving and excreting sodium Infants and formulas - Answers - less able to handle solute free liquid - they become over hydrated with diluted down formula - become dehydrated with over concentrated formula - EDUCATE these parents about mixing correclty factors affecting fluid losses - Answers - Radiant warmers and photosensitivity: nothing but diaper - skin defects and breakdowns/burns: keep it moist to prevent fluid loss - fever: treat this to prevent fluid loss - increased RR: treat and find underlying cause - elevated room temp: remove blankets, lower temp How can we make clients with fluid restrictions more comfortable? - Answers - by doing things such as giving them a lollipop, Popsicle, sucking a wet cloth, putting it in a small cup and giving more frequently, syringe, lip balm access to the fluid when on fluid restrictions - Answers - you can never leave the fluid bedside with children, you should schedule their drinks NPO - Answers - if they are nothing by mouth make sure they have some type of diet ordered Mental status in dehydration - Answers - mild: alert - moderate: alert to listless - severe: alert to camatose Fontanels in dehydration - Answers - mild: soft and flat - moderate: sunken - severe: sunken Eyes in dehydration - Answers - mild: normal - moderate: mildly sunken orbits - severe: deeply sunken orbits Oral mucosa - Answers - mild: pink and moist - moderate: pale and slightly dry - severe: dry skin turgor - Answers - mild: elastic - moderate: decreased - severe: tenting HR in dehydration - Answers - mild: normal - moderate: may be increased - severe: increased, progressing to bradycardia BP in dehydration - Answers - mild: normal - moderate: normal - severe: normal, progressing to hypotension extremities - Answers - mild: warm, pink, brisk cap refill - moderate: delayed cap refill - severe: cool, mottled or dusky, significantly delayed cap refill urine output in dehydrated patients - Answers - mild: might be slightly decreased - moderate: less than 1 ml/kg/hr - severe: significantly less than 1 ml/kg/h what is the first thing you are always going to do with a dehydrated patient? - Answers - weighing them is the first thing usually done causes of dehydration - Answers - trauma, burn, diabetes, meds Interventions for dehydration - Answers - document and report - REHYDRATE - record I&O - provide comfort measures Oral rehydration solutions (ORS) - Answers - pedialyte or anything with "lyte" promotes re-absorption of sodium and water to restore ECF, fluid volume How should we be giving ORS - Answers - small, frequent feedings - any way you can including with a spoon, syringe, G-tube, NG tube how much should be given? - Answers - 40-50 ml/kg over 4 hrs