Pediatric Fluid Balance- Dehydration and Gastroenteritis Exam Questions and Answers Already Passed

Already Passed Pediatric Variances- higher risk for fluid imbalance - Answers -TBW= 75% - 80% - Larger proportional surface area of the GI tract than adults - greater body surface area and higher metabolic rate than adults - dependent on others to meet fluid needs - Limited ability to dilute and concentrate urine Dehydration def - Answers occurs whenever total output of fluid exceeds intake Dehydration causes - Answers - insensible fluid loss (tachypnea, sweating) - Decreased fluid intake - increased renal excretion - GI tract dysfunction (V &D) - DKA - Burns Dehydration mild stage - Answers - 3-6% wt loss - thirst - Decreases urine frequency - Darker yellow urine - Dry, cool skin Dehydration Moderate stage - Answers - all mild symptoms - 7-10 % wt loss - Decreased urine output - Dry or sticky mouth - HA - Muscle cramps Dehydration Severe - Answers - all mild and moderate symptoms - >10 % wt loss - no urine output - Sleepy or lethargic - Not responding to pain - Irritability or confusion - Delayed cap refill Dehydration symptoms - Answers - tachypnea - Increased HR - restlessness and or irritability - lethargy weakness - poor skin turgor - sunken fontanelle (infants) - Sunken eyes - Lack of tears - wants to drink a lot of water - Decreased urine output Dehydration can lead to hypovolemic shock - what are some red flags - Answers - Sleepy or lethargic - Not responding to pain - Delayed cap refill - Hypotension - Cyanosis - Cool peripheries Types of dehydration - Answers isotonic (water and Na lost at equal amounts) ( main one seen in children), hypotonic (electrolytes loss greater than water), hypertonic (water loss greater than electrolyte) Manage dehydration - Answers -fluid replacement is the primary goal - Oral replacement for mild to moderate +( electrolyte drink- Pedialyte, give slowly if vomiting, Contraindications- Decreased LOC and Tachypnea) Management of IV fluids - Answers - IV bolus (isotonic fluids only)- fluids are given rapidly over a short amount of time) - Maintenance fluids; fluids that are run at a slower rate to account for decreased PO intake or expected fluid losses, wt- based, 4-2-1 Rule Care reminder for kids - Answers - a severely dehydrated child will need more than maintenance after fluid bolus complete- 1 1/2- 2 times maintenance - Adding K to IV solution; Never add in cases of oliguria/ anuria EQ for Minimum output - Answers - change Ib to Kg - X by whatever age category they are - X by hours = total Nursing management for dehydration - Answers - I and O (weighing diapers, at home - monitor # of diapers and degree of wetness) - VS (increased HR and RR) - Daily Weights - Assessment of Skin, mucous membranes, Fontanel Pediatric Exemplars associated with dehydration - Answers - Gastroenteritis - DM - Diabetes insipidus - Pyloric Stenosis - GERD - Ulcerative Colitis - Crohn's Disease - Celiac Disease