PHYA 418: PEDS EXAM #2. Study Guide.

PEDS EXAM #2 50 QUESTIONS: CLASS 7-FINISH  Describe the clinical manifestations of dehydration. o Class #7 o DEHYDRATION  Can develop quickly in infants and young children  Occurs when the total output of fluid exceeds the total, intake, regardless of the cause.  Usually attributable to vomiting or an acute viral or bacterial diarrhea  Characterized as mild, moderate, or severe  Check out Table 24-2: Disturbances of Select Fluid & Electrolyte Balance  We know that they can develop this more quickly than anyone else  Up to age 2 à most of their water is extracellular = lose more quickly  They are exposed developmentallyà we look at them as infants or young toddlersà they pick up everything and put it in their mouthsà more likely to get GI upset or problems = germs  Want to think aboutà that they have ear infections à #1 drug for that is amoxicillin = diarrhea is a side effect  Kids who are on monoxicillion = they have diarrhea as side effect = run risk of dehydration o S/S DEHYDRATION- Check out Table 24-2  Wt. loss  Lethargy  May be cyanotic  Decreased voiding to oliguria  Ask parents how many wet diapers?  Babies – sunken fontanel  Dry mucous membranes  Pale  S.G. of 1.020or >  BUN increased  Tachycardia (earliest sign)  Will have weight loss  When it’s a mild dehydration à not going to see really significant signs  As it worsens = tachycardia = EARLEST SIGNà trying to maintain homeostasis  ANOTHER important (especially in babies) à sunken fontal àAnterior frontal (soft spot) closes at 12-18 months  Posterior frontal = 6-18 weeks  Best way to look at fontal = two fingers , baby sitting up, should be level and soft  If bulging = neuro things going on  If sunken = dehydrated  Baby can become lethargic = if sunken  Want to ask parents how many wet diapers the baby has had in the past 8 or 24 hoursà voiding pattern will decrease  Dry mucous membranes à best place to check is mouth  Want to put gloves on à go to the buccal cavity where the jaw meetsà best place to check for dryness  BUN will increase  TACHYCARDIA = EARILEST SIGN OR BEGINNING OF DEHYDRATION o Diagnostic Evaluation  Mild moderate or severe comes into place  Will determine the treatment  Chances are if you have a child that expereinces this à  Don’t need to know these numbers  If it is mild à will probably be at homeà may call the peds doctors and they tell the parents what to do and what to look for  Pedalight is now in popsicles  Look at the weight loss, resp rate, thirst , tears ( another sign to ask parents , when they cry do they have tears?)  Look at BP  Look at urine  Look at fontaels  All these factors will be looked at to ID the degree  Want to also see if they are expereincing any other illness  Will draw labs , look at electrolytes and see if they are imbalanced  Differentiate among the 3 types of dehydration in terms of clinical manifestations and therapeutic treatment o Types of Dehydration  ISOTONIC  Water & sodium lost in = amounts  Major loss is from ECF  Results in circulatory blood volume reduction  Causes: vomiting, diarrhea, $ oral intake  S/S – serum Na is normal  Display symptoms characteristic of hypovolemic shock.  HYPOTONIC  Loss of Na is > than water  Compensatory fluid shift into ICF leads to a > ECF deficit  Causes : diuretics, hyperglycemia, third spacing, NG drainage, drinking plain water during illness, IV fluids without electrolytes  S/S – serum NA is < 130  Signs/symptoms tend to be more severe with smaller fluid losses.  HYPERTONIC  Loss of water is > than Na  Compensatory fluid shift from ICF into ECF keeps ECF fairly normal  Delay onset of S/S until very serious  Causes: Diabetes insipidus, administration of IV fluids or NG feedings with high electrolyte levels.  S/S- serum Na is > 150  Also see neuro sx with the more common symptoms  3 caterogories based on osmolailty à serum sodium  Most common is ISOTONIC *****à losing water and sodium in equal amountsà major lose is from the extracellular fluid  Blood volume is reducedà is the tachycaridia  Vomiting dirrhea , decreased oral intake = isotonic  Will find the serum sodium os normal à as this isontonic progresses , contiun losing fluids and sodium à will see HYPOVOLMIC SHOCK*****  HYPOTONIC: ECF will have decrease, diuretics ( most potent diurtic =Lasxi/ fluorsemids) , hyperglycemia ( kids who come with DKA), 3rd spacing ( drinking plain water when you are sick = no )  Any IV fluids without elcetrolytes  Will see these kidfs look sick and be sick more quickly  HYPERTONIC:  Sodium will be greater  This is the type of dehydration that lends itself to NEURO sysoms à don’t pick up on this right because of the NEURO à makes us do our homework  Need to figure out if its dehydration or if more neuro o THERAPEUTIC MANAGEMENT  Correct fluid loss or deficit ( #1 thing to do)  Treat underlying disease (#2)  Oral rehydration management: Table 24-5 Composition of Some Oral Rehydration Solutions  Mild: 50ml/kg  Moderate: 100ml/kg  Diarrhea: 10ml/kg/stool  Weigh the diaper and than subtract, have some idea how much they are losing  Vomiting:  Oral syringe: 2-5 ml ORS every 2-3 minutes  Zofran  We need to break the cycle , used medication to break this. THIS IS THE DRUG OF CHOICE  Want to correct the fluid losee and defciet #1  Than treat the disease  Pedalight à recommend this à offically a oral rehdyration solution  Does have a little bit of a taste to it à put a bit of apple juice in it to taste better  LOOK AT THE TABLE  Treamtment is based on the severity of it  Recommendation of oral replacement à if child had mild : 50 ml per body weight o THERAPEUTIC MANAGEMENT – SEVERE  Parenteral Fluid Therapy  Usually isotonic solutions: 0.9% NaCL, Lactated Ringer  Normal Saline is what you see in practice (bolus)  Has 3 phases: