Assessment
Assessment of fluid status in a 3 year old
LOC, pulse, BP, RR, skin turgor, capillary refill, I&O hx
name nutritional sources of potassium
apricots, bananas, orange juice, etc. (chart on p.707)
Give the 24 hour maintenance fluid amount (ml) for a 15 kg child.
1000 + 250 = 1250 ml
A full-term infant is ______% water by weight.
75%
Sign of dehydration when this part of an infant's head is depressed or sunken
Anterior fontanel
A potential cause for a Na 120 in an infant
fluid overload (inappropriate mixing/overloading of powdered formula), infant vomiting and given tap water; excessive swallowing of swimming pool water (vulnerable to hyponatremia because they have a poorly developed thirst mechanism and may continue to drink; unable to excrete excess water quickly due to immature kidney function
Give the hourly IV rate for a 10 kg infant who is NPO.
1000 divided by 24 = 41.6 or 42 ml/hr or 4 x 10 = 40 ml/hr
Name a difference between children and adults in terms of intracellular and extracellular fluid proportions.
Adult has more intracellular fluid than extracellular fluid; newborn has more extracellular fluid than intracellular fluid; child is growing closer to and adult.
4 signs/symptoms in a 2 year old with a 10% weight loss due to dehydration
Lethargic to comatose; low BP; rapid, weak pulse; very poor skin turgor; parched mucous membranes; very decreased or absent urine output, delayed capillary refill (>3-4 seconds); changing RR and respiratory pattern
2 possible causes of hypokalemia in a hospitalized child
diuretics, NG drainage not replaced and increased loss of K; drugs (insulin, glucocorticoids, ahminoglycosides, antifungals, chemo, laxatives)
Name the percent of weight loss with a weight change from 15kg to 13kg
2 divided by 15 = 13%
Name two reasons why infants and young children can become dehydrated more quickly.
Kidneys are immature and cannot conserve or excrete water and solutes effectively; radiant heat used to treat hyperbili. Increases insensible water loss through the skin; increased RR in some illnesses leads to excessive water loss from lungs; fever increases the metabolic rate and therefore water demands of metabolism increase; V&D)
Identify 2 problems that might show up in parents' history or your physical evaluation of an infant with dehydration
LOC hard to assess; parent may not be able to tell you # of diapers or accurate intake
name 3 signs and/or symptoms of hypocalcemia
tetany; twitching and cramping, tingling around the mouth or in the fingers, carpal spasm, pedal spasm; seizures, cardiac arrhythmias; CHF in infants (don’t have any stores…ionized calcium is measured, not just serum calcium
Teach the parent how many 8 oz. Bottles are needed to meet the maintenance fluid requirements for a 12 kg. 1 year old.
Maintenance fluids = 1000 + 100 = 1100 ml
8 oz. = 240 ml
1100 divided by 240 = 4.5 bottles in 24 hours.
(Or convert 1100 to oz.= 36.6 oz in 24 hours
36.6 divided by 8 oz/bottle = 4.5 bottles in 24 hours.)
Children under 2 years of age have difficulty regulating which specific electrolytes
Na and Ca
5 safety precautions used with IV fluid therapy in a 6 mo baby
use of a pump and buretrol setup; no more than 2 hours of fluid available to baby via buretrol; site check q1h; double check rate and pump; use of arm/foot board to prevent dislodging/dcing IV; parent education
name 3 nursing interventions for a child with hyperkalemia
monitor serum potassium, assessment of muscle strength, monitor cardiac status, monitor I and O, parent teaching
IV replacement therapy for a 12 kg child with a 8% weight loss. (moderate dehydration).
Maintenance fluid + (8 x 10)/kg/24hr = 24 hour fluid needs
1000ml + (50 x 2) 80 x 12
1100 + 960 2060 mls/24 hours
( Some of this amount may be in a bolus to begin with. Also remember if he is still vomiting or having diarrhea, there will be added amount for continued loss)
Describe a nursing intervention to teach a parent appropriate fluid intake and assessment of a 2 year old (15kg) for dehydration.
child needs 1250ml or 5 cups of fluid/day; give fluids in small amounts at a time, do not use sugary or carbonated beverages, assess for dehydration…no urine output in 4-6 hours; lethargic; V&D; call clinic/MD/NP for concerns