Fluid Balance Compartments & Transport
Paediatric Consideration
Dehydration
Electrolytes & Lab Values
Critical Thinking/Misc.
100
Define "Fluid Balance"
"Regulation of the amount of liquid in the body"
100
Do infants have a larger ECF or ICF compartment?
ECF Fluid compartments in infants are different from those in adults, mainly due to an expanded ECF which accounts for more than half the TBW at birth.
100
What is dehydration?
A common body fluid disturbance in infants and children that occurs when the total output of fluid exceeds the total intake of fluid. *Important Info - The pathophysiology of dehydration is understood by recognizing that the distribution of water between the ECF & ICF depends on the active transport of potassium into the cells and sodium out of the cells by energy-requiring processes.
100
What is the main intracellular cation, which helps to control ICF osmotic pressure?
Potassium (K+)
100
Identify NURS 3000 concepts that can be applied to fluid & electrolyte balance/dehydration, and give a brief reason as to why.
- Health/Illness - Epidemiology - Family etc...
200
What is the total body water (TBW) in an adult and in a child?
Adult: Approximately 60% Child: Approximately 70%
200
At what age does the ECF become the same as an adults?
Up until age 2 infants will maintain a greater amount than adults do.
200
Using this calculation determine what Mandeep's daily fluid requirement is... 1) Calculate the weight of the child in kilograms (Mandeep = 10.5 kg) 2) 100ml of fluid/kg for first 10 kg 3) 50ml/kg for second 10 kg 4) 20ml/kg for remainder of weight in kg.
1025 ml of fluids per day
200
What is the main extracellular cation which helps to govern ECF osmolarity?
Sodium (Na+) * Important Info - When ECF volume is reduced because of acute dehydration, the total body sodium is almost always reduced as well. Sodium depletion in diarrhea occurs in 2 ways: Out of the body stool and into the ICF to replace potassium to maintain electrical equilibrium.
200
Differentiate between insensible and sensible fluid loss
Insensible fluid loss - water losses that occur through the skin and respirations. This loss cannot be measured Sensible fluid loss - fluid loss that occurs from urination, defecation, wounds, and other means
300
How many compartments are there in extracellular fluid(ECF)?
3... Interstitial fluid - fluid around the cells (including lymph) Intravascular fluid - Plasma Transcellular fluid - secreted by epithelial cells, therefore is found in many places in the body some examples are: cerebrospinal fluid, digestive fluids, and synovial fluid
300
What causes children to have increased heat production, insensible fluid loss, and an increased need for water excretion?
A greater basal metabolic rate
300
When electrolytes and water are lost in balanced proportions this is considered to be which form of dehydration? Identify 5 clinical presentations of a child/infant with this form of dehydration
Isotonic dehydration - Na+ levels are normal (130-150 mEq/L) - sunken eyeballs/fontanel - Resps and pulse become rapid - skin turgor is lost - Absent tearing/salivation - Body temperature is subnormal or elevated - Patient may be irritable to lethargic - Hypovolemic shock
300
Why are children at a higher risk for hypoglycemia than adults?
- Infants & children have a higher BMR - Have low glycogen stores because they require glucose constantly for growth & development.
300
What symptoms does Mandeep present with that indicate dehydration?
- Lethargic & drowsy - Vital signs - increased HR, Resps, and temp - skin pale & dry - dry lips - No tears while crying - Eyes slightly sunken
400
ICF is contained within cells and accounts for about two thirds of all body fluids in adults. In infants_______________ of all fluids is intracellular
less than half
400
Explain why it is difficult for infants to handle concentrated or unconcentrated fluids?
Immature kidney function - causes a decreased ability to concentrate or dilute urine, conserve or excrete sodium, and acidify urine. Dehydration may occur when infants recieve large amounts of concentrated formulas and overhydration may occur when given excessive water or dilute formula.
400
Which type of dehydration presents with sodium levels below 130 mEq/L? - Identify 3 symptoms of someone presenting with this form of dehydration.
Hypotonic Dehydration - Slightly moist mucous membranes - Cold, clammy skin - Poor skin turgor - Absent tearing and salivation - Sunken eyeballs/fontanel - Body temp is subnormal or elevated - Pulse and resps are rapid - Pt. may be lethargic to comatose, and may experience convulsions.
400
What is the main ECF anion? Describe it's function
Chloride (Cl-) Helps to maintain normal ECF osmolarity (Cl- follows Na+ to balance charge). - Plays a critical role in maintaining acid-base balance and combines with hydrogen ions to produce hydrocholoric acid
400
What is the most reliable indicator of fluid loss or gain? a) Intake & Output b) Skin turgor c) Weight d) BUN
c) weight Degree of Dehydration is based on percentage of body weight lost. In infants and young children less than 5% indicates mild dehydration, 5-10% = moderate, and 10-15% = severe.
500
Identify and explain the four different transport systems for fluids and electrolytes?
1) Diffusion: Solutes shift from an area of higher concentration to an area of lower concentration 2) Osmosis: Movement of fluid across a membrane from an area of lower solute concentration with more water to an area of higher solute concentraton with less water. 3) Facilitated Diffusion: Uses a specific carrier protein 4) Active Transport: Against gradient, uses energy, pumps or phagocytosis to equalize concentrations.
500
Describe why an infant is more likely to develop a fluid imbalance than a school-age child.
A higher percentage of an infants body weight is fluid
500
Which type of dehydration is considered the most dangerous and why?
Hypertonic dehydration - fluid shifts from the ICF to the ECF. Physical signs & symptoms are less apparent, but neurological disturbances become evident, and can potentially cause permanent neurological damage.
500
Based on Mandeep's lab values on Day 1, can we identify which type of dehydration is she experiencing? Sodium - 135 (Normal 135-145) Potassium - 3.2 (Normal 3.5-5) Chloride - 99 (Normal 100-108) Bicarbonate - 20 (Normal 22-29)
Isotonic Dehydration What nursing assessments need to be done to identify dehydration? - Monitoring ins/outs - Urine/Stool: frequency, volume, colour, consistency (1g wet diaper = 1 ml urine) - Vomitus: Volume, frequency & type - Sweating: Can only be estimated from frequency of clothing & linen change - Vital signs - increased pulse, resps, temp, decreased BP - Skin: colour, temp, turgor, presence/absence of edema - Mucous Membranes - moisture, colour and secretions - Body weight - decreased in relation to degree of dehydration - Sensory Alterations - Presence of thirst
500
Describe the fluid needs of a child versus those of an adult
Children are more susceptible to fluid loss than adults because they have a greater body surface area, increased basal metabolic rate, immature kidney function & have little fluid volume reserve in dehydrated states. Children are also more susceptible to fluid overload because of immature kidneys
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