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why are children more susceptible to f/e imbalance?
- higher portion of water content
- inable to shiver or sweat
- greater proportion of fluid in teh ECF
- higher metabolic rate
- immature kidneys and GFR
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urine output in infants?
1 - 2 ml/kg/hr
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anterior fontanel palpable up until what age?
16 - 18 months
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why does tachypnea increase fluid needs?
insensible loss via lungs
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heart failure, renal failure, increased ICP, inappropriate secretion of ADH... fluid needs?
less than average. fluid restriction.
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why is urinalysis ineffective in determining F/E balance?
infants cannot concentrate urine appropriately
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Cl -
follows sodium - extracellular
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K+ affected by what?
intenstinal losses. diarrhea, NG drng, vomiting
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when do you NOT give K+ to a child?
if they are not urinating
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causes of hypokalemia?
diuretics, meds, CHF, GI losses, nephrotic syndrome
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causes of hyperkalemia?
hemolysis, reduced kidney fx, acidosis, blood transfusions
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danger of hyperkalemia?
cardiac symptoms, possible cardiac arrest
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what serum replacement should never be pushed IV?
K+
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treatments for hypo/hyperkalemia?
- hypo - replacement
- hyper - diuretics, regular IVF (increased extracellular volume)
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most abundant electrolyte in ECF? levels?
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hyponatremia? causes?
- < 130
- water moves from intra to extracellular, dilutes ECF, decreased Na+
- most common cause: dilute formula
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calcium normal values
8.5 - 11
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hypocalcemia? causes?
- decreased intake/absorption, increased excretion
- causes: inadequate diet, vit D deficiency, cow's milk given inappropriately
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hypercalcemia? causes?
increased absorption or intake, shift from bones to ECF, decreased excretion
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treatment for hypo/hyper calcemia?
- hypo: oral or IV calcium gluc
- hyper: increased fluids, lasix
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glucose needs of infants?
higher than adults due to higher BMR
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acidosis results from
accumulation of an acid OR a loss of a base
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alkalosis results from..
accumulation of base OR loss of an acid
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can evaluate acid-base balance by what tests?
ABG, electrolytes, protein/albumin, urine pH
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components of blood gas?
- pH, pCO2, paO2, BE, HCO3
- ph, carbon dioxide, oxygen, base excess, bicarb
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normal pH range?
7.35 - 7.45
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three mechanisms that operate to keep pH in normal range?
- chemical buffers
- respiratory control of CO2
- renal regulation of bicarb and secretion of H+ ions
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which mechanism usually used first in children to regulate ph?
respiratory
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chemical buffers used for ph maintenance?
bicarb, proteins
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respiratory alkalosis
- high pH, low CO2.
- over-ventilating.
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metabolic acidosis
- decrease in pH
- decrease in bicarb
- high lactic acid
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metabolic alkalosis
high pH, high bicarb, base excess
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tachypnea does what to compensate?
faster breathing = blowing off CO2 = trying to correct acidosis
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where is the fluid loss in early dehydration?
extracellular fluid loss
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where is fluid loss in late dehydration?
intracellular fluid loss
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first compensatory mechanism to dehydration?
increased HR
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dehydration is defined according to what electorlyte
Na+
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isotonic dehydration
losing water and Na+ same rate
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hypotonic dehydration
- losing salt faster than fluids.
- Na+ will be low
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hypertonic dehydration
- losing fluid faster than salt.
- Na+ will be high
- most dangerous. prone to seizures & neuro damage
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treatment of mild - moderate dehydration?
oral rehydration solutions (pedialyte, etc)
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treatment for severe dehydration?
- parenteral rehydration
- deficit + maintenance + ongoing losses >> fluid rate
- LR, NSS. adminstered until pulse, perfusion, mental status return to baseline
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fluid types for rehydration?
NS or LR.
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possible causes of acute diarrhea?
infectious. eg, gastroenteritis
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possible causes of chronic diarrhea?
malabsorption, food allergies, lactose intolerance, parasites
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we look at diarrhea by what characteristics?
frequency, fluidity, volume
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treatment/diagnosis of diarrhea?
stool cx, ova/parasites, give abx if bacterial, assess for dehydration
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most common virus causing gastroenteritis?
Norovirus. fecal-oral route, person-to-person via contaminated food/water
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rotavirus?
- leading cause of infx in children
- common in winter months. 50% of diarrhea cases
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adenovirus
usually respiratory illness, but can also cause gastroenteritis
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Giardiasis
- most common parasite seen in daycare-age children
- spread in water
- stool cultures over several weeks
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enterobiasis (pinworms) manifestations
- anal itching, no diarrhea
- hand-mouth ingestion from environment
- scratching causes reinfestation
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enterobiasis (pinworms) dx and treatment?
- tape test. tape on anus overnight, scrape onto slide.
- medication can stain stool/emesis red
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common interventions for parasite infections?
- monitor other family members
- handwashing
- cut fingernails
- diaper hygience, wash diaper area
- wash fruits and vegs
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interventions for impaired skin integrity
- diaper changes and cleansing
- protective ointment
- expose to air
- avoid wipes
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why are anti-diarrheals contraindicated?
want to get infection out
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rapid replacement of fluids for what types of dehydration?
- isotonic, hypotonic
- *want rapid expansion of intravascular space
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rapid replacement contraindicated in what type of dehydration?
hypertonic (hypernatremic)
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