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do neonates have more water or fat
- water
- they have less fat
- 50% of their water is in the extracellular fluid, making them more suceptable to fluid loss/dehydration
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should you rapidly hydrate hypertonic kids
- no
- solutes dont go in and out of cells easily so dont rapidl hydrate
- can lead to cerebral edema
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daily pediatric fluid requirements
- 1-10kg: 100ml/kg
- 11-20kg: 1000mL + 50ml/kg for each kg over 10kg
- >20kg: 1500mL + 20mL kg for each kg over 20kg
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scenarios where children need more fluids
- fever
- burn
- vomiting
- diarrhea
they also dont recognize that they are dehydrated and their thirst mechanism isnt activated
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dehydration
- fluid loss exceeds intake regardless of the cause
- a dynamic condition- so you hydrate them and bolus them. dont be fooled if they perk up, if they are still loosing you need to intervene again
- fluid loss is related to distribution of water and solutes in the body
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physiological differences that increase dehydration in infants KNOW THIS
- greater proportion of their weight is water and that water is in the extracellular fluid
- ratio of body surface area to weight is greater in infants so more fluid loss
- immature kidneys are less effective at concentrating urine and maintaining the acid-base balance
- thrirst mechanism not well developed
- infants have a higher bmr
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causes of dehydration
- inadequate oral intake
- vomiting
- diarrhea
- fever
- phototherapy for jaundiced babies
- enteral feeds
- drainage tubes
- blood loss
- DKA
- drugs
- burns
- diseases (ie kidney)
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types of dehydration
- isotonic: main form. clinical signs of hypovolemia
- hypotonic: lose more electrolytes than water. low sodium
- hypertonic: lose more water than electrolytes. hypernatremia. less common. cns disturbances
dehydration can also be mild, moderate or severe
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how to evaluate dehydration severity
- body weight
- % weight loss= (pre illness kg- current kg)/ pre illness kg
- every kg of weight lost = 1 liter fluid loss
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mild dehydration weight loss
- infants: 3-5% weight loss
- children: 3-4% weight loss
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moderate dehydration weight loss
- infants: 6-9%
- children: 6-8%
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severe dehydration weight loss
- infants: 10% or more
- children: 10%
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skin signs of dehydration
- dry lips and mucous membranes
- sunken eyes (dark circles)
- little to no tears
- poor turgor
- depressed fontanelles
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neurologic signs of dehydration
- changes in sensorium (not interactive/participating)
- irritable (suddenly wimpering when they were full crying)
- less vigorous crying in infants
- lethargy
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cardiovascular signs of dehydration
delayed cap refil, cool extremities, mottling (red purple marbling of skin)
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other signs of dehydration
- tachypnea
- anorexia, poor po intake, vomiting diarrhea
- decreased/no urine
- flaccidy- wet noodle appearance
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mild dehydration symptoms
- normal vital signs
- normal behavior
- slight thirst (older kids)
- mucous membranes not dry
- tears often present
- fonantels soft and flat
- normal turgor and cap refl
- urine output is adequate but CONCENTRATED
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Moderate dehydration symptoms
- mild tachypnea and tachycardia (higher if theres a fever)
- normal bp at rest
- irritable
- dry mucous membranes
- decreased tears and turgor
- fontanelles slightly depressed
- delayed cap refil
- decreased urine
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severe dehydration symptoms
- significant tachycardia
- hyperpnea (deep rapid breathing)
- hypotension
- lethargy
- severly dry mucous membranes
- no tears, sunken eyes and fontanels
- cap refill more than 4 sec
- tenting
- cool mottled extremities
- oliguria/aneuria
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treatment of dehydration
- mild: oral replacement if child awake/alert and willing to take fluids
- moderate: oral replacement therapy in conjunction with IVF
- severe: RAPID replacement of fluid loss with ivf
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oral replacement therapy
- common replacement solution is pedialyte
- clear liquids, but be mindful of na, k and glucose content
- encourage fluids often and as much as they can tollerate
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why might a child refuse to drink
- fatigued and weak
- fear of vomiting again
- belly pain/retching
- not thirsty
- they want control. theyve lost control when sick and drinking is the only thing thye have left to chose
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parenteral fluid therapy
- begins immediately, as dehydration is life threatening
- bolus: 20ml/Kg isotonic solution over 5-20 min followed by maintenance fluid
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should you add potassium to ivf
yes if lost and ordered, BUT, Must wait until they void to ensure that kidneys are functioning
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how to calculate maintanence IVF
4/2/1
- 4ml/kg/hr for the first 10kg
- 2ml/kg/hr for the secont 10kg
- 1ml/kg/hr for each additional kg
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monitoring dehydration KNOW THIS
- Protect the IV- check IT EVERY HOUR
- strict is and os (1g wet diaper weight =1ml urine)
- specific gravity 1.005-1.025 (the higher the dryer)
- daily weights
- weigh all diapers
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rotavirus
- vomiting followed by watery, foul smelling diarhea
- the most common gastroenteritis in kids under 5
- starts with lowgrade fever and puking followed by very watery stool for 5-7 days
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e.coli
- watery diarrhea for a few days followed by severe abdominal cramping and bloody diarrhea
- from contaminated food
- can lead to hyperuremia
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salmonella
- lives on raw chicken
- can be in turtles
- dont usually treat with abx- self limiting
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food poisoning
- usually from something like staph
- hits hard and fast with profuse diarrhea, nausea and vomiting
- worship the toilet then better after
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acute diarrhea
- leading cause of illness in kids under 5
- rotavirus most common
- infecious diarrhea often spread thru fecal oral route
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what can cause diarrhea
- acute and chronic digestive disorders
- infection
- abx therapy (c.diff)
- laxatives
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consequences of diarrhea
- dehydration
- electrolyte imbalances
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care management of diarrhea
- perianal skin care
- prevention
- DONT use antimotility drugs for infectious
- pedialyte
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foods to avoid with diarrhea
- juice
- caffeine
- sugar
- soda
- jello
- chicken/beef broth (high sodium, not always good)
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constipation
- alteration in the frequency, consistancy or easy of passing stool for more than 2 weeks
- in kids dont use frequency as a diagnostic
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