F+E: Gerontologic and Pediatric Considerations

Normal intake values:

Oral fluids 1.5 L

Food 1L

Normal Output Values

Urine 1.5 L

Sweat (variable output) up to 3L

Insensible (skin, lungs, stool

Infant considerations to F+E

Highest proportion of water-70%-80% body weight

• Little volume reserve

• Decreases with age

Causes for fluid loss in children less than 2 years old

Respiratory illness

• Stomach viruses (nausea, vomiting, diarrhea)

• High respiratory rates

Gerontologic Considerations

• Clinical manifestations of imbalance may be subtle

• Fluid deficit may cause delirium

• Decreased cardiac reserve

• Reduced renal function

• Dehydration is common

• Age related thinning of the skin and loss of strength and elasticity (skin turgor not valid)

How does total body water change with age, and why

Total body water decreases with age because body fat increases and thirst sensation decreases.

Nursing Management

Assess:I&O and daily weights; assess lung sounds, edema, other symptoms

Monitor: responses to medications— diuretics and parenteral fluids, avoid sources of excessive sodium, including medications

Promote: Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions, Promote rest

Hydration Assessment should include…

Present and past medical history:

• Cardiac disease • Diabetes • Current Medications

Physical assessment:

• Skin • Oral cavity • Mucous membranes • Eyes • Cardiovascular system • Respiratory system

Data needed to monitor hydration status…

Daily weights, Vital Signs, Intake and output, Heart rate(Tachycardia-early sign of hypovolemia • Increased/decreased pulse volume • Irregular pulse rate (electrolyte imbalance)

Gastroenteritis

Inflammation of the stomach and intestines

What are common symptoms of gastroenteritis?

Diarrhea, nausea, vomiting, abdominal cramps, fever, headache, and sometimes dehydration.

What are common causes of gastroenteritis?

Viruses (like norovirus or rotavirus), bacteria (like Salmonella or E. coli), parasites, and sometimes contaminated food or water.

What is rotavirus?

A virus that commonly causes gastroenteritis, especially in infants and young children, leading to diarrhea, vomiting, and dehydration.

What are the symptoms of rotavirus infection?

Severe watery diarrhea, vomiting, fever, abdominal pain, and dehydration.

What causes rotavirus infection?

Infection with the rotavirus, typically spread via the fecal-oral route, contaminated surfaces, or contaminated food and water.

Dehydration Risk Factors

Diarrhea, vomiting, fever, excessive sweating, increased urination, inadequate fluid intake, extreme ages (infants and older adults), and certain medical conditions like diabetes.

Assessment of dehydration

Level of consciousness, vital signs (blood pressure, heart rate), mucous membranes, skin turgor, urine output and color, daily weight, and laboratory values (BUN, creatinine, electrolytes, hematocrit, urine specific gravity).

What diagnostic tests help identify dehydration?

Serum electrolytes (especially sodium and potassium), BUN and creatinine, hematocrit, urine specific gravity, and sometimes blood osmolality.

What is the primary prevention for dehydration?

Adequate fluid intake, especially during illness, hot weather, or exercise; use of oral rehydration solutions when needed; and education on early signs of dehydration.

What is secondary prevention of dehydration?

Early recognition and prompt treatment of fluid loss through monitoring for signs and symptoms, encouraging oral fluids, and using oral rehydration solutions or IV fluids if needed.

What is tertiary prevention of dehydration?

Managing complications and preventing recurrence by treating the underlying cause (e.g., diarrhea, vomiting), monitoring fluid and electrolyte balance, adjusting medications if needed, and providing patient education.