Pedia 2 Module 3: Alterations in fluid and electrolytes

Volume depletion

Volume depletion

caused by fluid losses from vomiting and diarrhea

Pediatric depletion

most common complication of illness

Dehydration

happens when

• excessive body fluid loss

• can result to diabetic ketoacidosis, gastrointestinal infections, and extensive burns

• may be classified as isotonic, hypotonic, hypertonic

Signs and symptoms of dehydration

babies appear to have

• dry skin and dry mucous membrane

• poor skin turgor, tenting, dough-like feel

• temperature increase

• sunken eyeballs, no tears

• pale, ashen, cyanotic nail beds or mucous membranes

• delayed capillary refill > 3 secs

• pulse rate change - irregular BP

• change in respiratory rate

• tachypnea, apnea, shallow respiration

• fluid overload

Management of Severe dehydration

1. treat shock if present

   • if able to drink administer oral solution while with IV access

   • insert peripheral IV line using large IV catheter g24

   • Administer lactated ringer and monitor infusion rate

   • monitor if presence of peri orbital edema - means over hydration

2. continue ORS if able to drink

3. Monitor output

4. if lethargic, check blood glucose

5. once stable, reassess degree of dehydration

6. if with diarrhea - administer zinc sulfate if under 5 YO

7. BRAT diet - Banana, Rice, Apple, and Toast

signs to watch out in dehydration

1. diarrhea and vomiting

2. no improvement in child’s hydration status

Acute glomerulonephritis

inflammation of the glomerulus of the kidney, may occur as a separate entity but usually occurs in children as an immune complex disease after infection with nephritogenic streptococci

signs and symptoms of acute glomerulonephritis

patient may have

• headache

• increased BP

• facial/ periorbital edema

• malaise

• low grade fever

• weight gain

• proteinuria, hematuria, oliguria

Management of acute glomerulonephritis

to treat the symptoms patient must

• take antibiotic for 1-2 weeks

• diuretics

• if with heart failure - keep the child in a semi fowler’s position, give digitalis and oxygen

• if with hypertension - anti hypertensive medications be given

• diet - restricting salt to avoid edema and low protein intake to reduce proteinuria

Urinary tract infection

a clinical condition that may involve the

• urethra

• renal pelvis

• bladder

• calyces

• ureters

• renal parenchyma

Causative agent: E coli, Staphylococcus saprophyticus, streptococcus group B, Enterococcus species, proteus species, pseudomonas aeruginosa, klebsiella species, fungi (candida species)

risk factors of UTI

patients with the following are prone to the disease:

• 5 YO

• poor toilet and hygiene habits

• excessive use of bubble baths and infrequent urination

• incomplete emptying of bladder

• constipation

• Child receiving antibiotic, tight clothing

• catherization and sexual intercourse

• local inflammation and anatomical abnormality

• vesicoureteral reflux and family history

• altered urine and bladder chemistry

Febrile UTI

accompanied with fever and other physical signs of UTI

Cystitis

inflammation of the bladder

pyelonephritis

inflammation of upper urinary tract and kidneys

urosepsis

Febrile UTI with systemic signs of bacterial illness, culture test reveals presence of urinary pathogen

signs and symptoms of UTI

patients may appear to feel the following:

• painful, stinging, or burning sensation during urination

• frequent urination

• pain in lower abdomen

• irritability

• blood in urine

• foul and strong urine odor

• poor appetite

Diagnostic Evaluation for UTI

1. Urinalysis

   • proteinuria

   • hematuria

   • pH elevated

2. urine culture

   • midstream clean catch

   • suprapubic aspiration

   • catherization

3. ultrasound of kidney and bladder

4. voiding cystourethroprogram

Therapeutic management of UTI

remedy for the disease can be:

• increased fluid intake

• encourage toilet hygiene

• probiotic yogurt

• cranberry juice

Burn

• type of injury to the skin or flesh

superficial or first-degree burns

• burns that cause local inflammation of the superficial skin / epidermis

• skin is dry without blisters

• redness, pain

partial thickness or second-degree burns

• involve the skin layers beneath the top layer/ epidermis - dermis

• blisters, severe pain, and redness

full-thickness or third-degree burns

• involve all the layers of the skin and underlying tissue, the nerves and blood vessels / epidermis - subcutaneous

• dry, waxy, leathery, charred

fourth-degree burn

• involves injury to deeper tissue such as muscle or bone

Methods to determine TBSA

• Wallace rule of nines

• person’s palmar size

• Lund and Browder chart

Person’s Palmar size

• person’s palm and fingers in approximately 1% of their TBSA

Lund and Browder Chart

• used instead of the rule of nines for children in whom the head occupies a larger area and the lower limbs a smaller area than in adults

Management of Burn

patients experiencing can

• remove child

• remove all jewelry and clothing

• elevate burn area

• clean wound with tap water and early cooling with cold water

• apply topical antibiotic ointment

• do not brake any blisters

• 1st degree burn - no dressings

Fasciotomy

• an emergency procedure done to relieve internal pressure to the nerves, blood vessels, muscles, and other tissue, and is caused by severe injury trauma to a limb

Escharotomy

• incision of eschar for decompressing the constrictive effects caused by deep circumferential burn. surgical release of the skin done to treat or prevent problems with distal circulation, or ventilation

• removal of thick coagulated crust slough which develops following a burn injury

autograft/ autotransplant

• tissue transplanted from one part of the body to another in the same individual

isograft

• tissue obtained from genetically identical individuals

xenograft / Heterograft

tissue graft in which donor and recipient are of different species

Allograft/ Homograft

uses skin obtained from another human being