Body Fluids and Fluid Management in Pediatric Patients

These flashcards cover essential concepts related to the distribution of body fluids, fluid requirements, management of dehydration, electrolyte balance, and the recognition and treatment of associated pediatric conditions.

What percentage of total body weight is Total Body Water (TBW) in newborns?

75%.

What is the TBW percentage in late adolescence?

45%.

What are the two main areas TBW is distributed into?

Intracellular Fluid (ICF) and Extracellular Fluid (ECF).

What are the components of Extracellular Fluid (ECF)?

Intravascular Fluid, Interstitial Fluid, and Transcellular Fluid.

How is ECF proportion in infants compared to older children?

Newborns have ≈50% of body fluid in ECF, while toddlers have ≈30%.

Why is water regulation important in the body?

Precise regulation of fluid volume and composition is essential because small alterations can damage metabolic processes.

What can cause marked alterations in fluid volume or distribution?

Diseases such as Nephrotic Syndrome or Acute Kidney Injury (AKI).

What defines body fluid equilibrium?

The balance between water ingested and water lost.

What primarily determines the volume and distribution of body fluids?

Solutes, especially sodium, and physical forces.

What is obligatory fluid loss?

The volume of water needed to replace losses through urine, feces, and insensible evaporation.

What is Third spacing in terms of body fluids?

Pooling of body fluids in a non-functional space due to disease states.

How do you calculate daily maintenance fluid requirements for children aged 1 to 10 kg?

100 mL/kg.

How is fluid requirement calculated for children between 11 to 20 kg?

1000 mL plus 50 mL/kg for each kg over 10 kg.

What is the calculation for fluid requirements for children greater than 20 kg?

1500 mL plus 20 mL/kg for each kg over 20 kg.

What factors increase fluid requirements?

Fever, vomiting, diarrhea, burns, mechanical ventilation, and increased metabolic rates.

How does Total Body Water (TBW) relate to body fat in older children and adults?

TBW is inversely related to the amount of body fat.

What is the body fluid proportion in infants and how does it change with age?

Largest in Extracellular Fluid (ECF) at birth, decreasing as they grow.

How does insensible water loss change with fever in infants?

Infants and children may lose approximately 7 mL/kg/24 h with each 1°C rise in fever.

What is the distribution of insensible water loss in infants?

≈2/3 through the skin and ≈1/3 through the respiratory tract.

What major cause contributes to greater fluid loss in infants?

High body surface area (BSA) and increased metabolic rate.

What is considered a significant factor in the immature kidney function of infants?

Inefficiency in excreting metabolic wastes.

What is a key vulnerability in infants related to fluid management?

Their kidneys are functionally immature and struggle with urine concentration and sodium balance.

What is one of the most common pediatric problems linked to fluid depletion?

Depletion of ECF due to gastroenteritis.

What nursing care is critical for children with water depletion?

Provide replacement and maintenance fluids/electrolytes and monitor vital signs.

What are the manifestations of sodium depletion (hyponatremia)?

Weakness, dizziness, nausea, abdominal cramps, and apathy.

What can cause water excess (hypernatremia)?

High salt intake, insufficient breast milk intake, or high insensible water loss.

What are the signs of potassium depletion (hypokalemia)?

Muscle weakness, cramping, cardiac arrhythmias, and hypotension.

What is the main risk associated with hyperkalemia?

Cardiac arrest and muscle weakness.

What should be monitored in patients with dehydration?

Vital signs, weight, urine specific gravity, and serum electrolytes.

What is the primary treatment approach for severe dehydration?

Parenteral (IV) fluid therapy.

Why is rapid fluid replacement contraindicated in hypertonic dehydration?

Due to the risk of cerebral edema.

What are the objectives of fluid and electrolyte management in children?

Restore and maintain optimal fluid and electrolyte balance.

What complicating condition can result from water intoxication?

CNS symptoms, including irritability, somnolence, and seizures.

What is the most critical sign of dehydration in infants?

Tachycardia.

How is mild to moderate dehydration treated?

Oral rehydration therapy (ORT) is indicated.

What should be included in oral rehydration solutions (ORS)?

50 mEq of sodium per liter.

What is recommended when a child is reluctant to drink during ORT?

Administer small amounts by syringe frequently.

What are common causes of diarrhea in children?

Infectious agents leading to increased intestinal secretion or decreased absorption.

What is acute diarrhea?

An increase in frequency and change in stool consistency lasting ≤14 days.

What is chronic diarrhea?

Increased stool frequency lasting more than 14 days.

What should be monitored in diagnosing diarrhea-related dehydration?

Stool frequency, consistency, and associated symptoms.

Which virus is the leading cause of diarrhea-associated hospitalization in children under 5 years?

Rotavirus.

What laboratory evaluations are indicated for dehydrated patients?

CBC, serum electrolytes, and BUN.

What dietary modifications should be made for diarrhea management?

Avoid high-sugar drinks; opt for oral rehydration solutions.

What indicates the need for intravenous rehydration?

Severe dehydration or inability to drink adequately.

What is the primary nursing intervention for diarrhea in children?

Monitor hydration status and educate parents on fluid intake.

How should fiber intake be adjusted for managing constipation in children?

Age in years plus 5 grams per day.

What dietary changes can help relieve functional constipation?

Increasing vegetables, fruit, and hydration.

What is the recommended laxative for children, and why is it preferred?

Polyethylene glycol (PEG) 3350 because it is safe and effective.

What is the role of behavioral modification in managing childhood constipation?

To establish regular toilet habits and reduce fear of bowel movements.

What should be monitored in postoperative cases of appendectomy?

Signs of infection, pain management, and gastrointestinal function.

What indicates a high likelihood of Hirschsprung Disease in infants?

Failure to pass meconium within 24–48 hours.

How should nursing care management address symptoms of gastrointestinal obstruction?

By monitoring for pain, abdominal distention, and ensuring NPO status.

What two common congenital intestinal disorders need immediate surgical intervention?

Hirschsprung Disease and intestinal malrotation.

What is the primary sign of hypertrophic pyloric stenosis?

Projectile nonbilious vomiting.

What are two major complications of untreated biliary atresia?

Cirrhosis and liver failure.

What is required for diagnosis of Meckel diverticulum?

Technetium-99m pertechnetate scan.

What long-term monitoring is essential in patients with inflammatory bowel disease?

Surveillance for colorectal cancer.

What is the goal of nutritional support in managing children with IBD?

Correct deficits and manage malnutrition effectively.

What challenge does cleft lip and/or palate present during the feeding process in infants?

Inability to create suction.

What is critical nursing education for families of children with cleft palate?

Feeding techniques and recognition of potential complications.

How does the nursing management differ for children with anorectal malformations?

Requires careful monitoring of bowel function and possibly colostomy care.

What must be monitored closely in infants diagnosed with congenital esophageal conditions?

Airway management and feeding techniques.

How do nurses support families of children requiring surgical interventions?

Provide education on care, potential complications, and emotional support.

What is the importance of measuring abdominal girth in post-operative patients?

To monitor for signs of obstruction or peritoneal effusion.

What might indicate an incarcerated hernia that requires immediate surgical intervention?

Inability to reduce the hernia and signs of bowel strangulation.

What does the presence of excess frothy saliva in an infant suggest?

It may indicate esophageal atresia or tracheoesophageal fistula.

What corrective surgery is often performed for pyloric stenosis?

Pyloromyotomy.

What key piece of information is critical for managing patients with celiac disease?

Strict adherence to a gluten-free diet.

What are common symptoms of hypocalcemia in pediatric patients?

Neuromuscular irritability, tingling, and changes in heart rhythm.

What generally defines acute pancreatitis in children?

Transient abdominal pain with enzyme elevation.

What should be emphasized in the education of guardians about their child's post-operative care?

Identifying complications and the importance of follow-up appointments.

What dietary changes can help in managing symptoms of gastroesophageal reflux disease (GERD)?

Avoiding acidic and spicy foods, and feeding smaller, more frequent meals.

What is the significance of early diagnosis of biliary atresia?

Early surgical intervention can significantly improve outcomes.

What nursing intervention is crucial in managing postoperative hydration?

Monitoring intravenous fluid rates and precise input/output.

What are the risks associated with undiagnosed congenital heart defects in infancy?

The potential for shock or cyanotic episodes.

What preventative measure is essential for infants with cleft palate?

Preventing aspiration during feeding.

What signs might indicate a serious infection post-surgery?

Fever, increased pain, redness, or discharge at the surgical site.

What should families of children with congenital malformations be made aware of?

The need for multidisciplinary care and support.

What common condition may present as an obstructive but is often misdiagnosed in early childhood?

Intussusception.

What key concept should be understood about the management of chronic conditions like diabetes in children?

Involves coordinating medication, diet, and lifestyle.

What is an abnormal clinical finding suggesting complications after appendectomy?

Persistent fever or tachycardia.

What role does support from peer groups play in the management of congenital anomalies?

It provides emotional and social support for affected families.

What is important for parents to avoid in caring for children post-cleft lip repair?

Avoiding any objects in the mouth that could disturb the surgical site.

What measure should be included in postoperative instruction for hernia repair?

Educate on early detection of complications.

What aspect of care is important for children returning home after gastrointestinal surgery?

Understanding dietary restrictions based on their condition.

How frequently should parents monitor input and output in their postoperative children?

At least every 1-2 hours until stable.

What assessment should follow recognition of abdominal pain in children?

A thorough abdominal exam and possibly imaging studies.

What changes in bowel habits can indicate complications in children post-surgical repair?

Increased frequency or consistency changes.

What sign may indicate dehydration in children with vomiting?

Dry mucous membranes and decreased urine output.

What dietary recommendation should be made for children recovering from gastroenteritis?

Encourage the reintroduction of a regular diet as tolerated.

What intervention can prevent aspiration during feedings in children with esophageal atresia?

Nurse the infant in an upright position.

How should parents be educated regarding feeding regimens for children with cleft palate?

Using specialized bottles that allow for controlled flow.

What is a significant complication to monitor for postoperatively in children who have had bowel surgery?

Signs of intestinal obstruction.

How is the risk of dehydration managed in infants with diarrhea?

By using oral rehydration solutions and strict monitoring.

What common intervention might help alleviate constipation in children?

Increased fluid and fiber intake.

What factor primarily contributes to an inappropriate error in pediatric fluid management?

Misjudgment of fluid requirements based on body weight.

What is a common late complication seen after surgery for congenital gastrointestinal defects?

Strictures or obstructions due to scar tissue.