PEDS Fluids and Electrolyte (+ Gastroenteritis)

Decreased Infant FV = _______ Fontanel

sunken

Increased Infant FV = _________ Fontanel

bulging

Daily Fluid Volume Needed

1-10 kg = ______mL/kg

11-20 kg = _______mL + _____mL/kg for each kg > _____kg

>20 kg = _______ mL + ______mL /kg for each kg > _____kg

100, 1000, 50, 10, 1500, 20, 20

What is the Output Minimum for Infants?

1-2mL/kg/hr

What is the output minimum for children?

1mL/kg/hr

What is the output minimum for older children?

0.5mL/kg/hr

Signs of Dehydration

• no wet diapers in ___-___hrs

• __________

• _______ breathing

• excessive ________ then __________

6,8, tachycardia, rapid, thirst, vomitting

Management of Dehydration

• take _______ and ________ ________

• assess _______, __________, and _________ membranes

• weigh _________ and degree of __________

vitals, daily weights, skin, fontanel, mucous, diapers, wetness

What are the 4 main causes of dehydration in PEDs

increased renal excretion, V/D, Ketoacidosis, and burns

What are the 3 kinds of pediatric dehydration?

isotonic, hypotonic, and hypertonic

Dehydration where water loss = salt loss

isotonic dehydration

What is the primary form of dehydration in kids?

isotonic dehydration

Dehydration where electrolyte loss > water loss

hypotonic dehydration

Dehydration where electrolyte loss < water loss

hypertonic dehydration

Mild Dehydration. (____-_____% BW)

Moderate (____-____% BW)

Severe (> ____% BW)

5,6, 7,9, 9

2 signs of mild dehydration?

increased thirst, dry mucous membranes

2 signs of moderate dehydration?

sunken, loss of turgor

Signs of Severe Dehydration

• sunken and loss of turgor

• + 1 of the following (5)

weak, rapid pulse and breathing, cyanosis, lethargy, coma

For mild and moderate dehydration, treatment includes

• _____ ___________ ____________

• add volume of ______ lost

oral rehydration solution, stool

Severe Dehydration treatment

• _____ ________ till stable

• then oral rehydration solution

IV Fluids

For all instances of dehydration breastfeeding should…

continue

Inflamed stomach and inestines

Gastroenteritis

What are 2 symptoms of Gastroenteritis?

N/V/D, abd cramping

Predisposing Factors of Gastroenteritis

• poor ___________ and _______ ___________

• __________

• ____________

• infection process

sanitization, food preparation, daycare, antibiotics

Vitral agents of Gastroenteritis (common in winter)

• __________ and ___________

norovirus and rotavirus

Norovirus

• ____-____ hr post exposure

• lasts ___-___ weeks

• ________ destroys but not freezing

12, 48, 1,2, cooking

Rotavirus

• most common cause of diarrhea in children < 5yrs

• ___-____ days post exposure

• lasts ___-___ days

• vaccine available

• most vulnerable in ___-____month olds

2,3,3,9, 6,12

3 Bacterial Agents of Gastroenteritis (common in summer)

e coli, salmonella, shigella

Salmonella

• children < ____ are vulnerable

• comes from ______ and contaminated food

• short duration of ____/_____

• diarrhea ____-_____ weeks

• antibiotics not recommended

5, pets, N/V, 2,3

Shigella

• ____-______

• lasts ___-___ days

• from contaminated ______ or _______

• touching surfaces can transfer

oral, fecal, 5,10, food, water

E.Coli

• undercooked ______, water, juice, _______

• ___-___ day onset

• lasts a ______

• antibiotics are ineffective

• can progress into _____

beef, zoos, week, HVS

Management of Gastroenteritis

• assess ___________

• orally rehydrate

• protect ______

• IF SEVERE _____ _________

• avoid _____/__________ low fluids

• advance to normal diet as tolerated

• continue breastfeeding

• anti-diarrheals DISCOURAGED

dehydration, skin, IV therapy, carb, electrolyte

Gastroenteritis Nursing Interventions

• assess ___________ ______

• strict ___ and ____

• _______ ________

• ________ iso precaution as ordered

• ________ IV ____ and ______ assessment

hydration status, I, O, daily weights, enteric, hourly rate, site

Increase IV fluid rate if ___/____

Decrease IV fluid rate with _____ intake and signs of _______

N/V, fluid, edema

If Diarrhea increases ________ PO fluids

If Vomiting slowly give __________ and __________

increase, pedialyte, gatorade

If V/D continues _____ treatment and ______ _______ may be given if severe.

IV, fluid bolus

Fluid Volume Bolus for SEVERE dehydration w/ cont. V/D

• Isotonic Fluids (2) __________ _________ and ______ ____%

• Maintenance fluids post IV Bolus (2) _________ ___% in _____% ______ or ______% ______.

lactated ringers, NS 0.9, dextrose 5, 0.45, NS, 0.2, NS

Potassium can only be added to fluids if child has…

voided

Preventing Diarrhea

• 2 vaccines available for _________

• clean water supply

• teach hygiene and food prep

rotavirus

Follow-Up if…

• V/D _________

• no hydration status _____________

• won’t take_______

• NO ______ OUTPUT

increases, improvement, fluids, urine

Child will need ____-____x maintenance after fluid bolus is complete.

1.5-2

Adding potassium to IV solution is bad for _______/________.

oliguria, auria