fluid and electrolytes

more vulnerable to altered F/E

higher proportion of water content (80% BW), high body surface area, more fluid, Na, and Cl in ECF, inability to shiver/sweat, higher metabolic rate, immature kidneys cannot concentrate urine, greater insensible water loss (skin, lungs)

lab assess

electrolytes, BUN/creat, HGB/HCT (high), blood gas, urine spec gravity, serum osmolarity, total protein/albumin

glucose

infants have higher need bc higher BMR needed for growth and metabolism- if stressed, can become hypo/hyperglycemia

vs assess

HR (increases), quality of pulse (weak, thready), BP (later sign, hypotension), breathing (deep)

remainder of assess

Weight (10%+ wt loss), urine output (min), mental status (lethargic, unconscious), · fontanelle (sunken), eyes (deeply sunken), tears (absent), mucous membranes (dry), extremities (cold, cyanotic, moddled), cap refill (>2sec), turgor (tenting)

dehydration

fluid output greater than intake, commonly from vomiting and diarrhea, caution in children bc early loss from ECF then INF-> shock and death

vomiting causes

infection, obstruction, increased ICP, toxic ingestion, intolerance, allergy

diarrhea causes

abnormal digestion, absorption, or secretion, commonly from bacteria, virus, or parasite

E.coli

green, watery, + blood and mucous, explosive stool, from poorly cooked meat

Salmonella

variable stool with +blood and mucous, septicemia and meningitis, from contaminated food, infants at highest risk

Shigella

watery, mucous and pus stool with cramps, high fever, HA, nuchal rigidity, delirium, fecal-oral route

Camplyobacter

foul smelling, + blood stool with cramps and periumbical pain, from contaminated food like shellfish or fecal oral route

norovirus

acute onset of vomiting, water diarrhea with cramps, nausea, low fever, from fecal oral route- most common cause of diarrhea in children

rotavirus

vomiting and diarrhea, moderate fever, lasts for 3-7 days, from fecal oral route

giardiasis

diarrhea, vomiting, anorexia, poor eating, if >5yr- cramps, loose stools and constipation, spread in water, treat with tinidazole, metronidazole, and nitazoxanide

enterobiasis (pinworms)

anal itching, irritability, restless, bedwetting, scratching causes reinfection, from fecal oral route, use tape test to dx, treat with bendazole and pyrantel- caution <2yr

infection interventions

monitor fam, handwashing, cut fingernails, diaper hygiene, disinfection of diapering areas, wash raw fruit and veg

mild dehydration

3-5% loss BW, fluid loss <50mL/kg

moderate dehydration

6-9% loss BW, fluid loss 50-100mL/kg

severe dehydration

>10% loss BW, fluid loss >100mL/kg

isotonic dehydration

isonatremic- water and electrolytes lost in same proportion as exist in body, Na remains normal- most common

hypotonic dehydration

hyponatremic- electrolyte loss exceeds water loss- Na<130, shock, seizures (no salt)

hypertonic dehydration

hypernatremic- water loss exceeds electrolyte loss- Na>150, seizures, neuro damage, dangerous (no water)

maintenance fluid requirements

100ml/kg (1st 10kg) + 50ml/kg (2nd 10kg) + 20ml/kg (remaining kg), divide by 24hrs/day for hr replacement- should lose 1ml/kg/hr

impaired skin integrity of diaper region

diarrhea is acidic and can burn skin causing diaper dermatitis- use barrier like Vaseline to coat and avoid burn, treat redness with Desitin or something with zinc oxide, can leave to air, caution of becoming fungal infection

mild to mod dehydration treatment

give oral rehydration solution (ORS) to avoid AKI, small amounts frequently, no water, fluids with high carbs, or sports drinks

severe dehydration treatment

IV rehydration of LR, normal saline, or similar bolus (isotonic) admin (20 mL/kg body weight) until pulse, perfusion, and mental status return to normal, then add fluid with electrolytes and glucose for drip