dehydration

adrenal cortex function

increase sodium reabsorption,maintain extrea fluid volume and excrete potssium

ADH function

when release ,increase urine concentraction,and inhbit ADH,kidney inhbit reabsoprtion of water diluting the urine

patho of dehydration

reduce fluid loss:vomit,diarrhea,fever,hyperventilation,burn, trauma,hemorrhage diabete

sudden ECF loss

electrolyte imalance

loss of icf

cellular dysfunction

hypovolemic shock

diabete insiptisu

affect ADH release,unable to control water absoprtion,mostly related to brain injury

adult and ped diffewrence regarding to ECF ICF

infant have higher ECF than adult ,more susceptible for rapid fluid deplietiopm

compensatory mechanism

1.when water loss ,sodium up,stop ADH,retain water

2.IF move into IV. to maintamin hemocentration,hypovolemia

3.vasoconsition of periperal arteriole to maintain pumping pressure,if fluid loss excess compensary mechanism-hypoxia,metabolic acidosis

4.stinulte ADH to conserve liquid,vasoconsticution,less contrbution to less useful organ

diagnostic evaluation

-weight loss

-SS: resp abnormal,poor skin turgor

-LAB: USG.BUN (less reliable)

HCO3 acid base

ped difference regarding electoye imbalance

-hgher ECF

-immature kidney,less concetrante urine

-higher peristalsis-limit nutrient water absorption

-immature esohageal spincter.more regurgitation,dehydration,and electroye imbalance

-hard conpensate acidodsis,decrease abilkity acidify urine

-higher metabolic rate

-unable to verbalize thirst

-grater body surgace regarding to BMI,gretaer fluid loss through skin and GI

-higher propriatmate water.with largfer fluid in extracellular space

child immune system

not robust aas adult, more subsciptible to infection,fever,gastro,respillness,result in fluid and electrolyte disturbance and fluid volume deficit,also more expose to infection in daycare

hypovolemic shock

-reduce iV volume

-intitally compensate ny omcrease PVR,stroke volume,HR,redistrubite bllod to vital organ:brain,kidney,heart

-if fluid resiscotation not initate, altered LOC,oliguria

-tissue and organ damage

shock warning sign

-tachycardia

-tachypnea

-ppor perfusion, tissue oxygenation

-poor peripheral cirulation as result of reduce of blood volume:cool mottle skin, decrease cap refill

-impaired kidney perfusion-oliguria,azotemia

-low BP is a late signal of cardio collapse

other ss of shock

confusion,somnolence

metabolic acidosis

weak thready pulse

apnea ,periordic breathing

irreversible stupor/coma

isonatremic dehydration patho

equal electrolyet and water deficit

major loss in ECF

complete ,sudden cesssation of intake,prolong dimished intake

cause of isonatremic dehydration

-loss from GI :vomit diarrhea

-excessing renal excretion

-loss through skin -perspoiration lung-evaporation

increase temp.hypervenitlation,increase B<R,impaired skin integerity

greatst threat of isonatremic shock

hypovolemic shock d/t decrease plsama and circulating volume

hypotonic dehydration

electrolyte exceed water

more from ECF

Na<130mmol

loss from skin,lung GI,kidney(diruetic)

shock is threat decrease plasma and circulating volume

hypertonic dehydration

excess water than electrolyte

-large water loss or excessive elctrolyte intake

Shiftfrom ICF to EC F

most dangerous require specific fluid replca

cause by hypertonic diarrhea,give high amount of solute/protein feeding

Na>150

lead to cns disturbance such as seizure, permanent cerebral damgae -hyperreflexia,hyperirritability,change loc

minimum daily fluid requriement

<10kg: 100ml/kg

10-20kg;1000ml +50ml/kg (between 10-20)

>20 1500ml =20ml/kg ovwer 20kg

minimum urine output

infant and toddler:>2-3ml/kg/hr

preschooler&yong school age: >1-2ml/kg/hr

school age and adolescent:>0.5ml/kg /hr

mild dehyrationm clinical sign

Normal VS

-normal behavior,mucous mebrane,fontanel

-sligh thirst

-cap<2sec, sligh decreased skin turgor

-present tear,visiblt jugular vein

-slightly elvated Hct

-slight oliguria

3-5 weight loss

moderate dehydration

slight tachy pnea,tachycardia,ortho hypo

-irritable

-moderate thirst and dry mucous membrane

-decrease skin turgor,slow cap 2-4

-normal to sunken fontanel

-not visible expcept with supracalvicualr pressure

-electaed Hct

-oliguria

-weight losss 6-8

severev dehydration

tachypanea tachycardia,ortho to shock Bp

-hyperirritable lethargy

-intense thirst pand parched mucous membrane

-delayed cap refill >4sec,cool skin,tenting,acrocyanotic or mottled

-absent and sunken eye

-sunken anterior fontanel

-oligguria to anuria

>10%

therapeutic mangement are based on

-degree of dehydration based on physical assessment,based on illness patho

-specific physical sign other than general

-inital plasma sodium concentration

-bicarbonate concentration

-K and acid base imbalance

goal of medical mangement

correct fluid imbalance

treat underlying cause

no dehydration intervention

replca onging loss with ORS

age appropriate diet

mild dehydration <5 intervention

-rehydrate with ORS 50ml/kg over 4hr

-replacen ongoing loss with ORS

-age appropriate diet after rehydration

moderate dehydration 5-10 tx

-rehydrate with oRS 100ml/kg over 4hr

-replca ongoing loss with oRS

-age appropriate diet after rehydration

severe dehydration >10

-IV resusictation with NS and RL 20-40ml/kg for 1hr

-r/a if needed

-begin oRT when pt is stable

-repeat ongoing loss with ORS

-age appropriate diet

ongoing loss

-replace 1;1 with oRS-pedialyte

getroade not recommended

popsicle

resume diet ASAP

not brad diet

severe dehydration tx -iv

with uncontoleed vomiting start IV,or un able to drink or severev gastric distension

administer anti-emetic

nursing assessment-infant activity

decrease activity baseline,increase irritability,decrease protest-lethargic

nursing assessment cap refill

pinch abd,chest,arm leg,estimae blood return time

nurisng assessment-skin

-turgot:detremine elasticity and tenting

-skin color:mottling,acrocyanosis,fluisihing

-mucous membrane :moisture color,secretion

-fontanel -infant

-thirst

nursing assessment -IO

everyday same time weight

-I&o:

urine-freuqency,color,volume,weigh diaper

stool-frequency,volume,consistency

emesis;volume,freuqency ,colour

nursing assessment -vs

-fever increase metabolic rate and fluid requirement

increase HR,decrease quality,increase RR in order to c ompensate metabolic acidosis, BP decrease but late sign of hypovolemia

potebtial nursing diagnosis

fluid volume deficit

fluid and electrolyte imbalnce

nutrition less than body require

dehydration

impaired skin integrity

parent education

-prevention:hand hygiene,prper skin care,kid vaccine for rhotavirus-diarrhea<2yr

-early sign of dehydration

-how to treat