NSG 3600
EXAM 3 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
,UNIT 5
Reading:
Ward & Hisley (2016)
CH. 18: Caring for the Normal Newborn, Conditions That May Warrant Further
Assessment: pp. 681-682
CH. 19: Caring for the Newborn at Risk, pp. 743-744
CH. 24: Caring for the Child With a Gastrointestinal Condition, pp. 921-928; 934-937;
942-955
CH. 31: Caring for the Child With a Genitourinary Condition, pp. 1260-1264
CDC lead poisoning
article https://ptfceh.niehs.nih.gov/features/assets/files/key_federal_programs_to_reduce
_childhood_lead_exposures_and_eliminate_associated_health_impactspresidents_508.
pdf
Elimination: Gastric
A and P Review
Dehydration (*Included in Diarrhea, fluid & electrolytes and Vomiting Reading)
o Fluid and Electrolytes
Calculation of fluid requirements
Child’s Weight Daily Maintenance Fluid Requirement
0–10 kg 100 mL/kilogram of body weight
11–20 kg 1,000 mL + 50 mL/kilogram for each kg >10
>20 kg 1,500 mL + 20 mL/kilogram for each kg >20
Example:
A child weighs 48 kg. For the first 20 kg the child needs 1,500 mL.
For the next 28 kg, the child needs 20 mL/kg. So, 1,500 mL + (28 kg ×
20 mL) = 1,500 mL + 560 mL = 2,060 mL/day
Risk for fluid and electrolyte imbalance
Fluid volume deficit/excess related to disease process: sepsis, shock,
multiple dysfunction syndrome
• Decreased cardiac output related to disease process: sepsis, shock,
multiple dysfunction syndrome
• Ineffective tissue perfusion (cardiopulmonary, gastrointestinal, renal,
cerebral, peripheral) related to decreased cardiac output
• Risk for altered body temperature/hypothermia related to ineffective
tissue perfusion and decreased cardiac output
• Risk for altered patterns of urinary elimination related to decreased
perfusion to the kidneys and multiple dysfunction syndrome
Types of dehydrations
Isotonic
Isotonic dehydration occurs when electrolyte and
water deficits are present in balanced proportions
(sodium and water are lost in equal amounts).
Serum sodium remains in normal limits
(130–150 mEq/L). This is the most common
type of dehydration. Hypovolemic shock is
the greatest concern.
Hypotonic
o Hypotonic dehydration occurs when the electrolyte
, deficit exceeds the water deficit. Serum sodium concentration is less than 130 mEq/L. Physical
signs are more severe with smaller fluid losses.
Hypertonic
dehydration is the most dangerous type
and occurs when water loss is in excess of electrolyte loss. Sodium serum concentration is greater
than 150 mEq/L. Seizures are likely to occur.
Fluid deficit and excess
Fluid deficit (to determine normal values use calculation of daily maintenance fluid requirements)
CAUSE-------------------------SIGN & SYMPTOM-----------NURSING INTERVENTION
Diminished fluid intake-----dry skin------determine underlying cause
Diaphoresis----------------- dry mucous membranes-----------replace fluids
Vomiting----------------poor skin turgor----------------------------replace electrolytes
Diarrhea-----------------thirst-//scaphoid abdomen-----------Oral hydration
Nasogastric suction--------poor perfusion---------------------IV hydration
Fever---------------------------Decreased urinary output-----------Measure intake and output
Hemorrhage----------------- Weight loss-----------------------------Monitor vital signs
General fluid deficit------------ Fatigue, Tachycardia, Tachypnea, Decreased blood
Pressure, High urine specific gravity, High hematocrit---------------------- Monitor vital signs, Monitor
laboratory values (electrolytes)
Fluid excess (to determine normal values use calculation of
daily maintenance fluid requirements)
CAUSES-------------------------SIGN & SYMPTOM-----------NURSING INTERVENTION
Excessive oral intake------Pulmonary Edema------------Determine underlining cause
Hypotonic fluid overload--- Weight gain (fluid retention) --- Decrease fluid intake
Kidney disease----------------- Lethargy------------------- Administer diuretics
All causes------------------------ Decreased level of consciousness Slow, bounding
Pulse Low urine specific gravity Decreased hematocrit--------------- Monitor vital signs
Monitor laboratory values (electrolytes) Nursing care measures listed
EXAM 3 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
,UNIT 5
Reading:
Ward & Hisley (2016)
CH. 18: Caring for the Normal Newborn, Conditions That May Warrant Further
Assessment: pp. 681-682
CH. 19: Caring for the Newborn at Risk, pp. 743-744
CH. 24: Caring for the Child With a Gastrointestinal Condition, pp. 921-928; 934-937;
942-955
CH. 31: Caring for the Child With a Genitourinary Condition, pp. 1260-1264
CDC lead poisoning
article https://ptfceh.niehs.nih.gov/features/assets/files/key_federal_programs_to_reduce
_childhood_lead_exposures_and_eliminate_associated_health_impactspresidents_508.
Elimination: Gastric
A and P Review
Dehydration (*Included in Diarrhea, fluid & electrolytes and Vomiting Reading)
o Fluid and Electrolytes
Calculation of fluid requirements
Child’s Weight Daily Maintenance Fluid Requirement
0–10 kg 100 mL/kilogram of body weight
11–20 kg 1,000 mL + 50 mL/kilogram for each kg >10
>20 kg 1,500 mL + 20 mL/kilogram for each kg >20
Example:
A child weighs 48 kg. For the first 20 kg the child needs 1,500 mL.
For the next 28 kg, the child needs 20 mL/kg. So, 1,500 mL + (28 kg ×
20 mL) = 1,500 mL + 560 mL = 2,060 mL/day
Risk for fluid and electrolyte imbalance
Fluid volume deficit/excess related to disease process: sepsis, shock,
multiple dysfunction syndrome
• Decreased cardiac output related to disease process: sepsis, shock,
multiple dysfunction syndrome
• Ineffective tissue perfusion (cardiopulmonary, gastrointestinal, renal,
cerebral, peripheral) related to decreased cardiac output
• Risk for altered body temperature/hypothermia related to ineffective
tissue perfusion and decreased cardiac output
• Risk for altered patterns of urinary elimination related to decreased
perfusion to the kidneys and multiple dysfunction syndrome
Types of dehydrations
Isotonic
Isotonic dehydration occurs when electrolyte and
water deficits are present in balanced proportions
(sodium and water are lost in equal amounts).
Serum sodium remains in normal limits
(130–150 mEq/L). This is the most common
type of dehydration. Hypovolemic shock is
the greatest concern.
Hypotonic
o Hypotonic dehydration occurs when the electrolyte
, deficit exceeds the water deficit. Serum sodium concentration is less than 130 mEq/L. Physical
signs are more severe with smaller fluid losses.
Hypertonic
dehydration is the most dangerous type
and occurs when water loss is in excess of electrolyte loss. Sodium serum concentration is greater
than 150 mEq/L. Seizures are likely to occur.
Fluid deficit and excess
Fluid deficit (to determine normal values use calculation of daily maintenance fluid requirements)
CAUSE-------------------------SIGN & SYMPTOM-----------NURSING INTERVENTION
Diminished fluid intake-----dry skin------determine underlying cause
Diaphoresis----------------- dry mucous membranes-----------replace fluids
Vomiting----------------poor skin turgor----------------------------replace electrolytes
Diarrhea-----------------thirst-//scaphoid abdomen-----------Oral hydration
Nasogastric suction--------poor perfusion---------------------IV hydration
Fever---------------------------Decreased urinary output-----------Measure intake and output
Hemorrhage----------------- Weight loss-----------------------------Monitor vital signs
General fluid deficit------------ Fatigue, Tachycardia, Tachypnea, Decreased blood
Pressure, High urine specific gravity, High hematocrit---------------------- Monitor vital signs, Monitor
laboratory values (electrolytes)
Fluid excess (to determine normal values use calculation of
daily maintenance fluid requirements)
CAUSES-------------------------SIGN & SYMPTOM-----------NURSING INTERVENTION
Excessive oral intake------Pulmonary Edema------------Determine underlining cause
Hypotonic fluid overload--- Weight gain (fluid retention) --- Decrease fluid intake
Kidney disease----------------- Lethargy------------------- Administer diuretics
All causes------------------------ Decreased level of consciousness Slow, bounding
Pulse Low urine specific gravity Decreased hematocrit--------------- Monitor vital signs
Monitor laboratory values (electrolytes) Nursing care measures listed
