NR 328 Exam #2 Fluid and Electrolyte(answered)2022

What is the normal fluid output for a child? 1-2 mL/kg/hr What causes increased requirements for maintaining water balance? What can this lead to? •Fever, tachypnea, radiant warmer •Vomiting & diarrhea, DI, acidosis •Shock, burns, postoperative bowel surgery *Can lead to dehydration What causes decreased requirements for maintaining water balance? What can this lead to? •Heart failure, •Increased ICP •Renal failure *Can lead to fluid overload Generally describe water balance in infants -Larger quantities of fluid lost through skin -Greater production of metabolic wastes -Kidneys are immature and inefficient in excreting waste and have the inability to concentrate or dilute urine What are the daily maintenance fluid requirements based off of weight? •1-10kg: 100mL/kg/day •11-20kg: 1000mL + 50mL/kg for each kg 10kg •20kg: 1500mL + 20mL/kg for each kg 20kg If a child weighs 32 kg, what is their daily fluid requirement? 1500 mL + (12 x 20 = 240) = 1740 mL/24hr *Formula = 1500mL + 20mL/kg for each kg 20kg If a child weighs 44 lbs, what is their daily fluid requirement? 44lbs/2.2 = 20kg Answer: 1500mL/24hr Formula = 1500mL + 20mL/kg for each kg 20kg If a child weighs 14kg, what is their daily fluid requirement? 1000mL + (50mL x 4kg = 200mL) = 1200mL/24hr Formula: 11-20kg: 1000mL + 50mL/kg for each kg What are the degrees of dehydration in children? How do they differ in management? -Mild, moderate, severe -If the child has mild and even moderate dehydration, they will likely stay home drinking oral replacement solution What should you look for in infants and young kids with suspected dehydration? -Unusually sleepy or drowsy -Crying but not producing tears -Dry mouth and dry or sticky tongue -High fever -Decreased urine output (Infants/babies: no wet diapers in a 6-8hr period or diapers with a little dark-yellow urine; toddlers/older children: very little dark-yellow urine) -Sunken fontanelles (Infants) -Sunken eyes -Wants to drink a lot of water (but may vomit) -Rapid breathing, inc. HR -Restlessness or irritability -Poor skin turgor -Slow capillary refill What do you use to bolus a child with dehydration? Usually bolus with NS (in adults LR are usually used) NEVER bolus with IV fluids that are dextrose base (too much sugar = cerebral edema) What lab value is most reflective of hydration status? BUN