Pediatric Hesi Case Study Fluid and Electrolytes Exam Latest Updated Graded A+

Pediatric Hesi Case Study Fluid and Electrolytes Exam Latest Updated Graded A+ Ricky Sanchez is a term newborn. His parents are 18 and 19 years old. Mr. Sanchez works long hours as a mechanic and Mrs. Sanchez stays at home with Ricky, who is their first child. Mr. and Mrs. Sanchez express concern because their own parents live in another city and they are not available to help with Ricky's care. Mrs. Sanchez chooses to formula feed Ricky and she is given a 2-week supply of formula when discharged from the Newborn Nursery. The nurse provides client education related to nutrition and fluid needs of infants. - Answers - Pediatric HESI Case Study Fluid and Electrolytes What are the principles of fluid balance? - Answers - Infants have a greater percent of fluid in the extracellular compartment compared to adults; therefore, they have greater and more rapid fluid losses Ricky weighs 3.4 kg. Referencing the fluid composition chart, what is Ricky's daily maintenance fluid requirements? - Answers - 340 The nurse suspects that Ricky has an excess of fluid and that he may be experiencing water intoxication. Which findings confirms assessment? - Answers - Irritability (Lethargy or irritability characterize water intoxication.) Specific Gravity of 1.005 (Low specific gravity indicates diulte urine and is associated with water intoxication.) Moist Rales Bilaterally (Moist rales will be heard due to fluid excess.) Ricky is admitted and prescribed a diuretic. What is a priority intervention? - Answers - implement seizures precautions (Fluid and electrolyte imbalances can cause seizures.) Based on Ricky's weight, what is the correct amount of medication to administer? - Answers - 0.68 (Ricky weighs 3.4kg. 3.4kg *2mg/kg = 6.8mg. Dose ordered [6.8mg] divided by dose on hand [10mg] times 1mL is 0.68mL to be administered.) Which nutrition option is best suited for 3-week old Ricky, given that his mother has chosen formula feedings? - Answers - Undiluted commercial iron-fortified formula for the first 6 months not to exceed 32 oz (Iron fortified formula provides all the nutrients an infant needs for the first 6 months of life.) Based on weight loss, what degree of dehydration does Ricky exhibit? - Answers - Moderate (Ricky has lost 0.9 kgs, which is approximately 9% of his body weight. This is consistent with moderate dehydration.) The nurse completes a head-to-toe assessment of Ricky. What additional findings support the assessment of moderate dehydration? - Answers - Slightly rapid respiration (Resp. rate increases with each degree of dehydration.) Irritability (characteristic of moderate dehydration.) Moderate thirst (characteristic of moderate dehydration.) Oliguria (Present in moderate dehydration and can progress to anuria at the severe level.) Ricky's temp is 38.5 C. What impact does this have on his fluid needs? - Answers - Increases fluid by 12% (Normal temp for an infant is 37.5 degrees Celsius. Fever increases fluid needs by 12% for every 1 degree Celsius rise in temperature and Ricky's temperature is 1 degree Celsius above normal.) Which statement reflects the principles of fluid and electrolyte imbalance? - Answers - Fluids must be administered carefully to avoid serious reactions. (Rapid fluid replacement may result in water intoxication and marked cerebral edema. ) Which nursing assessment is most indicative of Ricky's clinical condition improving? - Answers - Serum sodium of 140 mEq/L (Expected serum sodium levels for infants are 133 to 142 mEq/L. Normal sodium levels are considered part of quality patient outcomes for dehydration.) Which goal should receive the highest priority in the education plan of care? - Answers - Seek prompt treatment for diarrhea. (Fluid losses with diarrhea in infants re more serious and severe than in adults. Parents should seek treatment for diarrhea within the first 24 hours of the illness.)