week2

• On average 75-80% of child's body weight is water

  Intercellular fluid: 65%

  Interstitial fluid: 25%

  Plasma volume: 10%
• When children are ill, they often have experienced a fluid deficit
• Diffusion- solutes move from an area of high concentration to an area of lower concentration
• Osmosis- fluid passively moves from areas with more fluid to areas with less fluid
• Reabsorption- prevent too much fluid from leacing the capillaries no matter how much hydrostatic pressure exists within the capillaries 
• Albumin- a large protein molecule, acts like a magnet to attract water and hold it inside the blood vessels
• Electrolytes- crucial for nearly all cellular reactions and functions

  • Work with fluids to maintain health
  • Account for approximately 95% of the solute molecules in the body water
  • Found in various concentrations and monitored through bloodwork to determine abnormalities
• Sodium- helps transmit impulses in nerve and muscle fibers(135-145)
• Potassium- plays a role in muscle contraction and myocardial membrane responsiveness(3.5-5.5)
• Magnesium- contributes to protein synthesis; acts as a catalyst for enzyme reactions
• Chloride- plays a vital role in maintaining acid-base balance(connected to sodium)
• Phosphate- crucial role in membrane integrity; promotes energy storage and carbohydrate, protein, and fat metabolism
• Hyponatremia

  Relate to pure NA+ loss, low intake, delusional hyponatremia

  NA+ deficits cause plasma hypo-osmolarity and cellular swelling

  • Hypotension, tachycardia, decreased urine output(0.5-2.0 mls per kg), neurological changes(seizure, decreased LOC, cerebral edema, increased ICP)
• Hypo-Hypernatremia- Mild- treated with oral sodium chloride or fluid restriction(can be both)

  Severe- treated with IV NS or lactated ringers solution
• Hypokalemia

  Reduced intake of K+ 

  Increased entry of K+ into cells

  Increased loss of K+ leading to membrane hyperpolarization

  • Decreased neuromuscular excitability, skeletal muscle atony, cardiac dysrhythmias, n/v, decreased GI motility
• Hyperkalemia

  Rare bc of efficient renal excretion

  Caused by increased intake, shift of K+ from ICF to ECF, decreased renal excretion, Insulin deficiency, or cellular trauma

  • Increased neuromuscular irritability, restlessness, intestinal cramping, diarrhea, cardiac changes, abdominal pain
• Oral forms of potassium- must be diluted either water or fruit juice(100 to 250ml) and taken with food or immediately after meals to minimize gi distress

  IV Potassium- must not be given faster than a rate of 10 mmol/hr to patient who are not on cardiac monitor

  • Never give as an iv bolus or undiluted
• Acid base balance:

  • Depends on the regulation of free hydrogen ions
  • Balance is maintained by chemical buffers, resp reactions and kidney reactions
  • Children are at greater risk because of their lower residual lung volumes, higher metabolic rate, and immature organs
  • Blood gas analysis is a major diagnostic tool for evaluating acid-base 
  • PaCO2 reflects the adequacy of ventilation by the lungs
  • Bicarbonate reflects the actively of the kidneys in retaining or excreting bicarbonate
• Methods to obtain blood gasses

  Arterial- most effective blood gasses

  Venous

  Capillary- little kids, NICU can do blood draws from umbilical cords
• Respiratory acidosis

  pH- decrease

  paCO2- increase

  Bicarbonate- normal
• Respiratory alkalosis

  pH- increases

  paCO2- decreases

  Bicarbonate- decreased
• Metabolic acidosis

  pH- decreased

  paCO2- normal

  Bicarbonate- decreases
• Metabolic acidosis

  pH- increased

  paCO2- normal

  Bicarbonate- increases
• Calculating fluid balance intake in children

  Know age and weight

  100mL/kg for first 10 kg

  50mL/kg for next 10 kg

  20mL/kg for remaining kg

  Add total together for a 24 hour period 

  Divide by 24 for mL/hour fluid requirement
• Fluid Balance output in children

  0.5-2.0mL/kg/hour

  Ex.child ways 25kg 0.5(25) + 2.0(25) divided by 2= 31.25ml/hr
• Children can experience edema

  • Accumulation of fluid within the interstitial spaces
  • Can be localized or generalized
• Children can experience dehydration and excess fluid loss

  • Need to exam their acid-base balance
  • Sodium is the principle extracellular electrolyte, playing a major role in maintaining water concentration
• Key nursing assessments

  • For dehydration: delayed cap refill, poor skin turgor, sunken fontanels
  • For overload: peripheral edema, pulmonary edema, cerebral edema
• Dehydration- delayed cap refill(4-5 seconds), blood being shunted to core-organ, poor skin Turgor(tenting, feel doughy), di/depression in fontanel, hypotension, tachycardia, skin temp(cool, pale, blue)
• Overload- peripheral edema, periorbital edema, lung crackles(retaining fluid along lungs), neurological changes(cerebral edema), hypertension, hr still in normal range
• Isotonic solutions:

  Solutions containing fluids and electrolytes that are normally found in the body

  Do not contain proteins

  No risk for viral transmission, anaphylaxis, or alteration in coagulation profile with administration

  Better for treating dehydration rather than expanding plasma volume

  Used as maintenance fluids to:

  • Compensate for insensible fluid losses
  • Replace fluid
  • Manage specific fluid and electrolyte disturbances
  • Promote urinary flow
• Crystalloids- correct deficit, help maintain equilibrium or correct anticipated losses, increase urinary output, NS 0.9%, ringers lactate
• Hypotonic- 0.45% normal saline
• Hypertonic- D5W NS
• Isotonic- 0,9% sodium chloride, ringers lactate
• Isotonic- a solution equal concentration to a cell. No fluid shift occurs, cell stays the same
• Hypotonic- a solution of lower concentration than a cell- cell swells
• Hypertonic- a solution of higher concentration than a cell, cell shrinks
• Nursing implications for IV therapy

  1. Baseline
  2. Vital signs
  3. Iv access(dont repeat same site, after 1 week of iv therapy think of changing to central line/device)
  4. Assess response
  5. Assess for contraindications
  6. Monitor electrolytes
  7. Observe infiltration
• Drug- any chemicals that affect the physiological process of a living organism