True or false: Infants and children are at a higher risk for rapid fluid depletion than adults True Why children are at a higher risk of rapid fluid depletion Total body fluid content Higher metabolic rate Fluid depletion occurs through the Skin GI tract Percentage of infant's total body weight that comes from fluid 75-80% Percentage of young child's total body weight that comes from fluid 60-65% Percentage of adolescent and adult's total body weight that comes from fluid 50-60% Systems that regulate acid-base balance Chemical buffering system Respiratory control of CO2 Renal regulation Organs that regulate acid-base balance Lungs Kidneys Normal blood pH 7.35-7.45 How the respiratory system responds to acidosis Increases rate and depth of respiration How the respiratory system responds to alkalosis Decreases rate and depth of respiration Kidney's role in chemical buffering Remove hydrogen Regulate bicarbonate True or false: Compensation of the kidneys is slower than that of the respiratory system True What kidneys do in acidic conditions Increase release of hydrogen Conserve bicarbonate To raise pH What kidneys do in conditions of alkalosis Increase release of bicarbonate Conserve hydrogen To lower pH pH of less than 7.35 indicates Acidosis pH of more than 7.45 indicates Alkalosis Dehydration can rapidly progress to Hypovolemic shock Organ failure 3 types of dehydration Isotonic (isonatremic) Hypotonic (hyponatremic) Hypertonic Common diagnostics for dehydration CBC Electrolytes CMP Urinalysis ABG Accucheck When would an accucheck be considered for dehydration? Change in mental status or LOC Most common type of dehydration Isotonic (isonatremic) Isonatremic (isotonic) dehydration definition Equal loss of water and sodium Causes of isonatremic (isotonic) dehydration Vomiting Diarrhea Insensible water loss with respiration Decreased oral intake Hyponatremic (hypotonic) dehydration definition Greater loss of sodium that water Sodium levels in isotonic dehydration 130-150 Cells do what in hypotonic dehydration Swell (stronger intracellular osmolarity) Sodium levels in hypotonic dehydration Less than 130 Causes of hyponatremic (hypotonic) dehydration Renal diuretics Nephritis Interstitial fluid shift Water overload Vomiting Diarrhea Heart failure SIADH Hypernatremic (hypertonic) dehydration definition Greater loss of water than sodium Hypertonic dehydration can lead to Dysfunction Shock Death Causes of hypernatremic (hypertonic) dehydration Renal diuretics Poorly managed diabetes Diarrhea Sodium levels of hypertonic dehydration Greater than 150 How to determine level of mild dehydration in infants 5% loss of body weight How to determine level of mild dehydration in adolescents 3% loss of body weight How to determine level of moderate dehydration in infants 5-10% loss of body weight Change in VS How to determine level of moderate dehydration in adolescents 6% loss in body weight Change in VS Mild dehydration treatment location At home Mild dehydration treatment Dietary and fluid replacement Oral rehydration solutions 10 mL/kg/event Initial intake 2/mL q5min Moderate dehydration treatment location Hospital Moderate dehydration treatment Rapid ORS therapy 50-100 mL/kg for 2-4hrs IV fluid bolus followed by D5 0.45% NaCl 30 mL/kg for 1-2 hours Add potassium chloride IF voiding well ORS stands for Oral rehydration solutions What prevents adverse cardiac side effects when administering potassium chloride? Adequate urine output before administration (1 mL/kg/hr) How to determine level of severe dehydration in infants 15% loss in body weight Significant hemodynamic changes How to determine level of severe dehydration in adolescents 9% loss in body weight Significant hemodynamic changes Focus of care for severe dehydration Correct underlying metabolic condition Keep child NPO Severe dehydration treatment IV fluid bolus up to 60 mL/kg given over 15-30 min Repeat if no improvement Change to D5 0.45% NaCl with improvement Way to quickly determine circulatory improvement Capillary refill Normal urine volume 1-2 mL/kg/hr Oliguria volume < 1> 3 mL/kg/hr Diet for gastroenteritis recovery Complex carbs Lean meat Veggies Fruit True or false: High carb foods and drinks can further irritate the bowel and worsen diarrhea True Priorities of nursing care for dehydration Vital signs Neurological assessment I&O Urinalysis Hydration assessment True or false: A change in blood pressure is an early sign of shock False Late sign True or false: A specific gravity of less than 1.005 is a sign of dehydration False > 1.020 Ways to assess hydration status Mucous membranes Presence of tears Skin color and turgor Anterior fontanel Weights I&O True or false: Hypovolemic shock is indicated by hypertension and bradycardia False Hypotension and tachycardia True or false: ABGs are minimally invasive and not as painful as a regular venipuncture False Invasive and painful Early indicators of shock Changes in heart rate, sensorium, and skin color True or false: Potassium can be given by IV push False Rotavirus is also called Viral gastroenteritis Diarrhea can lead to Metabolic acidosis