ALTERATIONS IN
FLUIDS &
ELECTROLYTES
NURS 211
Family Centered Care I
Learning Objectives
1.
Describe normal fluid & electrolyte status for children at various ages.
(CLO: 1.01 - PLO: 5)
2.
Recognize threats to fluid & electrolyte balance in children. (CLO:
1.01/1.08/1.102.01/2.02 - PLO: 5)
1.
Analyze assessment findings to recognize fluid & electrolyte problems
in children. (CLO: 1.04/1.07/1.08/1.09 - PLO: 2, 3, 5)
2.
Plan appropriate nursing interventions for children experiencing fluid
& electrolyte problems. (CLO: 1.02/1.03/2.01/3.04/ - PLO:1,3,5)
3.
Safely calculate and administer replacement fluids to the child with a
fluid volume imbalance. (CLO: 1.05/1.06/1.07/5.02 - PLO: 4,5)
Why Kids are Different
■ Higher metabolic rate.
– Insensible fluid loss
■ Greater body surface area.
– Insensible fluid loss
■ Kidneys cannot fully conserve fluid and electrolytes until child is 2 years
old.
– Sensible fluid loss
– Greater daily fluid need
– Newborn
■
4 to 5 times greater daily water need
Fluid Differences
Normal Urine Output
Calculate mL/kg/hr
2 mL/kg/hr
Birth to 1 yr
**6 wet diapers
per day
Childs weight = 15 pounds
Childs age = 11 months
1 mL/kg/hr
2 yr – 10 yr
15/2.2 = 6.818 = 6.82 kg
6.82 kg x 2 mL – 13.636 mL/hr
13.64 mL/hr x 24 hr = 327.36 mL/day
40-80 mL/kg/hr
11 yr – 18 yr
Identification of Risk
Assessment of Fluid Imbalances
■ GU function
– Urine output
■ Cardiovascular volume
– Heart Rate – trending up
– Capillary refill
– Pulses
– Blood Pressure
■ Late indicator
– Fontanels
■ Bulging/Sunken
– Lung sounds
■ Interstitial volume
– Skin tugor
■ Neurological function
– LOC
■ GI Function
– Vomiting/Diarrhea
Classification of Dehydration
Isonatremic – Hyponatremic – Hypernatremic
Na+ WNL
Na+ low
Na+ high
Diagnostic Labs
■ Electrolytes:
– sodium
– Potassium
■ Urine Specific Gravity 0.030
■ What does USG tell us?
■ Not reliable < 2 yr
■ Others:
– Cultures (blood, urine, stool)
– Urine analysis
■ Know the Reference Ranges and Implications
Acid-Base imbalance
Bring the knowledge with you!!
■ Metabolic Acidosis
– Diarrhea (Loss of bicarb)
– Fever
■ Metabolic Alkalosis
– Vomiting (LOSS OF Hydrogen)
– Gastric Drainage
Management of Dehydration
■ Rehydrate
– Mild to Moderate –
■ Oral Replacement Fluid
– Moderate to Severe – IV Hydration
■ Bolus of 10 – 20 mL/Kg NS
– Replaces H2O & Na+
■ Treat the Cause/Symptoms
■ Correct Electrolyte Imbalance
■ Fluid Maintenance
– 1st D5.33 NaCl
– 2nd 20 mEq KCl/L in IV solution (1000 mL)
■ With normal K+
■ after confirming child is voiding
Care for the Child with Diarrhea
■ Oral Rehydration Solution
■ Continue normal diet
– Hold milk if not tolerated
– Provide easily digested healthy foods
■ Infants – breastmilk/formula
– Skin Care to Diaper Area
■ Treat the Cause/Symptoms
– Avoid Antidiarrheal Meds
– Skin Integrity
Care for the Child with Vomiting
■ Prevent Aspiration
■ Mouth Care
■ Replacement Fluids
– Oral Rehydration Solution
– Small amounts frequently usually tolerated
■ Treat the Cause
■ Antiemetics
– Ondansetron (Zofran)
Calculating Hydration Needs
Maintenance Rate
■ 24 Hour Requirement based on weight mL/kg/day
■ First 10 Kg or any portion of 10 - multiply by 100
■ Second 10 Kg or any portion of 10– multiply by 50
■ Remaining Kg - multiply by 20
■ Add these amounts for the 24 Hour Total
■ Divide the fluid needed in 24 hr by 24 hr to get the mL/hr rate to set
the IV pump
■ This is the amount of fluid the child needs to maintain fluid
homeostasis in 24 hours
Fluid Needs for a 6 Kg Child
■
■
■
■
6 X 100 kg = 600 mL
__ X 50 kg = 0
_ X 20 kg =__0______
6 kg
600 mL/day
■ Hourly Need
– 600mL/day / 24 hr = 25 mL/hr
– The problem will tell you how to round your answer
Fluid Needs for a 11.88 Kg Child
■
■
■
■
10 X 100 kg = 1000 mL
1.88 X 50 kg = 094 mL
0 X 20 kg = 0mL
11.88 kg
1094 mL/day
■ Hourly Need
– 1094mL/day / 24 hr = 45.58 or 46 mL/hr
– The problem will tell you how to round your answer
Fluid Needs for a 25 Kg Child
■
■
■
■
10 X 100 kg = 1000 mL
10 X 50 kg = 500 mL
5 X 20 kg = 100 mL
25 kg
1600 mL/day
■ Hourly Need
– 1600mL/day / 24 hr = 66.67 or 67 mL/hr
– The problem will tell you how to round your answer
Calculating the % Weight Loss
■ #1
Calculate amount of lost weight
– Subtract Current Weight from Baseline Weight
■ #2 Amount of weight lost divided by the
Baseline Weight
■ #3 Multiply X 100
% Lost = Baseline Wt – Current Wt X 100
Baseline Weight
Calculating % Weight Loss
Example for a child who weighs 34 pounds today
and had a Baseline Weight of 37 pounds.
% Loss = 37 lb – 34 lb X 100
37 lb
% Loss =
3 lb X 100
37 lb
% Loss = 0.081 X 100 = 8.1%
Moderate Weight Loss
Can also be done in kg utilizing the same formula
Resource
■ There is a work sheet and key related to these problems on Moodle
– Resource section – Math Folder
–
–
–
I suggest that you practice these problems over and over.
There will be at least of each of these problems on every test
Please see me if you are having trouble