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HESI PN PEDIATRICS PROCTORED EXAM
VERSION 8
Pediatrics Exam 3 Objectives Fluid & Electrolyte Balance in Infants & children
- Identify nursing interventions for the infant & child with dehydration
Isotonic Dehydration- most common type, electrolyte & water deficits are present in approximately balanced proportions (loss of equal amounts of water & electrolytes/salt). Because no osmotic force is present to cause a redistribution of water between the ICF & ECF, the major loss is sustained from the ECF compartment. This significantly reduces the plasma volume & thus the circulation blood volume, with the effect on the skin, muscles, & kidneys. Shock is the greatest threat to life in isotonic dehydration; & the child with isotonic dehydration displays symptoms characteristics of hypovolemic shock.Plasma sodium remains within normal limits, between 130-150 mEq/L Dry mucous membranes Hypotonic Dehydration- the electrolyte deficit exceeds the water deficit (more electrolytes/salt lost than water). Because ICF is more concentrated than ECF in hypotonic dehydration, water transfers from the ECF to the ICF to establish osmotic equilibrium. This movement further increases the ECF volume loss, & shock is a frequent result. The physical signs tend to be more severe; sweating, fever, tachypnea. Replacing fluid loss with just water & not sodium (electrolytes). Also called hyponatremic because the ECF electrolyte loss is Na.Plasma sodium concentration is are typically less than 130 mEq/L 1 / 2
1 Very poor turgor, clammy skin, slightly moist mucous membranes, lethargic or comatose, convulsions Hypertonic Dehydration- water loss in excess of electrolyte loss (more water loss than electrolytes/salt) & is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. Rare, but the most dangerous dehydration because of neurological implications & requires much more specific fluid therapy. This sometimes occurs in infants with diarrhea who are given fluids PO that contain large amounts of solute or in children receiving high protein nasogastric tube feedings that place an excessive solute load on the kidneys. Results from high salt intake, undiluted infant formulas, & some metabolic disorders. Fluids shift from ICF to ECF. Shock is less apparent, however, neurological disturbances such as seizures (prolonged) are more likely to occur.Flushed skin, lethargic, intense thirst, disturbance in consciousness, poor ability to focus attention, increase muscle tone with hyperreflexia, & hyperirritability to stimuli (tactile, auditory, bright lights) Plasma sodium concentration greater than 150 mEq/L Cold or hot temperature, turgor is fair, skin feels thickened/doughy, and mucous membranes are parched
THE MOST SERIOUS CLINICAL MANIFESTATION OF
DEHYDRATION IS HYPOVOLEMIC SHOCK! The earliest detectable sign is tachycardia.Circulatory Collapse (failure) - not having enough volume, coolness & mottling of the extremities. The blood pressure falls.
Quality patient outcomes:
Moist mucous membrane Na+ and K+ within normal limits
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