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How do children under 2 years lose fluid compared to older children?
How do children under 2 years lose fluid compared to older children?
What is a significant factor that increases fluid demands in children?
What is a significant factor that increases fluid demands in children?
Which of the following is a component of extracellular fluid?
Which of the following is a component of extracellular fluid?
What calculation is used to determine daily fluid maintenance for a child weighing 35 kg?
What calculation is used to determine daily fluid maintenance for a child weighing 35 kg?
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What characteristic of kidney function contributes to fluid loss in children under 2 years?
What characteristic of kidney function contributes to fluid loss in children under 2 years?
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What factor contributes to the greater insensible losses in children?
What factor contributes to the greater insensible losses in children?
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What is the primary cause of isotonic dehydration?
What is the primary cause of isotonic dehydration?
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What is NOT a reason why infants and children are at higher risk for fluid and electrolyte imbalance?
What is NOT a reason why infants and children are at higher risk for fluid and electrolyte imbalance?
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Which serum sodium concentration indicates hypotonic dehydration?
Which serum sodium concentration indicates hypotonic dehydration?
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Which treatment is typically recommended for isotonic dehydration?
Which treatment is typically recommended for isotonic dehydration?
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What is a common symptom of hypotonic dehydration?
What is a common symptom of hypotonic dehydration?
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What indicates that the body is experiencing hypovolemic shock due to dehydration?
What indicates that the body is experiencing hypovolemic shock due to dehydration?
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Which condition may lead to hypotonic dehydration due to pressure on the posterior pituitary?
Which condition may lead to hypotonic dehydration due to pressure on the posterior pituitary?
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What could be the first sign of rapid shifts in fluid compartments when administering hypertonic solutions?
What could be the first sign of rapid shifts in fluid compartments when administering hypertonic solutions?
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What type of solution is administered initially in cases of hypotonic dehydration?
What type of solution is administered initially in cases of hypotonic dehydration?
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What condition is characterized by electrolyte losses exceeding water deficits?
What condition is characterized by electrolyte losses exceeding water deficits?
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What is a common cause of chronic non-specific diarrhea in children aged 6-54 months?
What is a common cause of chronic non-specific diarrhea in children aged 6-54 months?
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Which method is NOT indicated for assessing fluid and electrolyte imbalance?
Which method is NOT indicated for assessing fluid and electrolyte imbalance?
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When managing mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be administered over four hours?
When managing mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be administered over four hours?
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Which organism is NOT typically associated with chronic diarrhea caused by infectious etiologies?
Which organism is NOT typically associated with chronic diarrhea caused by infectious etiologies?
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Which of the following symptoms is not indicative of chronic non-specific diarrhea?
Which of the following symptoms is not indicative of chronic non-specific diarrhea?
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What is the primary characteristic of hypertonic dehydration?
What is the primary characteristic of hypertonic dehydration?
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Which of the following is a potential cause of hypokalemia?
Which of the following is a potential cause of hypokalemia?
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What symptoms are most commonly associated with hyperkalemia?
What symptoms are most commonly associated with hyperkalemia?
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Which of the following treatments is appropriate for managing severe hypokalemia?
Which of the following treatments is appropriate for managing severe hypokalemia?
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Which serum sodium level indicates hypertonic dehydration?
Which serum sodium level indicates hypertonic dehydration?
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What is a common treatment for hyperkalemia?
What is a common treatment for hyperkalemia?
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In the case of oliguria caused by hypertonic dehydration, what underlying factor should be addressed?
In the case of oliguria caused by hypertonic dehydration, what underlying factor should be addressed?
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In what situation might a rapid infusion of 0.45 NS lead to negative outcomes?
In what situation might a rapid infusion of 0.45 NS lead to negative outcomes?
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Which condition could lead to an increased K+ excretion among patients?
Which condition could lead to an increased K+ excretion among patients?
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What percentage weight loss is classified as severe dehydration?
What percentage weight loss is classified as severe dehydration?
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What is a sign of dehydration that may indicate a more serious condition?
What is a sign of dehydration that may indicate a more serious condition?
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Which of the following is NOT considered a nursing assessment for dehydration?
Which of the following is NOT considered a nursing assessment for dehydration?
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In a child who is 5% dehydrated, which symptom is typically observed?
In a child who is 5% dehydrated, which symptom is typically observed?
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What characterizes acute diarrhea as identified in the content?
What characterizes acute diarrhea as identified in the content?
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Which of the following is a common cause of chronic diarrhea in infants?
Which of the following is a common cause of chronic diarrhea in infants?
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What specific characteristic of diarrhea indicates it is acute, rather than chronic?
What specific characteristic of diarrhea indicates it is acute, rather than chronic?
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Which of the following is a potential cause of dehydration in a young child?
Which of the following is a potential cause of dehydration in a young child?
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What physiological change accompanies dehydration as per the content?
What physiological change accompanies dehydration as per the content?
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What is a common finding in the assessment of a child with dehydration?
What is a common finding in the assessment of a child with dehydration?
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What can be a potential complication of prolonged diarrhea in infants?
What can be a potential complication of prolonged diarrhea in infants?
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What is the primary reason that children under 2 years have an increased risk of dehydration?
What is the primary reason that children under 2 years have an increased risk of dehydration?
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What is a significant factor influencing the fluid intake calculations for a child weighing 35 kg?
What is a significant factor influencing the fluid intake calculations for a child weighing 35 kg?
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Which fluid compartment does not include intravascular fluid?
Which fluid compartment does not include intravascular fluid?
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What role does kidney immaturity play in fluid balance for children under 2 years?
What role does kidney immaturity play in fluid balance for children under 2 years?
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Why is it crucial to monitor fluid requirements in infants and children under 2?
Why is it crucial to monitor fluid requirements in infants and children under 2?
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Which component of fluid loss is primarily linked to skin and respiratory tract insensible losses?
Which component of fluid loss is primarily linked to skin and respiratory tract insensible losses?
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What calculation method is used to determine the fluid requirements for a child weighing 35 kg?
What calculation method is used to determine the fluid requirements for a child weighing 35 kg?
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What is a key characteristic of chronic non-specific diarrhea in children aged 6-54 months?
What is a key characteristic of chronic non-specific diarrhea in children aged 6-54 months?
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Which organism is commonly linked to chronic diarrhea as mentioned in the content?
Which organism is commonly linked to chronic diarrhea as mentioned in the content?
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During the management of mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be given per kilogram?
During the management of mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be given per kilogram?
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What is the most common cause of chronic non-specific diarrhea in children?
What is the most common cause of chronic non-specific diarrhea in children?
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What laboratory test can help determine dehydration in a child?
What laboratory test can help determine dehydration in a child?
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What is the primary form of dehydration characterized by equal losses of electrolytes and fluid?
What is the primary form of dehydration characterized by equal losses of electrolytes and fluid?
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Which symptom is likely associated with hypotonic dehydration due to excessive fluid retention?
Which symptom is likely associated with hypotonic dehydration due to excessive fluid retention?
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In cases of hypotonic dehydration, what is the first intervention typically implemented?
In cases of hypotonic dehydration, what is the first intervention typically implemented?
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Which of the following is listed as a treatment method for hypotonic dehydration?
Which of the following is listed as a treatment method for hypotonic dehydration?
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Which sign is most indicative of a 5% level of dehydration in a child?
Which sign is most indicative of a 5% level of dehydration in a child?
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What defines isotonic dehydration in terms of serum sodium concentration?
What defines isotonic dehydration in terms of serum sodium concentration?
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What is a common symptom associated with chronic diarrhea that lasts more than 14 days?
What is a common symptom associated with chronic diarrhea that lasts more than 14 days?
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Which condition is NOT a common cause of hypotonic dehydration?
Which condition is NOT a common cause of hypotonic dehydration?
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When assessing a dehydrated child, which condition is a sign of more severe dehydration?
When assessing a dehydrated child, which condition is a sign of more severe dehydration?
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What is the correct course of action when administering a hypertonic solution after isotonic solutions fail?
What is the correct course of action when administering a hypertonic solution after isotonic solutions fail?
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What would be an expected vital sign change in a child experiencing dehydration?
What would be an expected vital sign change in a child experiencing dehydration?
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Which treatment is safest for replacing fluid lost in isotonic dehydration?
Which treatment is safest for replacing fluid lost in isotonic dehydration?
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What is a potential consequence of rapidly administering hypertonic solutions in older children?
What is a potential consequence of rapidly administering hypertonic solutions in older children?
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Which of the following would not be used to assess dehydration in a patient?
Which of the following would not be used to assess dehydration in a patient?
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Which of the following symptoms is least likely to be associated with hypertonic dehydration?
Which of the following symptoms is least likely to be associated with hypertonic dehydration?
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Which condition is least likely to contribute to dehydration in infants?
Which condition is least likely to contribute to dehydration in infants?
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What is the primary treatment for severe hypokalemia?
What is the primary treatment for severe hypokalemia?
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Which of the following causes is most directly related to metabolic alkalosis leading to hypokalemia?
Which of the following causes is most directly related to metabolic alkalosis leading to hypokalemia?
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What common characteristic is found in acute diarrhea compared to chronic diarrhea?
What common characteristic is found in acute diarrhea compared to chronic diarrhea?
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What physiological change often accompanies dehydration?
What physiological change often accompanies dehydration?
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What consequence can arise from administering 0.45 NS too rapidly in a patient with hypertonic dehydration?
What consequence can arise from administering 0.45 NS too rapidly in a patient with hypertonic dehydration?
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What is a critical nursing assessment for evaluating a child's dehydration status?
What is a critical nursing assessment for evaluating a child's dehydration status?
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Which electrolyte imbalance is most likely to lead to digoxin toxicity symptoms?
Which electrolyte imbalance is most likely to lead to digoxin toxicity symptoms?
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Which of the following factors is NOT typically associated with acute diarrhea in children?
Which of the following factors is NOT typically associated with acute diarrhea in children?
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In a state of hyperkalemia, which of the following physiological changes is expected?
In a state of hyperkalemia, which of the following physiological changes is expected?
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What condition could directly lead to an increase in potassium excretion in the body?
What condition could directly lead to an increase in potassium excretion in the body?
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Which weight loss percentage would be classified as moderate dehydration?
Which weight loss percentage would be classified as moderate dehydration?
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Which treatment modality is primarily used to manage hyperkalemia in end-stage renal failure?
Which treatment modality is primarily used to manage hyperkalemia in end-stage renal failure?
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Which of the following is a common symptom of hypokalemia?
Which of the following is a common symptom of hypokalemia?
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Study Notes
Fluids and Electrolytes
- Fluids are essential for bodily functions.
- Fluid loss occurs through insensible losses (2/3 through skin, 1/3 through respiratory tract), urine, and feces.
- Major fluid compartments include intracellular fluid (inside cells) and extracellular fluid (outside cells), which includes intravascular fluid (in blood vessels) and interstitial fluid (surrounding cells).
- Infants and children under 2 lose a greater proportion of fluid daily due to a larger body surface area (BSA), higher metabolic rate, greater metabolic waste production, and immature kidney function unable to effectively conserve water.
Major Fluid Compartments
- Intracellular fluid is the fluid inside cells.
- Extracellular fluid is the fluid outside cells. It contains intravascular (blood) and interstitial (surrounding cells) fluids.
Fluid Requirements
- Daily maintenance requirements are calculated based on weight, with higher fluid needs for younger children.
Urine Output
- Fluid loss through urine varies based on age: Infants and toddlers (>2-3 mL/kg/hr), Preschool and young school age (>1-2 mL/kg/hr), Older school age and adolescents (0.5-1 mL/kg/hr).
Dehydration
- Dehydration is classified by serum sodium concentration and osmolarity (and in reference to electrolyte balances).
- Isotonic: Electrolyte and fluid loss is equal. Primary causes of isotonic dehydration are fluid losses mostly from the extracellular fluid compartment (ECF) due to vomiting and diarrhea. Treatment involves isotonic solutions.
- Hypotonic: Electrolytes lost > H2O. Hyponatremia is a concern. Underlying causes should be rectified to combat this type of dehydration. Treatment includes limiting fluids and administering sodium and fluids in necessary amounts.
- Hypertonic: H2O losses > electrolyte losses. Hypernatremia. Requires restricting sodium and administering fluids as necessary.
Electrolytes
- Electrolyte concentration varies between intracellular and extracellular fluids.
Hypokalemia
- Serum K+ < 3.5 mmol/L. This low level can cause several symptoms, which vary from muscle weakness to EKG changes.
- Causes include diuretics, osmotic diuresis, renal disease, diarrhea, decreased intake, NPO, etc.
- Treatment involves managing the underlying cause, monitoring cardiac status, ensuring adequate potassium intake, and avoiding adding potassium to any IV while monitoring cardiac output.
Hyperkalemia
- Serum K+ > 5.8 mmol/L. Symptoms include cramping, irregular heartbeat, increased deep tendon reflexes, and possible muscle weakness. Causes include massive cell death, excessive potassium IV infusion, metabolic acidosis, and impaired potassium excretion.
- Treatment involves managing the underlying cause, restricting intake, and in cases with very high concentrations, administering IV fluids, insulin, glucose, diuretics, sodium polystyrene sulfonate ("Kayexalate"), and/or dialysis as needed.
Diagnostic Evaluation of Dehydration
- Weight loss is a key indicator.
- 5% = mild, 10% = moderate, 15% = severe
- Calculating percentage weight loss is done by dividing the change in weight by the initial weight.
- Other indicators include changing levels of consciousness, response to stimuli, decreased skin elasticity and turgor, prolonged capillary refill, increased heart rate, sunken eyes and fontanels, dry mucus membranes, and absent tears. Decreased urine output is another key indicator.
Diarrhea
- Diarrhea is caused by abnormal intestinal fluid and electrolyte transport.
- Acute diarrhea is mostly common among young children (under 5) and usually self-limited but there are several causes such as gastroenteritis (caused by infections), antibiotics, laxatives or an underlying intolerance.
- Chronic diarrhea can have several causes in various age groups, usually lasting over 14 days. Intractable and chronic diarrhea in infants usually have underlying causes such as absorption issues, inflammatory diseases, food intolerances, infections etc.
- Chronic non-specific diarrhea in children is characterized by 6 until 54 months of age, characterized by loose stools with undigested food and potentially, no signs of blood, infection, or malnutrition.
Etiology
- Diarrhea is often caused by contaminated food or water.
- Viral, bacterial, and parasitic pathogens (Rotavirus, Salmonella, Shigella, Campylobacter, Giardia, Cryptosporidium), are common causes.
- Antibiotics sometimes can worsen the infection and should be used with caution.
Diagnosis
- Thorough history gathering (duration, severity, potential cause).
- Laboratory tests (stool samples, urine specific gravity, CBC, serum electrolytes, creatinine, BUN)
Management
- Assessment for fluid and electrolyte imbalances
- Rehydration (mild: 50 mL/kg ORT over 4 hrs; moderate: 100 mL/kg ORT over 4 hrs)
- Maintenance of fluid therapy (consider appropriate diet)
- Reintroduction of adequate diet
Nursing
- Assessment (vital signs, I&O, skin, mucus membranes, fontanel, and weight)
- Implementation and education regarding oral rehydration
- Monitoring I&O (adequate urine output)
- Skin care (preventing breakdown)
- Prevention (identifying and addressing potential causes)
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Description
This quiz covers the essentials of fluids and electrolytes, focusing on their significance for bodily functions, fluid loss mechanisms, and the major fluid compartments in the body. It highlights the unique fluid requirements for infants and children due to their physiological differences. Test your knowledge on how these factors impact health and hydration.
