Pediatric Fluid and Electrolyte Management
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Questions and Answers

What is the primary method of insensible water loss in children?

  • Sweating due to high temperatures
  • Urinary fluid loss
  • Fecal fluid loss
  • Evaporation through the skin (correct)
  • In pediatric patients, what proportion of insensible fluid loss occurs through the respiratory tract?

  • 2/3
  • 1/3 (correct)
  • 1/2
  • 1/4
  • Why do infants and children under 2 lose more fluid each day compared to older individuals?

  • Higher percentage of body surface area to body weight (correct)
  • Lower body temperatures leading to reduced evaporation
  • Increased activity levels causing more sweating
  • Higher renal function efficiency
  • Which factor contributes to increased fluid loss in children with high fevers?

    <p>Increased respiratory rate</p> Signup and view all the answers

    What are the two major fluid compartments in the body?

    <p>Intracellular and extracellular</p> Signup and view all the answers

    What clinical manifestation is most likely associated with hypokalemia?

    <p>Skeletal muscle weakness</p> Signup and view all the answers

    Which of the following treatments is NOT indicated for hyperkalemia?

    <p>Magnesium supplements</p> Signup and view all the answers

    In a case of dehydration, which assessment finding indicates a higher degree of fluid loss?

    <p>Increased heart rate</p> Signup and view all the answers

    What condition could be a direct consequence of severe hypokalemia?

    <p>Cardiac arrhythmias</p> Signup and view all the answers

    Which explanation best describes the mechanism by which Kayexalate works?

    <p>Exchanges sodium for potassium in the intestines</p> Signup and view all the answers

    What is the primary extracellular electrolyte in the human body and its reference range?

    <p>Sodium (approx. 142 mEq/mL)</p> Signup and view all the answers

    What condition is characterized by electrolyte losses being greater than water deficits?

    <p>Hypotonic dehydration</p> Signup and view all the answers

    What is the healthiest urine output range for infants and toddlers?

    <blockquote> <p>2 - 3 mL/kg/hr</p> </blockquote> Signup and view all the answers

    What is a primary complication of isotonic dehydration?

    <p>Shock</p> Signup and view all the answers

    Which of these treatments is appropriate for hypotonic dehydration?

    <p>Restrict fluids and administer sodium</p> Signup and view all the answers

    What is the most appropriate treatment for a child with uncomplicated unilateral acute otitis media who presents with mild symptoms?

    <p>Observation for 48 - 72 hours</p> Signup and view all the answers

    Which symptom is NOT commonly associated with croup syndrome?

    <p>Severe ear pain</p> Signup and view all the answers

    In what situation is administration of fluids by mouth contraindicated for a child with severe laryngotracheobronchitis (LTB)?

    <p>Child is experiencing tachypnea</p> Signup and view all the answers

    Which characteristic finding is associated with acute epiglottitis that distinguishes it from other respiratory conditions?

    <p>Drooling and difficulty swallowing</p> Signup and view all the answers

    What is the primary cause of laryngotracheobronchitis (LTB) in children?

    <p>Viral infection</p> Signup and view all the answers

    What is a common symptom of chronic nonspecific diarrhea in children?

    <p>Frequent loose stools with undigested food particles</p> Signup and view all the answers

    Which etiology of diarrhea is least likely to cause chronic nonspecific diarrhea?

    <p>Severe dehydration from prolonged vomiting</p> Signup and view all the answers

    What is indicated by substernal and subcostal retractions in infants?

    <p>Lower respiratory tract disorder</p> Signup and view all the answers

    What is the appropriate management of a child experiencing moderate dehydration due to diarrhea?

    <p>Provide oral rehydration therapy at a rate of 100 mL per kg over 4 hours</p> Signup and view all the answers

    Which sound is characteristic of severe respiratory distress in young children?

    <p>Stridor, a high-pitched sound</p> Signup and view all the answers

    What is the incubation period of bronchiolitis caused by RSV?

    <p>4 - 6 days</p> Signup and view all the answers

    Which strain of RSV is considered the most serious and is the source of most severe bronchiolitis cases?

    <p>Strain A</p> Signup and view all the answers

    What symptoms distinguish RSV bronchiolitis from asthma?

    <p>Nasal pharyngeal secretion culture</p> Signup and view all the answers

    In the treatment of bronchiolitis caused by RSV, which of the following treatments is NOT indicated?

    <p>Corticosteroids</p> Signup and view all the answers

    What percentage of children hospitalized for bronchiolitis is associated with RSV?

    <p>50%</p> Signup and view all the answers

    Which statement accurately describes the characteristics of asthma?

    <p>Asthma episodes primarily stem from airway inflammation and smooth muscle spasms.</p> Signup and view all the answers

    What is the primary purpose of a peak flow meter in asthma management?

    <p>To gauge how quickly air can be expelled from the lungs.</p> Signup and view all the answers

    What is one appropriate therapeutic intervention for managing bacterial pneumonia in children?

    <p>Use of antibiotics specific for the organism.</p> Signup and view all the answers

    Which of the following asthma medications is considered a long-acting beta-2 agonist (LABA)?

    <p>Serevent Diskus</p> Signup and view all the answers

    What classification of asthma includes symptoms occurring more than twice a week but less than once a day?

    <p>Mild persistent</p> Signup and view all the answers

    What procedure is the only definitive way to diagnose Hirschsprung's disease?

    <p>Rectal biopsy</p> Signup and view all the answers

    What manifestation is commonly associated with children suffering from Hirschsprung's disease?

    <p>Ribbon-like stool</p> Signup and view all the answers

    What complication is the leading cause of death in children with Hirschsprung's disease?

    <p>Enterocolitis</p> Signup and view all the answers

    During which procedure is a catheter with an inflated balloon used to assess anal sphincter pressure?

    <p>Anorectal manometry</p> Signup and view all the answers

    What is typically avoided if a patient with suspected Hirschsprung's disease has enterocolitis?

    <p>Barium enema</p> Signup and view all the answers

    What is the recommended volume of oral rehydration therapy (ORT) solution for mild dehydration in children?

    <p>50 mL per kg</p> Signup and view all the answers

    Which of the following organisms is NOT commonly associated with the etiology of diarrhea?

    <p>Lactobacillus</p> Signup and view all the answers

    What symptom indicates a lower respiratory tract disorder in infants?

    <p>Substernal retractions</p> Signup and view all the answers

    Which treatment approach should be avoided in formula-fed infants experiencing diarrhea?

    <p>Increasing protein intake</p> Signup and view all the answers

    What characteristic finding on otoscopy indicates acute otitis media (AOM)?

    <p>Bulging tympanic membrane</p> Signup and view all the answers

    Which of the following symptoms is least likely to be associated with hypokalemia?

    <p>Increased deep tendon reflexes</p> Signup and view all the answers

    In patients with dehydration, which measurement is considered the most critical for evaluating their fluid status?

    <p>Weight change</p> Signup and view all the answers

    What characterizes insensible water loss in children?

    <p>Fluid loss through evaporation from the skin and exhalation</p> Signup and view all the answers

    What is the primary mechanism by which potassium-wasting diuretics contribute to the condition of hypokalemia?

    <p>Increased potassium loss through urine</p> Signup and view all the answers

    Which nursing priority is essential when managing a patient with hypokalemia before administering potassium IV?

    <p>Ensure patient is voiding adequately</p> Signup and view all the answers

    Which statement is true regarding fluid loss in infants compared to older children?

    <p>Infants lose a greater proportion of fluid each day</p> Signup and view all the answers

    In cases of hyperkalemia, which treatment option is specifically aimed at promoting potassium excretion?

    <p>Kayexalate</p> Signup and view all the answers

    What is the primary reason for increased insensible water loss in pediatric patients with high fevers?

    <p>Higher respiratory rates causing more evaporation</p> Signup and view all the answers

    In pediatric patients, which two compartments primarily involve fluid loss?

    <p>Intracellular and extracellular fluids</p> Signup and view all the answers

    What portion of insensible fluid loss occurs through the skin in children?

    <p>2/3</p> Signup and view all the answers

    What measurement indicates the presence of middle ear effusion (MEE)?

    <p>Visible bubbles behind the tympanic membrane</p> Signup and view all the answers

    In children with unilateral acute otitis media (AOM) and mild symptoms, what is the recommended approach?

    <p>Observation for 48-72 hours before taking action</p> Signup and view all the answers

    What treatment is typically indicated for chronic otitis media with effusion if symptoms persist for more than 3 months?

    <p>Myringotomy procedure</p> Signup and view all the answers

    Which of the following best describes the presentation of acute epiglottitis in a child?

    <p>Difficulty swallowing, drooling, and tripod position</p> Signup and view all the answers

    What clinical symptom typically differentiates croup syndrome from other upper respiratory conditions?

    <p>Barking cough</p> Signup and view all the answers

    What is the characteristic of body surface area (BSA) in infants under 2 years of age?

    <p>BSA is high, resulting in increased insensible water loss.</p> Signup and view all the answers

    In the context of fluid maintenance for children, what does the 100/50/20 rule specify?

    <p>100 mL for the first 10 kg, 50 mL for the next 10 kg, and 20 mL for every kilogram thereafter.</p> Signup and view all the answers

    What factor contributes to the higher metabolic waste excretion observed in infants?

    <p>Higher body surface area leading to increased metabolic demands.</p> Signup and view all the answers

    What are the implications of immature renal function in infants under 2 years of age?

    <p>Greater susceptibility to dehydration and fluid imbalance.</p> Signup and view all the answers

    What serum sodium level is observed in hypotonic dehydration?

    <p>Less than 130 mEq/L</p> Signup and view all the answers

    What condition is primarily characterized by the absence of ganglionic cells in segments of the colon?

    <p>Hirschsprung's disease</p> Signup and view all the answers

    Which of the following is a common manifestation of Hirschsprung's disease in infants?

    <p>Failure to thrive</p> Signup and view all the answers

    What is the most effective diagnostic method for confirming Hirschsprung's disease?

    <p>Rectal biopsy</p> Signup and view all the answers

    Which surgical procedure involves removing the diseased section of the intestine and connecting the remaining healthy portion to the anus?

    <p>Pull-through surgery</p> Signup and view all the answers

    What complication is most commonly linked to intestinal distention and ischemia in Hirschsprung's disease?

    <p>Enterocolitis</p> Signup and view all the answers

    What is the primary risk factor for developing asthma related to RSV infection during early childhood?

    <p>Age of initial RSV infection</p> Signup and view all the answers

    What key clinical manifestation might indicate the progression of bronchiolitis caused by RSV?

    <p>Cough and wheezing</p> Signup and view all the answers

    How is bronchiolitis caused by RSV primarily transmitted?

    <p>By contact and droplet spread</p> Signup and view all the answers

    Which radiographic finding is most typically associated with bronchiolitis RSV on a chest x-ray?

    <p>Hyperinflation and peribronchial infiltrates</p> Signup and view all the answers

    What is the proposed clinical approach after confirming an RSV diagnosis in a child presenting with respiratory symptoms?

    <p>Discontinue asthma medications</p> Signup and view all the answers

    What triggers asthma manifestations most commonly in children?

    <p>Cold air</p> Signup and view all the answers

    What is a key characteristic of barrel chest as seen in chronic asthma?

    <p>Increased anterior-posterior diameter</p> Signup and view all the answers

    Which of the following best describes long-acting beta-2 agonists (LABAs) used in asthma management?

    <p>They have a black box warning due to severe asthma episodes risk.</p> Signup and view all the answers

    Which aspect of the asthma action plan signifies a 'yellow zone' condition?

    <p>50 - 80% of personal best on peak flow meter</p> Signup and view all the answers

    What is the primary function of leukotriene modifiers in asthma treatment?

    <p>They prevent the release of histamines and slow-reacting substances.</p> Signup and view all the answers

    What proportion of insensible water loss occurs through the skin and respiratory tract in children?

    <p>67% through the skin and 33% through the respiratory tract</p> Signup and view all the answers

    Which factor increases fluid loss in infants with high fevers?

    <p>Increased metabolic rate during fever</p> Signup and view all the answers

    Why do children and infants under 2 lose fluid more rapidly than older children and adults?

    <p>They possess an immature renal system</p> Signup and view all the answers

    In insensible water loss, what is the primary route of fluid loss for children during breathing?

    <p>Roughly 33% of total fluid loss</p> Signup and view all the answers

    What is the definition of 'insensible water loss'?

    <p>Water loss not detectable by the person</p> Signup and view all the answers

    What is the primary cause of isotonic dehydration in infants and young children?

    <p>Diarrhea and vomiting</p> Signup and view all the answers

    In hypertonic dehydration, which electrolyte condition is most likely to occur?

    <p>Serum Na+ &gt; 150 mEq/L</p> Signup and view all the answers

    Which of the following statements is true regarding the kidneys of infants and children under 2 years of age?

    <p>They are immature and cannot conserve water and electrolytes efficiently.</p> Signup and view all the answers

    What is a characteristic manifestation of hypotonic dehydration?

    <p>Confusion and headache</p> Signup and view all the answers

    For the calculation of daily fluid maintenance in children not suffering from dehydration, what does the '100/50/20 rule' state?

    <p>100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for the remainder.</p> Signup and view all the answers

    What is a common cause of chronic nonspecific diarrhea in children aged 6-54 months?

    <p>Drinking apple juice containing artificial sweeteners</p> Signup and view all the answers

    Which of the following is NOT a hallmark symptom of respiratory distress in infants?

    <p>Recurrent vomiting</p> Signup and view all the answers

    Why is it critical to monitor urine output when addressing dehydration in children?

    <p>Urine output helps determine if the child needs intravenous fluids.</p> Signup and view all the answers

    How is otitis media primarily diagnosed in children?

    <p>Using an otoscope to examine ear structures</p> Signup and view all the answers

    What proportion of ORT solution should be given for moderate rehydration in children?

    <p>100 mL per kg over 4 hours</p> Signup and view all the answers

    What serum potassium level indicates hyperkalemia?

    <p>Greater than 5.8 mmol/L</p> Signup and view all the answers

    Which of the following manifestations is NOT commonly associated with hypokalemia?

    <p>Abdominal cramping</p> Signup and view all the answers

    Which factor does NOT typically lead to hypokalemia?

    <p>Excessive potassium infusion</p> Signup and view all the answers

    What is the appropriate nursing priority for a patient with dehydration?

    <p>Monitor vital signs, including blood pressure and heart rate</p> Signup and view all the answers

    In cases of hyperkalemia, which treatment should be utilized?

    <p>Kayexalate</p> Signup and view all the answers

    What is the defining characteristic of middle ear effusion (MEE)?

    <p>Absence of tympanic membrane mobility</p> Signup and view all the answers

    In which situation should observation be the preferred approach instead of immediate antibiotic treatment for acute otitis media (AOM)?

    <p>A child with unilateral AOM and mild symptoms</p> Signup and view all the answers

    What is a primary symptom associated with chronic otitis media with effusion?

    <p>Fullness or popping sensation in the ear</p> Signup and view all the answers

    What is the primary treatment approach for severe laryngotracheobronchitis (LTB)?

    <p>Hospitalization with oxygen therapy and nebulized medications</p> Signup and view all the answers

    Which of the following factors is a typical cause of acute epiglottitis?

    <p>Bacterial infection</p> Signup and view all the answers

    What is the primary cause behind the majority of bronchiolitis cases in children?

    <p>Respiratory syncytial virus (RSV)</p> Signup and view all the answers

    By what age have all children generally been infected with RSV at least once?

    <p>3 years</p> Signup and view all the answers

    Which statement best describes the character of the strain A of RSV?

    <p>It causes inflammation and edema in the bronchioles.</p> Signup and view all the answers

    What characteristic of bronchiolitis caused by RSV helps distinguish it from asthma in diagnosis?

    <p>Nasal pharyngeal secretion culture</p> Signup and view all the answers

    What is the most common duration for a bronchiolitis RSV infection?

    <p>7-10 days</p> Signup and view all the answers

    What is the primary role of leukotriene modifiers in asthma management?

    <p>Reduce inflammation and prevent asthma exacerbations</p> Signup and view all the answers

    What percentage of children typically experience their first asthma symptoms before the age of 5?

    <p>80 - 90%</p> Signup and view all the answers

    Why is it important to wean patients off oral prednisone?

    <p>To allow adrenal glands time to normalize cortisol production</p> Signup and view all the answers

    What distinguishes a long-acting beta-2 agonist (LABA) from a short-acting one?

    <p>LABAs have a prolonged duration of action for symptom control</p> Signup and view all the answers

    Which medication is NOT typically classified as a quick relief beta-adrenergic agent?

    <p>Theophylline</p> Signup and view all the answers

    What is the leading cause of death in children with Hirschsprung's disease?

    <p>Enterocolitis</p> Signup and view all the answers

    Which diagnostic method is considered definitive for confirming Hirschsprung's disease?

    <p>Rectal biopsy</p> Signup and view all the answers

    In which population is Hirschsprung's disease four times more common?

    <p>Males</p> Signup and view all the answers

    What is a common manifestation of Hirschsprung's disease in newborns?

    <p>Failure to pass meconium within 24 to 48 hours</p> Signup and view all the answers

    What surgical procedure involves the removal of the diseased section of intestine in Hirschsprung's disease treatment?

    <p>Pull-through surgery</p> Signup and view all the answers

    Which statement accurately represents the division of insensible water loss in children?

    <p>2/3 through skin and 1/3 through the respiratory tract</p> Signup and view all the answers

    What is the primary reason that infants and children under 2 experience greater fluid loss than older children?

    <p>Higher metabolic rates and increased respiratory rates</p> Signup and view all the answers

    Which of the following conditions is most likely to exacerbate insensible water loss in children?

    <p>Tachypnea due to respiratory infections</p> Signup and view all the answers

    Why is it not common for adults to lose as much fluid through insensible pathways as infants?

    <p>Adults have a lower respiratory rate and metabolic demand</p> Signup and view all the answers

    What proportion of total urinary fluid loss typically occurs in pediatric patients?

    <p>Around 30%</p> Signup and view all the answers

    What effect does an increased body surface area (BSA) have on insensible water loss in children under 2 years of age?

    <p>It increases insensible water loss.</p> Signup and view all the answers

    Which statement accurately describes the renal capabilities of infants and children under 2 years old?

    <p>Their glomeruli and tubules are immature.</p> Signup and view all the answers

    What is the primary source of fluid loss in isotonic dehydration?

    <p>Extracellular fluid (ECF)</p> Signup and view all the answers

    Which of the following is a potential complication of introducing a hypertonic solution too rapidly in cases of hypotonic dehydration?

    <p>Cell shrinkage and altered LOC</p> Signup and view all the answers

    Which clinical manifestation is most commonly associated with hypotonic dehydration?

    <p>Confusion</p> Signup and view all the answers

    What is the serum potassium level that indicates hyperkalemia?

    <p>Greater than 5.8 mmol/L</p> Signup and view all the answers

    What are the common clinical manifestations of hypokalemia?

    <p>Skeletal muscle weakness and constipation</p> Signup and view all the answers

    What is considered moderate weight loss in terms of body weight percentage?

    <p>10% of body weight</p> Signup and view all the answers

    Which condition is associated with increased potassium excretion leading to hypokalemia?

    <p>Diuretic use</p> Signup and view all the answers

    Which factor is NOT a cause of dehydration?

    <p>Excessive fluid intake</p> Signup and view all the answers

    What is a characteristic finding of middle ear effusion (MEE)?

    <p>Bulging of the tympanic membrane</p> Signup and view all the answers

    In which situation is the immediate prescribing of antibiotics for acute otitis media (AOM) in children most justified?

    <p>Child is 4 months old with unilateral AOM and a fever of 102.5°F</p> Signup and view all the answers

    What is the appropriate management strategy for severe laryngotracheobronchitis (LTB)?

    <p>Hospitalization and IV corticosteroids</p> Signup and view all the answers

    What symptom is specifically associated with acute epiglottitis that differentiates it from other respiratory conditions?

    <p>Severe sore throat and drooling</p> Signup and view all the answers

    Which statement best describes the treatment approach for chronic otitis media with effusion?

    <p>Myringotomy if fluid persists over three months and leads to hearing loss</p> Signup and view all the answers

    What is the appropriate amount of ORT solution for mild rehydration in children experiencing diarrhea?

    <p>50 mL per kg in small frequent amounts over a few hours</p> Signup and view all the answers

    Which of the following is NOT a cause of chronic nonspecific diarrhea in children?

    <p>Viral infection</p> Signup and view all the answers

    What characterizes the sound of wheezing during lung auscultation?

    <p>Continuous, coarse, whistling sound due to airflow obstruction</p> Signup and view all the answers

    Which statement accurately describes the incidence of otitis media in young children?

    <p>Incidence is highest between 6 months to 2 years and decreases as children grow</p> Signup and view all the answers

    What is the primary indication for assessing a child's fluid intake and output when managing diarrhea?

    <p>To monitor for sufficient urine output before adding potassium to IV fluids</p> Signup and view all the answers

    What is the typical age range during which the peak incidence of RSV occurs?

    <p>2 - 3 months</p> Signup and view all the answers

    What is the primary role of lung function tests like PFTs in asthma management?

    <p>To assess the presence of lung disease and determine response to treatment</p> Signup and view all the answers

    Which statement best describes the immune response to RSV after initial infection?

    <p>No immunity occurs, but incidence and severity decrease with age.</p> Signup and view all the answers

    Which of the following classifications of asthma indicates symptoms that occur more than twice a week but less than once a day?

    <p>Mild persistent</p> Signup and view all the answers

    What is a common clinical manifestation of pneumonia in younger children?

    <p>Irritability and poor feeding</p> Signup and view all the answers

    What is a key characteristic of the medication theophylline, in the context of asthma treatment?

    <p>It is a bronchodilator used as a third-line agent</p> Signup and view all the answers

    Which risk factor is NOT associated with increased hospitalization for bronchiolitis due to RSV?

    <p>Recent vaccination against pneumonia</p> Signup and view all the answers

    What is the usual duration of bronchiolitis caused by RSV?

    <p>7 - 10 days</p> Signup and view all the answers

    What is the purpose of using a peak flow meter in asthma management?

    <p>To determine the efficacy and control of asthma by recording peak expiratory flow rates</p> Signup and view all the answers

    What adverse effect is commonly associated with the use of systemic corticosteroids like Prednisone?

    <p>Weight gain and immunosuppression</p> Signup and view all the answers

    What is the underlying cause of enterocolitis in children with Hirschsprung's disease?

    <p>Intestinal distention and ischemia</p> Signup and view all the answers

    What is the primary manifestation of Hirschsprung's disease in infancy?

    <p>Abdominal distention</p> Signup and view all the answers

    What method is used to definitively diagnose Hirschsprung's disease?

    <p>Rectal biopsy</p> Signup and view all the answers

    Which treatment method involves the removal of the diseased section of intestine in Hirschsprung's disease?

    <p>Pull-through surgery</p> Signup and view all the answers

    What is the significance of performing a colonic irrigation in children with Hirschsprung's disease?

    <p>To clear the bowels when enterocolitis is a concern</p> Signup and view all the answers

    What is a primary characteristic of Hirschsprung's disease?

    <p>Absence of nerve fibers in the aganglionic portion</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with an increased risk of Hirschsprung's disease?

    <p>Down syndrome</p> Signup and view all the answers

    What typically occurs when a child with Hirschsprung's disease fails to pass meconium within the appropriate timeframe?

    <p>Potential sign of mechanical obstruction</p> Signup and view all the answers

    What complication primarily leads to death in children suffering from Hirschsprung's disease?

    <p>Enterocolitis</p> Signup and view all the answers

    What physiological issue arises in Hirschsprung's disease due to the absence of ganglionic cells in the colon?

    <p>Inability of the internal anal sphincter to relax</p> Signup and view all the answers

    Which symptom is most indicative of enterocolitis in a child with Hirschsprung's disease?

    <p>Foul-smelling stool</p> Signup and view all the answers

    What is the main goal of surgery in treating Hirschsprung's disease?

    <p>To remove the aganglionic segment</p> Signup and view all the answers

    What is a common complication of Hirschsprung's disease that can be life-threatening?

    <p>Enterocolitis</p> Signup and view all the answers

    Which examination finding may indicate the presence of fecal impaction in a child?

    <p>Palpable fecal masses</p> Signup and view all the answers

    What condition is characterized by tight internal sphincter and absence of stool upon rectal exam?

    <p>Hirschsprung's disease</p> Signup and view all the answers

    What is the primary purpose of colonic irrigation in the management of enterocolitis?

    <p>To remove fecal matter</p> Signup and view all the answers

    Which of the following is NOT a symptom associated with Hirschsprung's disease?

    <p>Chronic cough</p> Signup and view all the answers

    What is the initial step to take if a child shows symptoms of enterocolitis?

    <p>Administer colonic irrigation</p> Signup and view all the answers

    Which condition should lead to immediate medical attention instead of colonic irrigation?

    <p>Recent surgery for Hirschsprung disease</p> Signup and view all the answers

    What is a common symptom of gastroesophageal reflux in infants?

    <p>Vomiting or frequent regurgitation</p> Signup and view all the answers

    How is gastroesophageal reflux disease diagnosed?

    <p>24-hour esophageal pH monitoring</p> Signup and view all the answers

    Which factor is NOT a trigger for chronic inflammatory bowel disease?

    <p>Excessive dietary fiber</p> Signup and view all the answers

    What surgical procedure is indicated for severe cases of gastroesophageal reflux when medical therapy fails?

    <p>Nissen Fundoplication</p> Signup and view all the answers

    What common complication may arise from Nissen Fundoplication surgery?

    <p>Inability to burp</p> Signup and view all the answers

    What is a significant concern in infants with gastroesophageal reflux?

    <p>Persistent weight loss or failure to thrive</p> Signup and view all the answers

    Which medication class is typically recommended after H2 blockers for treating reflux?

    <p>Proton pump inhibitors</p> Signup and view all the answers

    What is one of the common extra intestinal signs associated with inflammatory bowel disease?

    <p>Erythema nodosum</p> Signup and view all the answers

    Which of the following medications is primarily used to control inflammation in Crohn's disease?

    <p>Corticosteroids</p> Signup and view all the answers

    What is the primary goal of treatment for Crohn's disease?

    <p>Control of the inflammatory process</p> Signup and view all the answers

    What is a common nutritional recommendation for managing Crohn's disease?

    <p>High calorie, high protein diet</p> Signup and view all the answers

    Which treatment is considered an adjunct therapy for Crohn's disease?

    <p>Antibiotics</p> Signup and view all the answers

    What long-term complication is associated with Crohn's disease?

    <p>Colon cancer</p> Signup and view all the answers

    Which of the following is NOT a method to aid in managing nutritional needs for a patient with Crohn's disease?

    <p>High fiber meals</p> Signup and view all the answers

    Which of the following statements about Crohn's disease is accurate?

    <p>It requires continuous drug therapy.</p> Signup and view all the answers

    What is a significant factor influencing the prognosis of a patient with Crohn's disease?

    <p>Severity of gastrointestinal involvement</p> Signup and view all the answers

    What is the stomach capacity of a newborn?

    <p>10 to 20 ml</p> Signup and view all the answers

    At what age does the emptying time of the stomach typically increase to 3 to 6 hours in infants?

    <p>1 to 2 months</p> Signup and view all the answers

    Why is regurgitation common in infants?

    <p>The lower esophageal sphincter tone is decreased.</p> Signup and view all the answers

    What contributes to the soft frequent stools commonly observed in infants?

    <p>More secretions in the small intestine</p> Signup and view all the answers

    What characteristic is true about an infant's liver and spleen compared to an adult's?

    <p>They are proportionately larger.</p> Signup and view all the answers

    What is the primary reason for the more protuberant abdomen seen in infants?

    <p>Less well-developed abdominal musculature</p> Signup and view all the answers

    What age range marks the deficiency in digestive enzymes in infants?

    <p>4 to 6 months</p> Signup and view all the answers

    What indicates malnutrition or displaced abdominal organs in an infant's abdomen?

    <p>Scaphoid appearance</p> Signup and view all the answers

    What might asymmetry in the abdominal area indicate in children?

    <p>Mass or organomegaly</p> Signup and view all the answers

    What is the expected pattern of bowel sounds in a healthy child?

    <p>Heard every 10-20 seconds</p> Signup and view all the answers

    How should abdominal palpation be conducted in infants?

    <p>Distract the child during the process</p> Signup and view all the answers

    What is the expected condition of the umbilical stump during the first few weeks of life?

    <p>It may contain a small hernia</p> Signup and view all the answers

    Which of the following describes a characteristic of the spleen in infants during a palpation exam?

    <p>It has a soft texture with a sharp edge</p> Signup and view all the answers

    What can cause high-pitched and frequent bowel sounds during examination?

    <p>Peritonitis and intestinal obstruction</p> Signup and view all the answers

    When assessing the integrity of the abdominal area in infants, which response is considered a sign of pain?

    <p>Facial grimacing and high-pitched crying</p> Signup and view all the answers

    How should one evaluate for the presence of percussion sounds in an infant's abdomen?

    <p>Percuss as you would with an adult, noting tympanic sounds</p> Signup and view all the answers

    Study Notes

    Insensible Water Loss

    • Insensible water loss is the unnoticed loss of water through evaporation from the skin and exhalation from the lungs.
    • Two-thirds of insensible losses are through the skin, one-third through the respiratory tract.
    • Children with high respiratory rates (tachypnea) and infections (like RSV) experience increased fluid loss.
    • Infants and young children have higher body temperatures, leading to greater sensible losses through their skin.

    Fluid Losses in Pediatrics

    • Insensible losses: Two-thirds through skin, one-third through the respiratory tract.
    • Urinary losses: Via the kidneys.
    • Fecal losses: From the digestive tract.

    Fluid Compartments

    • Intracellular fluid (ICF): Fluid within the body's cells.
    • Extracellular fluid (ECF): Fluid outside the cells, further divided into:
      • Intravascular fluid: Fluid within blood vessels.
      • Interstitial fluid: Fluid surrounding cells.

    Differences in Fluid Needs for Infants and Children (<2 yrs)

    • Increased body surface area (BSA): Leads to higher insensible water loss.
    • Larger extracellular fluid (ECF) volume: Maintained until approximately 2 years of age.
    • Increased metabolic rate: Requires higher fluid intake to fuel metabolic processes.
    • Greater metabolic waste production: Requires increased kidney excretion.
    • Immature kidney structures: Kidneys are unable to effectively conserve water and electrolytes.

    Dehydration Types

    • Isotonic Dehydration:
      • Causes: Vomiting, diarrhea.
      • Electrolyte levels: Serum sodium (Na+) 130-150 mEq/L.
      • Treatment: Isotonic solutions (0.9% normal saline, Lactated Ringers).
      • Major complication: Hypovolemic shock.
      • Fluid loss: Primarily from extracellular fluid (ECF).
    • Hypotonic Dehydration:
      • Causes: Excessive intake of fluids low in solutes, SIADH (Syndrome of Inappropriate Antidiuretic Hormone), excessive sweating, burns, diuretics, vomiting, diarrhea, renal disease, heart failure.
      • Fluid imbalance: Electrolyte losses are higher than water deficits, with ICF more concentrated than ECF.
      • Treatment: Addressing the underlying cause, restricting fluids, administering sodium (Na+), and providing appropriate IV fluids (e.g., D5W or D10).
    • Hypertonic Dehydration:
      • Causes: Inadequate fluid intake, low antidiuretic hormone (ADH), diarrhea, vomiting, excessive sweating, high solute intake without enough water, renal disease, osmotic diuresis (e.g., T1DM).
      • Fluid imbalance: Water loss is greater than electrolyte deficits, ECF is more concentrated than ICF.
      • Treatment: Treating the underlying cause, restricting sodium (Na+), and providing appropriate IV fluids (e.g., 0.45% normal saline).

    Electrolytes

    • Primary extracellular electrolyte: Sodium (Na+) (approx. 142 mEq/mL).
    • Primary intracellular electrolyte: Potassium (K+) (approx. 140 mEq/mL).

    Fluid Maintenance Calculations

    • The 100/50/20 rule is used for calculating daily fluid maintenance for children (not in dehydration cases):
      • 100 mL/kg for the first 10 kg of weight.
      • 50 mL/kg for the next 10 kg of weight.
      • 20 mL/kg for the remaining weight in kilograms.
      • Divide by 24 hours to get mL/hour.

    Urine Output Ranges

    • Healthy urine output ranges vary by age.

    Diarrhea

    • Acute diarrhea: Sudden increase in stool frequency and consistency, typically lasting less than 14 days.
    • Causes: Infections (bacterial, viral, parasitic), excessive laxative use. (Rotavirus decline due to vaccination.)
    • Chronic diarrhea: Lasting more than 14 days.
    • Causes: Cystic fibrosis, celiac disease, inflammatory bowel disease, food allergies, lactose intolerance, immunodeficiency, malabsorption syndromes.
    • Intractable diarrhea of infancy: Persistent diarrhea for more than 2 weeks with no identifiable cause.
    • Chronic non-specific diarrhea: Frequent loose stools with undigested food, lasting over 14 days. No blood or infection, often not malnourished.

    Respiratory Infections

    • Upper Respiratory Tract (URT): Nose, mouth, pharynx, trachea/epiglottis/larynx
    • Lower Respiratory Tract (LRT): Bronchi, bronchioles, alveoli
    • Structural differences: Shorter distances, smaller airways in children make URT infections more likely to descend to the LRT.
    • First signs of respiratory distress: Tachypnea.
    • Types of sounds and their causes: Rhonchi (rumbling from airway obstruction), crackles (rales) (popping sounds from collapsed airways), wheezing (whistling from narrowed airways), stridor (strained, high-pitched sound on inspiration from obstruction).

    Otitis Media (Ear Infections)

    • Etiology: Bacterial (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) or viral infections, non-infectious causes (allergies).
    • Tube differences in young children: Eustachian tubes are shorter and more horizontal, hindering drainage.
    • Presentations: Irritability, fever, poor feeding, ear pulling, lymphadenopathy, rhinorrhea, anorexia, vomiting, diarrhea.
    • Diagnosis: Otoscopy and auditory testing, checking for TM mobility.
    • Criteria for diagnosis: Acute onset s/sx of middle ear inflammation, middle ear effusion (e.g., bulging, redness).
    • Treatment: Antibiotics (PO Amoxicillin) or IM Ceftriaxone (depending on severity or compliance), pain relief, warm soaks, Prevnar and Hib vaccines.

    Other Respiratory Conditions

    • Croup Syndrome: Hoarseness, barking cough, inspiratory stridor, respiratory distress due to swelling or obstruction in the airway.
    • LTB (laryngotracheobronchitis): Most common croup syndrome; Inflammation and obstruction of the larynx, trachea, and bronchi from a viral infection.
    • Acute Epiglottitis: Inflammation of the epiglottis potentially leading to a critical airway obstruction.Bacterial infection; abrupt onset; characterized by severe sore throat, fever, muffled voice, painful swallowing, tripod position, drooling, and difficulty breathing. High risk for acute airway obstruction MEDICAL EMERGENCY. Prevent with Hib vaccine.
    • Bronchiolitis (RSV): Inflammation of the bronchioles primarily caused by RSV.
    • Pneumonia: Inflammation of the lungs (viral, more common; bacterial, acute onset).

    Additional Conditions

    • Hirschsprung's Disease (HD): Congenital condition affecting bowel motility leading to obstructed intestines.
    • Gastroesophageal Reflux Disease (GERD): Stomach acid or bile regurgitates through the lower esophageal sphincter.
    • Childhood Cancers: Leukemia, brain tumors (medullablastoma, others), neuroblastoma, lymphoma, osteosarcoma, Hodgkin's disease.

    Cancer Treatment

    Details on chemotherapy, radiation, surgery, bone marrow/stem cell transplants, biotherapy, and supportive therapies including nutritional considerations, pain management, and psychosocial support are presented.

    Additional Details

    • Specific details about types of solutions, medications, and techniques for diagnosis and treatment are included.
    • Information about complications (e.g., chemotherapy side effects, tumor lysis syndrome) and their management.
    • Information about monitoring (I&O, vital signs, weight, etc.) is integrated with descriptions of the conditions.

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    Description

    Test your knowledge on pediatric fluid and electrolyte management with this comprehensive quiz. Explore questions on insensible water loss, fluid compartments, hypokalemia, and more specific to children. This quiz is essential for healthcare professionals working with pediatric patients.

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