in Fluid and Electrolyte Status Pediatric Nursing在体液和电解质的状态儿科护理学的改变课件.ppt

Moderate to Severe Dehydration IV Therapy needed Fluid Resuscitation Crystalloid Solution: used for volume resuscitation to expand the interstitial volume rather that the plasma volume. Isotonic Saline is the prototype crystalloid fluid. 0.9% NaCl or normal saline. Lactated Ringers contains potassium and calcium. Fluid Replacement Standard Orders: Normal Saline or 0.9% NaCl at 20 mL / kg Followed by Dextrose 5% in 0.45 normal saline Followed by Dextrose 5% in 0.45 normal saline with 20 mEq KCL per 1000 mL Potassium is only added to the IV when there is documentation of voiding. Nursing Interventions Assess child’s hydration status Accurate intake and output Daily weights most accurate way to monitor fluid levels Hourly monitoring of IV rate and site of infusion. Increase fluids if increase in vomiting or diarrhea. Decrease fluids when taking po fluids or signs of edema. Care Reminder A severely dehydrated child will need more than maintenance to replace lost fluids. 1 ? to 2 times maintenance. Adding potassium to IV solution. Never add in cases of oliguria / anuria Urine output less than 0.5 mg/kg/hour Never give IV push Double check dosage Over hydration Occurs when child receives more IV fluids that needed for maintenance. In pre-existing conditions such as meningitis, head trauma, kidney shutdown, nephrotic syndrome, congestive heart failure, or pulmonary congestion. Assessment of over-hydration Tachypnea Dyspnea Cough Moist breath sounds Weight gain from edema Jugular vein distention Safety Precautions Use small bags of fluid or buretrol to control fluid volume. Check IV solution infusion against physician orders. Always use infusion pump so that the rate can be programmed and monitored. Even mechanical pumps can fail, so check the intravenous bag and rate frequently. Record IV rate q hour Acid – Base Imbalances Acidosis: Respiratory acidosis is too much carbonic acid in body. Metabolic Acidosis is too much metabolic acid. Alkalosis. Respiratory alka