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23 - The Child with Fluid and Electrolyte ImbalanceAce Your Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson & Rogers Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Registered Nurse (RN) Students
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Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson & Rogers | Registered Nurse (RN) School Study Aid
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
Hypokalemia
- Assessment
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- Interventions
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Nursing Considerations
- Monitor Respiratory Status
3 mins
Hyperkalemia
- Assessment
- > 5.0 mEq/L K+
- Abdominal Cramps
- Muscle Weakness
- Diarrhea
- Arrhythmia
- Tall, Peaked T Waves
- Interventions
- IV Calcium
- Infusion of Glucose and Insulin
- Loop or Thiazide Diuretics
- Kayexalate
- Dialysis
- Prevention Education
2 mins
Hypocalcemia
- Muscle Spasms
- Assessment
- < 8.5 mg/dL Ca2+
- Decreased Bone Density
- Tetany
- Chvostek's Sign
- Trousseau's Sign
- Increased DTR
- ECG Changes
- QT Prolongation
- Considerations
- Oral and IV Replacement of Ca2+
- Seizure Precautions
2 mins
Hypocalcemia Causes
- Hypoalbuminemia
- Hypomagnesemia (Less Common Hypermagnesemia)
- Hypovitaminosis D
- Hypoparathyroidism
- Medications
- Hyperphosphatemia
- Malnutrition
- Acute Pancreatitis
- Alkalosis
- Sepsis
- Chronic Kidney Disease
2 mins
Hypocalcemia Treatments
- Characteristics
- Treat Underlying Disorder
- Acute Treatments
- IV Calcium Gluconate
- Cardioprotective
- Chronic Treatments
- Calcium Carbonate
- Calcium Citrate
- Vitamin D Supplements
- Considerations
- Treat Hypomagnesemia
2 mins
Hypercalcemia
- Assessment
- > 10.5 mg/dL Ca2+
- Pathologic Fractures
- Lethargy
- Hypercoagulation
- Constipation
- ECG Changes
- QT Shortening
- Interventions
- No Calcium Intake
- Chelating Drugs
- Calcitonin
- Bisphosphonates
- Loop Diuretics instead of Thiazide Diuretics
- Considerations
- Increased Risk for Renal Calculi
- Increase Fluids
3 mins
Hypercalcemia Treatments
- Treat Underlying Disorder
- Hydration
- Dialysis
- Calcium Restriction
- Bisphosphonates
- Calcitonin
- Cinacalcet
- Glucocorticosteroids
- Denosumab
2 mins
IV Solutions
- Hypotonic (< 280 mOsm/L)
- 1/4 Normal Saline (0.225% NaCl)
- 1/2 Normal Saline (0.45% NaCl)
- Isotonic (280-300 mOsm)
- Normal Saline (0.9% NaCl)
- Lactated Ringer's (LR)
- Dextrose 5% in Water (D5W)
- Hypertonic (> 300 mOsm)
- 3% or 5% NaCl
- Dextrose 5% in 0.45% NaCl
- Dextrose 10% in Water (D10W)
3 mins
Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
2 mins
Gastroenteritis
- Cause/Mechanism
- Viruses
- Bacteria
- Food Intolerances
- Assessment
- Flu-Like Symptoms
- GI Distress
- Bloody Stool
- Interventions
- Oral Rehydration
- Considerations
- Self-Limiting
- Prevention
2 mins
Severe Sepsis and Septic Shock Assessment
- Microthrombi
- DIC
- Decreased Oxygen Saturation
- Decreased WBC
- Oliguria
- High Output Heart Failure
- Multiple Organ Failure
2 mins
Systemic Inflammatory Response Syndrome (SIRS) Criteria
- Must have 2 or more of the following:
- Temperature < 36C or > 38C
- Pulse > 90 beats per minute
- Respirations > 20/min or PCO2 < 32
- WBC < 4,000 or > 12,000 or 10% bands
- Mechanism
- Subset of Cytokine Storm and Related to Sepsis
2 mins
Anaphylaxis Intervention
- Intervention
- Assess Airway and Oxygen Needs
- Reassure Patient with Anxiety
- Supine Position
- Methylprednisolone (Solu-medrol)
- Epinephrine
- Diphenhydramine (Benadryl)
- Medical Alert Bracelet
2 mins
Types of Burns
- Superficial Thickness
- Sunburn
- Superficial Partial Thickness
- Blisters
- Blanching
- Deep Partial Thickness
- Little or Non-blanching
- Full Thickness
- Waxy White, Yellow or Black
- Decreased Pain
2 mins
Burns Assessment
- Stage and Extent of Burn
- Dyspnea
- Singed Nasal Hairs
- Pain
- Initial Decrease Urinary Output
- Paralytic Ileus
- Signs of Inadequate Hydration
- Shock
- Hypothermia
- Hyperkalemia
2 mins
Stages of Burn Care
- Phase / Stage 1
- Resuscitative/Emergent Phase
- Injury to Return of Capillary Permeability
- 48-72 hours
- IV Fluid Replacement
- Phase / Stage 2
- Acute Phase
- Diuresis to Near Wound Closure
- Phase / Stage 3
- Wound Closure to Return of Optimal Level
2 mins
Burns Interventions
- Ensure Airway Patency
- O2
- IV Fluid Replacement
- Dry Sterile Dressing
- Debridement
- Elevate Burned Limbs
- Analgesics
- Silver Sulfadiazine
- Escharotomy
2 mins
Burns Considerations
- Maintain Body Temperature
- Increased Risk of Infection
- Venous Thromboembolism (VTE) Prophylaxis
- Curling's Ulcer
- Excision and Grafting
- Adequate Nutrition
- Contractures
2 mins
Rule of 9's for Burns
- Total Body Surface Area (TBSA)
- Head
- Anterior Torso (18%)
- Chest
- Abdomen
- Posterior Torso (18%)
- Upper Back
- Lower Back
- Extremities
- Posterior Leg (each)
- Anterior Leg (each)
- Each Arm
- Genitalia 1%
2 mins
Parkland Formula
- Burn victims
- 24 hours
- TBSA% x Weight x 4 = Fluids
- TBSA %
- x Weight (kg)
- x 4
- = Fluid Requirement (in first 24 hrs)
- Fluids in first 8 hours
- 1/2 of fluid given in first 8 hours
1 min
Types of Wound Healing
- Types of Wounds
- Acute
- Chronic
- Healing Process
- Primary Intention
- Approximated Edges
- Secondary Intention
- Edges Not Approximated
- Tertiary Intention
- Delayed Closure due to Infection and Necrosis
2 mins
Total Parenteral Nutrition (TPN)
- Mechanism
- Nutrition Given Outside GI
- Side Effects
- Hyperglycemia
- Hyperlipidemia
- Refeeding Syndrome
- Nausea and Vomiting
- Considerations
- Slow IV Infusion
- Use Large Central Vein
- No Added Meds to TPN Line
2 mins
Silver Sulfadiazine (Silvadene) and Mafenide Acetate (Sulfamylon)
- Mechanism
- Topical Antimicrobial
- Indications
- Burns
- Open Wound Care
- Side Effects
- Mafenide
- Pain
- Acidosis
- Considerations
- Administer Analgesic Prior to Wound Care
1 min
