unit #12 fluid & electrolytes peads.pptx

An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, but it can be more painful than a traditional blood draw.
Here are some steps that may be involved in an ABG test:
An arterial blood gas (ABG) test is a procedure that involves taking a blood sample from an artery in the wrist, arm, or groin to measure oxygen levels. The test is often performed by a respiratory therapist and is usually safe, bu

1. Pediatric Health Nursing Fluid and Electrolytes Imbalance in children with various dysfunction Presented by Ms. Nazish Lakhani Lecturer ‹#›

2. Objectives: By the end of presentation students will be able to know about Nursing Care aspects for maintaining fluid and electrolyte balance in the children with following conditions Burns, GI GU ‹#›

3. Burns Fluid & Electrolytes ‹#›

4. Electrolytes normal ranges Na 135-147 Cl 96-108 K 3.5-5.0 Ca 8.5-10.5 Mg 1.8 -2.2 ‹#›

5. Electrolyte Concentrations ‹#› Component ECF ICF Na+ High Low K+ Low High Ca++ Low Low (higher than ECF) Proteins High High

6. Distribution of Body Water ‹#› Intravascular Interstitial Intracellular ICF ECF Na+ K+ Cl-

7. Fluid composition varies at different ages ‹#› 75% water ECF=45%,ICF=30% 65% water, ECF= 25%, ICF = 40% Adult female 50% water, ECF=10-15%, ICF=40%

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10. Fluid Losses in Infants ‹#› LUNGS URINE, FECES SKIN

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13. Maintenance Requirements Weight Requirement 0-10 kg 100cc/kg/24hr 11-20 kg 50cc/kg/24hr >20 kg 20cc/kg/hr Example: 8 kg child 800cc/24hr 33 cc/hr ‹#›

14. Dehydration = Total Out > Total In Types: Isotonic Electrolyte = Water Hypotonic Electrolyte > Water Hypertonic Water > Electrolyte ‹#›

15. Degrees of Dehydration Mild Moderate Severe Fluid Vol loss <50ml/kg 50-90ml/kg >100 ml/kg Skin Color Pale Gray Mottled Skin Elasticity Decreased Poor Very Poor M.M. Dry Very Dry Parched U.O. Decreased Oliguria Marked Oliguria BP Normal Normal or lowered Lowered Pulse Normal or Increased Increased Rapid, thready Cap R. <2 sec 2-3 sec >3 sec ‹#›

16. Earliest Detectable Signs Tachycardia Dry skin and mucous membranes Sunken fontanels Circulatory Failure (coolness, mottling of extremities) Loss of skin elasticity Delayed cap refill ‹#›

17. Loss of Skin Elasticity due to dehydration ‹#›

18. Manifestations of ECF Deficit (Dehydration) S & S Weight loss Blood pressure drop Delayed capillary refill Oliguria Sunken fontanel Decreased skin turgor Physiologic Basis Decreased fluid vol. Inadequate circ. Blood Decreased vascular volume Inadequate kidney works Decreased fluid volume Decreased interstitial fluid ‹#›

19. Management of Mild to Moderate Dehydration Oral Rehydration Pedialyte Infalyte( medication used in dehydration ) Rehydralate Rules regarding rehydration 50-100ml/kg within 4 hours ‹#›

20. Moderate to Severe Dehydration Management ‹#›

21. Goals of IV Therapy ‹#› Expand ECF volume and improve circulatory and renal function (Isotonic solution .9%NS,RL, D5W) K+ after kidney function is assessed Begin oral feedings

22. Conditions causing Fluid Imbalances Phototherapy Increased RR Fever Vomiting Diarrhea * (Gastroenteritis)* Drainage tubes, blood loss Burns ‹#›

23. What are your nursing responsibilities when caring for a child with Fluid and Electrolyte imbalance? ‹#› I & O Charting Weights Initiate IV and maintain Accurate infusion, type and rate Protect IV site Assess hydration status Parental support

24. BURN ‹#›

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26. TYPES OF BURN Chemical burn Electrical burn Radiation burn Cold burn ‹#›

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30. Degree of burn ‹#›

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34. Burns Physiology & Classification Depth/Degree of Injury Third Degree : full-thickness, most severe of burns results in necrosis and avascular areas tough, waxy, brownish leathery surface with eschar, numb to touch grafting required usually have permanent impairment ‹#›

35. Burns Physiology & Classification Depth/Degree of Injury Fourth Degree: full-thickness as well as adjacent structures such as fat, fascia, muscle or bone reconstructive surgery is indicated severe disfigurement(scar) is common ‹#›

36. Burn Assessment Body Surface Area Rule of Nines adult: 9% head; 9 % arms; 18 % legs ; 18 % chest; 18% back; 1 % perineum child: 18% head; 9% arms; 14 % legs; 18 % chest; 18 % back ‹#›

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38. Burn Assessment Lund & Browder Chart ‹#›

39. Mortality in Burns ∙          >65% body surface area (BSA) ∙          associated smoke inhalation ∙          infection >20% BSA with shock and other complications/related ‹#›

40. MANAGEMENT ‹#›

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44. Collaborative Nursing & Medical Management Pathology of the First 24 hours: ∙      Temperature loss → hypothermia ∙      Plasma & Protein Loss ∙      Hypovolemia/hemoglobin concentration ∙      Tissue/blood destruction hypoxia ∙      Release hemoglobin pigment/myoglobin → ↓ GFR & UO ∙      Tissue hypoxia and reduced renal function → metabolic acidosis ∙      Platelet destruction & of activation clotting cascade via intrinsic/extrinsic pathway → DIC   ‹#›

45. Collaborative Nursing & Medical Management Pathology of the Second 48 hours: temperature ↑ 2. fluid mobilization to intravascular space 3. renal loss K+ 4 Fluid resuscitation → ↑ Serum Na+ →   dilutional coagulopathy   ‹#›

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47. Collaborative Nursing & Medical Management Wound Care      ∙    tetanus toxoid > 50% BSA burn ∙    and/or tetanus immunization ∙     chemical burns irrigate all burns, cover until initial resuscitation complete   ∙     electrical burns AC current → Tetany & risk Vent Fib High energy → check # volts & blunt injuries ‹#›

48. Nursing Care IV access (Multiple) Manage perfusion needs by parameters of CVP, Urinary Output Pain management once vital signs have stabilized, pain medication should be used (ie morphine, or meperidine, fentanyl, benzodiazepines as indicated ) Morphine or Fentanyl Drip ‹#›

49. Gastro intestinal Replace the fluid as per body deficit. e.g. Diarrhea, stoma, colostomy. Keep patient in positive balance in order to prevent from dehydration. ‹#›

50. Genito urinary Fluid and electrolytes depend on The degree of burn. Special monitoring require for sodium, potassium, chloride, magnesium and calcium. ‹#›

51. References McHenry, Charles, ed. (1992). The New Encyclopedia Britannica. 1 (15 ed.) Syzdek J, Armand M, Gizowska M, Marcinek M, Sasim E, Szafran M, Wieczorek W (2009) ‹#›

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