Peds Exam 2 Study Guide

Fluid & Electrolytes Chapter 29:  Signs and symptoms of fluid overload pg. 1056 pg. 949 & 956-957 Generalized edema, pulmonary edema (moist rales & crackles), Hepatomegaly, slow bounding pulse, weight gain, lethargy, elevated venous pressure, seizures, coma. Lab findings: Decreased serum electrolytes, low urine specific gravity, decreased hematocrit, variable urine volume.   Signs and symptoms of fluid deficit pg. 1056 pg. 949 & 951-955 Top 3: #1 Poor skin turgor #2 abnormal respirations= Tachypnea #3 Prolonged capillary refill >2 secs Tachycardia, dry skin & mucous membranes, sunken eyes & fontanels, irritability, lethargy, thirst, weight loss, diminished urine output, and altered level of consciousness, disorientation. Lab findings: High urine specific gravity, increased hematocrit, increased BUN, increased serum osmolality Hypo and hyperkalemia & Foods that contain potassium  Hypokalemia: Pg. 1359 pg. 1271 ooo< 3.5 mEq/L Abnormal EKG; notched or flattened T waves, decreased ST segment, premature ventricular contractions Muscle weakness, cramping, stiffness, paralysis, hyporeflexia, hypotension, cardiac arrhythmias, gallop rhythm, tachycardia or bradycardia, ileus, apathy, drowsiness, irritability, fatigue Hyperkalemia: o > 5.5 mEq/L o Variable urine volume o Flat P wave on ECG, peaked T waves, widened QRS complex, increased PR interval o Muscle weakness, flaccid paralysis, twitching, hyperreflexia, bradycardia, ventricular fibrillation and cardiac arrest, oliguria, apnea—respiratory arrest Foods that contain potassium: Foods with thick skin: Oranges, banana, nuts, squash, carrots, broccoli, kale, tomatoes, beans, avocado, fish, mushrooms  Signs and symptoms of hypo & hypernatremia pg. 1056 pg. 949-950  Hyponatremia (less than 135 mEq): anorexia, nausea, vomiting, weakness, lethargy, confusion, muscle cramps, twitching, & seizures.  Hypernatremia (more than 145 mEq): Thirst, hyperpyrexia (Extremely high fever), sticky mucous membranes, dry mouth, oliguria (diminished urine output) hallucinations, lethargy, irritability, & seizures.  Types of dehydration: Isotonic, hypotonic, hypertonic (see Ecollege:DocSharing: Powerpoints: GI dysfunction)  Babies= ECF > ICF (75% water) leads to more rapid loss  Isotonic Dehydration: This is the primary form of dehydration occurring in children (Na remains normal since H2O loss and electrolyte loss are equal. Leads to shock) H2O loss = electrolyte loss  hypovolemic shock. The major loss is from the ECF. Symptoms are related to hypovolemic shock  Hypotonic Dehydration: Dehydration occurs when the electrolyte deficit exceeds the water deficit. Water moves from ECF to ICF which further increases the ECF volume loss and leads to shock. (Na level usually less than 130 mEq/L) Electrolyte loss >H2O loss  shock & seizures (low sodium)