A nurse is caring for a child with severe dehydration who weighs 14 kg.
What would be the total hourly fluid replacement rate for this child?
Approximately 58 mL/hour.
Approximately 140 mL/hour.
Approximately 100 mL/hour.
Approximately 82 mL/hour.
The Correct Answer is C
Approximately 100 mL/hour.
To calculate the total hourly fluid replacement rate, we can use the Holliday-Segar method, which is commonly used in pediatrics.
According to this method, a child's daily maintenance fluid requirement is calculated as follows: For the first 10 kg of body weight: 100 mL/kg/day.
For the next 10 kg of body weight: 50 mL/kg/day.
For each additional kg of body weight: 20 mL/kg/day.
In this case, the child weighs 14 kg.
So, we calculate as follows: For the first 10 kg: 10 kg x 100 mL/kg/day = 1000 mL/day.
For the next 4 kg (14 kg - 10 kg): 4 kg x 50 mL/kg/day = 200 mL/day.
Now, add these two together: 1000 mL/day + 200 mL/day = 1200 mL/day.
To find the hourly rate, we divide the daily requirement by 24 (hours in a day): 1200 mL/day ÷ 24 hours/day = 50 mL/hour.
So, the child's total hourly fluid replacement rate should be approximately 50 mL/hour.
However, this is an approximate rate.
To be more conservative in the case of severe dehydration, it's common to round this up to approximately 100 mL/hour to ensure that the child receives adequate fluids to rehydrate.
Choice A rationale:
Approximately 58 mL/hour is not The correct answer.
This calculation does not match the standard Holliday-Segar method used in pediatrics for fluid replacement.
Choice B rationale:
Approximately 140 mL/hour is not The correct answer.
This calculation significantly exceeds the recommended hourly fluid replacement rate for a child of this weight, which could potentially lead to overhydration.
Choice D rationale:
Approximately 82 mL/hour is not The correct answer.
This calculation does not align with the standard method for calculating fluid replacement in pediatric patients.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Vital signs are essential in assessing dehydration.
An elevated heart rate may indicate compensatory mechanisms due to decreased intravascular volume.
Low blood pressure may suggest severe dehydration, and abnormal temperature may indicate an underlying infection.
These parameters provide crucial information about the child's circulatory status, helping to assess the severity of dehydration.
Choice B rationale:
Physical examination findings, such as skin turgor and mucous membrane moisture, are valuable indicators of dehydration.
Poor skin turgor, where the skin doesn't return to its normal position promptly when pinched, indicates decreased tissue turgor due to fluid loss.
Dry mucous membranes, including the mouth, suggest dehydration and help evaluate the extent of fluid deficit.
These signs offer direct visual clues about the child's hydration status.
Choice C rationale:
Laboratory tests play a significant role in diagnosing dehydration.
A complete blood count (CBC) helps identify elevated hematocrit levels, indicating hemoconcentration due to fluid loss.
Electrolyte levels, specifically sodium and potassium, provide insights into the child's electrolyte balance, which can be disrupted in dehydration.
Urine specific gravity measures the kidney's ability to concentrate urine; a high specific gravity suggests concentrated urine due to reduced fluid intake.
These tests aid in confirming the diagnosis and assessing the severity of dehydration.
Choice D rationale:
Assessing the child's history is fundamental in understanding the underlying cause of dehydration.
Recent fluid intake and urine output patterns help determine the balance between intake and output.
Symptoms such as diarrhea, vomiting, and fever indicate potential causes of fluid loss.
Additionally, evaluating the child's overall health and any recent illnesses provides context for the dehydration, guiding appropriate treatment.
Correct Answer is A
Explanation
Choice A rationale:
Albumin (5% or 25%) Albumin is the most appropriate IV fluid for a client with hypoalbuminemia and shock.
Albumin is a colloid solution that helps to increase oncotic pressure, which can be decreased in conditions like hypoalbuminemia.
This increased oncotic pressure can help draw fluids back into the vascular space, improving intravascular volume and blood pressure.
Therefore, it is a suitable choice for a patient with shock.
The two concentrations mentioned, 5% and 25%, refer to the percentage of albumin in the solution, and the choice between them depends on the severity of the patient's condition and the desired effect.
The 5% solution is often used for volume expansion and to improve hemodynamics, while the 25% solution is used for rapid volume expansion.
Choice B rationale:
Dextrans (Dextran-40 or Dextran-70) Dextrans are another type of colloid solution, but they are not the best choice for this specific situation.
Dextrans are often used as volume expanders but are more commonly employed in conditions where there is no issue with albumin levels.
In this case, the primary concern is hypoalbuminemia, and using albumin-based solutions would be more appropriate.
Choice C rationale:
Gelatin (Gelofusine or Haemaccel) Gelatin-based solutions are also colloids and can be used for volume expansion.
However, they are not the best choice for a patient with hypoalbuminemia because they do not address the low albumin levels.
Albumin solutions are preferred in such cases to help restore oncotic pressure and improve intravascular volume.
Choice D rationale:
Plasma protein fraction (Plasmanate or Plasmasteril) Plasma protein fraction solutions, also known as human albumin, are similar to albumin solutions.
However, in this context, albumin solutions are more commonly used.
Plasma protein fraction solutions may be indicated in specific situations, but the primary choice for a patient with hypoalbuminemia and shock would be albumin-based solutions, as they are specifically designed to address albumin deficiencies.
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