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Case Study-Infant with Fluid Imbalance

An 11 kg (24.2 lb) 1-year-old child is admitted with a


weight loss of 1 kg.

1. Calculate the child's 24-hour fluid needs based on


maintenance fluid need for her weight and replacement fluid
need for her degree of dehydration.

Maintenance fluid is calculated as follows:


100 mL of fluid per 10 kg of body weight = 1,000 mL PLUS 50 mL of fluid per 1 kg of
body weight = 50 mL. So, total maintenance fluid requirement is 1,050 mL/24 hour.
To calculate the amount of replacement fluid required for the degree of diarrhea, the
percentage of body weight lost needs to be calculated: 1 kg is approximately 10% of
the total weight of 11 kg; therefore, 10 × 10 = 100 mL/kg/24 hours. The replacement
need is 100 mL × 11 kg = 1,100 mL/24 hour. The maintenance fluid requirement
plus the replacement fluid need is 2,150 mL/24 hours.

2. Once you have calculated the 24-hour fluid needs, space it


over the day as you would expect it to be administered.

About one-half of the 24-hour total usually is given in the first 6 to 8 hours, and then
the rate is adjusted to administer the remainder in the rest of the 24-hour period.
The first half—1,075 mL—will be given over 8 hours at 134 mL/hour. The remaining
1,075 mL will be administered over 16 hours at 67 mL/hour.

3. The child continues to vomit. How will those replacement


needs alter the amount of required fluid intake for the child?

Weight is the best indicator for fluid balance. All diapers, clothes, or bedding that
contains vomit can be weighed. Additionally, the child's weight reflects additional
fluid loss and should be monitored closely.

4. If the child has lost 0.5 kg from the former weight, what is
the amount of fluid deficit?

In the metric system, 1 mg equals 1 mL. A kilogram equals 1,000 mL. Therefore, 0.5
kg equals 500 mL.

5. If the infant's weight originally was 15 kg and now is 14.5


kg, what is the percentage of weight loss?

The weight loss is 0.5 kg. The question is what percent of 15 kg is 0.5 kg, so 0.5 kg ÷
15 kg yields a 3% weight loss.
NCLEX Questions

1. A 6-month-old infant is admitted with severe


dehydration. Effectiveness of therapy is evaluated with
which of the following assessment measures? Select all
that apply.

1. Record intake and output accurately


2. Daily weights on the same scale, same time, with no
clothes
3. Evaluate level of consciousness continuously
4. Document mucous membrane moisture every shift
5. Document abdominal girth every shift

Rationale: All of the choices represent assessment measures that evaluate the
effectiveness of therapy except abdominal girth, which does not provide information
regarding hydration status.

2. Arterial blood gases results indicate pH 7.33 and PCO2


of 38 mmHg following arrest and subsequent
resuscitation of a 3-year-old child. Which nursing
intervention should be utilized to attempt to correct this
metabolic disorder?

1. Determine if the endotracheal tube is positioned correctly


2. Administer sodium bicarbonate 1 mEq/kg IV
3. Assess the effectiveness of the respiratory pattern
4. Treat the cause of the acidosis
Rationale: Sodium bicarbonate is used to correct serious metabolic acidosis. Metabolic acidosis
is present, but sodium bicarbonate is given only in serious imbalance. We do not have enough
information to determine if that is the case. The medication often complicates acid-base
imbalance. Airway always is important to assess, but the PCO2 level indicates that respirations
are not contributing to the problem. The best answer is to find and treat the cause of the
acidosis.

3. The nurse notes the following changes in the past 24


hours in a child with heart failure. Which finding is the
most significant in assessing the child for fluid volume
overload?

1. Weight gain of .4 kg
2. Jugular venous distention
3. Presence of lung crackles
4. Bounding pulse

Rationale: All are signs of fluid volume overload. However, an increase of weight is
always the best indicator of an increase in fluid. The other options indicate heart
failure as a result of the increase fluid.