1. Endocrine
1.1. Anatomy & Physiology
1.1.1. Hormones
1.1.1.1. Local
1.1.1.2. General
1.1.2. Secretion
1.1.2.1. -tropic hormones
1.1.2.2. Negative feedback loop
1.1.2.3. "Master gland" = ant. pituitary
1.1.2.4. Releasing or inhibitory hormones
1.1.3. Purposes
1.1.3.1. Growth
1.1.3.2. Sexual development
1.2. Pituitary Disorders
1.2.1. GH deficiency
1.2.1.1. R/T decreased pituitary activity
1.2.1.1.1. Infarction
1.2.1.1.2. Infection
1.2.1.1.3. Trauma
1.2.1.1.4. Tumors
1.2.1.1.5. Psychosocial dwarfism
1.2.1.2. Insufficient GH
1.2.1.3. Manifestations
1.2.1.3.1. Slow growth (>3% on growth charts)
1.2.1.3.2. Hypoglycemic seizures
1.2.1.3.3. Hyponatremia
1.2.1.3.4. Delayed dentition
1.2.1.3.5. Youthful facial features
1.2.1.3.6. Delayed skeletal maturation
1.2.1.4. Diagnostics
1.2.1.4.1. Low, insulin-like growth factor
1.2.1.4.2. X-rays determine bone age
1.2.1.4.3. Provocative GH testing
1.2.1.5. Nursing care
1.2.1.5.1. Monitor growth
1.2.1.5.2. Education
1.2.1.5.3. HRT
1.2.1.5.4. Nutrition
1.2.1.5.5. Finances
1.2.2. GH excess
1.2.2.1. Oversecretion of GH in kids
1.2.2.1.1. Epiphysial plate still open r/t hypogonadism
1.2.2.1.2. Excessive linear growth
1.2.2.1.3. Heights may reach up to 8 feet
1.2.2.2. Usually caused by pituitary adenoma
1.2.2.3. Manifestations
1.2.2.3.1. Increased IGF
1.2.2.3.2. Increased muscle, viscera development
1.2.2.3.3. Increased in wt in proportion to ht
1.2.2.3.4. HA r/t IICP with tumor
1.2.2.4. Treatment
1.2.2.4.1. Early detection
1.2.2.4.2. Surgery
1.2.2.4.3. Radiation therapy
1.2.2.5. Nursing care
1.2.2.5.1. Growth patterns
1.2.2.5.2. Education
1.2.2.5.3. Counseling re: appearance
1.2.3. DI
1.2.3.1. Undersecretion of ADH
1.2.3.1.1. Uncontrolled diuresis
1.2.3.1.2. Most common post. pit. disorder
1.2.3.1.3. Usually caused by brain tumors & treatment
1.2.3.1.4. Inability to concentrate urine
1.2.3.2. Manifestations
1.2.3.2.1. Polyuria, polydipsia
1.2.3.2.2. Dehydration
1.2.3.2.3. Weight loss
1.2.3.2.4. hTN
1.2.3.2.5. Hypernatremia
1.2.3.2.6. Low urine specific gravity
1.2.3.3. Diagnostics
1.2.3.3.1. Serum electrolytes
1.2.3.3.2. Urinalysis
1.2.3.3.3. Fluid deprivation test
1.2.3.4. Management
1.2.3.4.1. Assessment
1.2.3.4.2. HRT
1.2.3.4.3. Education
1.2.3.4.4. Fluid replacement
1.2.3.4.5. Electrolyte monitoring
1.2.3.4.6. Dehydration treatment
1.2.3.4.7. Low sodium diet
1.2.3.4.8. Don't restrict fluids!
1.2.4. SIADH
1.2.4.1. Excess ADH
1.2.4.1.1. CNS infection
1.2.4.1.2. Trauma
1.2.4.1.3. Tumors
1.2.4.1.4. Some pulmonary dx
1.2.4.2. Manifestations
1.2.4.2.1. Increased urine specific gravity
1.2.4.2.2. Decreased serum osmolality
1.2.4.2.3. Water intoxication
1.2.4.2.4. HTN
1.2.4.2.5. Crackles
1.2.4.2.6. Seizures
1.2.4.2.7. Weight gain
1.2.4.3. Treatment
1.2.4.3.1. Fluid restriction
1.2.4.3.2. Diuretics
1.2.4.3.3. Demeclocyline
1.2.4.3.4. Hypertonic saline IVF
1.2.5. Precocious puberty
1.2.5.1. Early manifestations of sexual development
1.2.5.1.1. Girls <8
1.2.5.1.2. Boys <9
1.2.5.2. Premature activation of HPG axis
1.2.5.2.1. Secondary sex characteristics develop
1.2.5.2.2. >> Activated by release GnRH
1.2.5.3. Causes
1.2.5.3.1. Central
1.2.5.3.2. Peripheral
1.2.5.4. Treatment
1.2.5.4.1. Synthetic GnRH
1.2.5.4.2. Monitor adult height
1.2.5.4.3. Psych support
1.3. Thyroid Disorders
1.3.1. Hypothyroidism
1.3.1.1. Etiology
1.3.1.1.1. Born w/o ability to make TH
1.3.1.1.2. R/T thyroid dysgenesis
1.3.1.1.3. Present at birth, but delayed diagnosis
1.3.1.1.4. Common with Down syndrome
1.3.1.1.5. Transient or permanent
1.3.1.1.6. May progress to mental retardation
1.3.1.2. Manifestations
1.3.1.2.1. Not obvious in newborns
1.3.1.2.2. Around 6 wo
1.3.1.2.3. Thick, dry, cool skin
1.3.1.2.4. Coarse, dry hair
1.3.1.2.5. Bradycardia, hTN, hypothermic
1.3.1.2.6. Protruding tongue
1.3.1.2.7. Hypotonia
1.3.1.3. Diagnosis
1.3.1.3.1. Mandatory heel-stick
1.3.1.3.2. Risk for permanent mental delay if untreated
1.3.1.4. Treatment
1.3.1.4.1. Lifelong HRT
1.3.1.4.2. Levothyroxine sodium
1.3.1.5. Nursing care
1.3.1.5.1. Good screening, monitoring
1.3.1.5.2. Education
1.3.1.5.3. Meds don't correct mental defects
1.3.2. Hyperthyroidism
1.3.2.1. Rare in kids
1.3.2.1.1. Usually caused by Graves disease
1.3.2.1.2. Autoimmune response to TSH receptors >> increased TH
1.3.2.2. Manifestations
1.3.2.2.1. Various
1.3.2.2.2. Exophthalamos
1.3.2.3. Diagnostics
1.3.2.3.1. High T4, T3
1.3.2.3.2. Decreased TSH
1.3.2.4. Management
1.3.2.4.1. Anti-thyroid drugs*
1.3.2.4.2. Thyroidectomy (complications)
1.3.2.4.3. Ablation w/radiodine
1.3.2.5. Nursing care
1.3.2.5.1. Alert for S/S
1.3.2.5.2. Quiet environment
1.3.2.5.3. Education
1.3.2.5.4. Surgical care
1.3.2.5.5. Thyrotoxicosis
1.4. Adrenal Disorders
1.4.1. Cushing syndrome
1.4.1.1. Excess free cortisol
1.4.1.1.1. Adrenal tumor
1.4.1.1.2. Prolonged steroids
1.4.1.2. Manifestations
1.4.1.2.1. Hyperglycemic
1.4.1.2.2. HTN
1.4.1.2.3. Hypokalemia
1.4.1.2.4. Susceptible to infection
1.4.1.3. Diagnostics
1.4.1.3.1. FBG
1.4.1.3.2. Electrolytes
1.4.1.3.3. 24-hr urine
1.4.1.3.4. Radiographic studies
1.4.1.3.5. Dexamethasone suppression test
1.4.1.4. Therapy
1.4.1.4.1. Surgery for tumor
1.4.1.4.2. Lifelong cortisol replacement
1.4.1.5. Nursing care
1.4.1.5.1. Alter steroid treatment
1.4.1.5.2. Post-op teaching for CRT
1.4.1.5.3. No abrupt DC of meds
1.4.2. Congenital adrenal hyperplasia
1.4.2.1. Etiology
1.4.2.1.1. Decreased enzyme activity
1.4.2.1.2. Excess androgen production
1.4.2.2. Manifestations
1.4.2.2.1. FTT
1.4.2.2.2. Weakness
1.4.2.2.3. Vomiting
1.4.2.2.4. Dehydration
1.4.2.2.5. Salt-losing crisis
1.4.2.2.6. Short stature
1.4.2.2.7. Premature 2ndary sex characteristics
1.4.2.2.8. Elevated K, decreased Na >> cardiac arrest
1.4.2.3. Diagnostics
1.4.2.3.1. Initial inability to assign sex
1.4.2.3.2. Chromosome typing
1.4.2.3.3. Pelvic ultrasound
1.4.2.3.4. Increased 17-OHP levels*
1.4.2.3.5. Electrolytes
1.4.2.4. Management
1.4.2.4.1. Decrease androgens & replace hormones
1.4.2.4.2. Affirm sex; reconstructive surgery
1.4.2.4.3. Glucocorticoid RT
1.4.2.5. Nursing care
1.4.2.5.1. Psychological effects
1.4.2.5.2. Parenting styles
1.4.2.5.3. Home health
1.4.2.5.4. Genetic counseling
1.4.3. Chronic adrenocortical insufficiency
1.4.3.1. Addison disease
1.4.3.1.1. Decreased adrenal hormones
1.4.3.1.2. R/T destruction of gland or neoplasms
1.4.3.1.3. May be idiopathic
1.4.3.2. Manifestations
1.4.3.2.1. Hypoglycemic, hyponatremic
1.4.3.2.2. Dehydration
1.4.3.2.3. Hyperpigmentation
1.4.3.3. Diagnostics
1.4.3.3.1. Functional cortisol reserve
1.4.3.3.2. ACTH-stim test
1.4.3.3.3. Decreased serum cortisol
1.4.3.4. Treatment
1.4.3.4.1. Hydrocortisone
1.4.3.4.2. Aldosterone replacement (severe)
1.4.3.5. Nursing care
1.4.3.5.1. Drug therapy education
1.4.3.5.2. Follow-up care
1.4.3.5.3. Stress-free environment
1.4.4. Pheochromocytoma
1.4.4.1. Benign tumor
1.4.4.1.1. Adrenal gland or anywhere w/chromaffin cells
1.4.4.1.2. Secretes catecholamine
1.4.4.2. Manifestation
1.4.4.2.1. HTN
1.4.4.2.2. Tachy
1.4.4.2.3. HA
1.4.4.2.4. Diaphoresis
1.4.4.3. Diagnosis
1.4.4.3.1. 24-hr urine for catecholamine
1.4.4.3.2. CT or MRI
1.4.4.4. Treatment
1.4.4.4.1. Uni- or bilateral adrenalectomy
1.4.4.4.2. Removal of tumor
1.4.4.4.3. Premedication
1.4.4.4.4. Surgical crisis
1.4.4.5. Nursing care
1.4.4.5.1. Post-op
1.4.4.5.2. Repeat 24-hr urine
1.4.4.5.3. Monitor for decreased bp, glucose
1.4.4.5.4. Lifelong HRT if both adrenal glands removed
1.5. Pancreatic Disorders
1.5.1. Diabetes mellitus
1.5.1.1. Type 1
1.5.1.1.1. Idiopathic or autoimmune
1.5.1.1.2. Usually in kids or slim young adults
1.5.1.1.3. May be triggered by virus
1.5.1.1.4. Most common endocrine dx for children
1.5.1.2. Type 2
1.5.1.2.1. Insulin-resistent or decreased production
1.5.1.2.2. Increasing incidence in pediatrics
1.5.1.3. Diagnostics
1.5.1.3.1. FSG
1.5.1.3.2. RSG
1.5.1.3.3. OGTT
1.5.1.4. Manifestations
1.5.1.4.1. Frequent infections (esp. yeast)
1.5.1.4.2. Slow healing
1.5.1.4.3. 3 P's
1.5.1.5. Treatment
1.5.1.5.1. Type 1
1.5.1.5.2. Type 2
1.5.1.6. Acute complications
1.5.1.6.1. Hypoglycemia
1.5.1.6.2. DKA
1.6. Phenylketonuria
1.6.1. Overview
1.6.1.1. Autosomal recessive
1.6.1.2. Absence of phenylalanine hydroxylase
1.6.1.3. Cannot metabolize phenylalanine
1.6.1.3.1. High levels in blood, urine
1.6.1.3.2. Decreased melanin production
1.6.2. Manifestations
1.6.2.1. Musty urine
1.6.2.2. Growth retardation
1.6.2.3. Frequent vomiting
1.6.2.4. Irritability & hyperactivity
1.6.2.5. Hyperactivity, hypertonia, hyperactive deep tendon reflexes
1.6.2.6. Eczema-like rashes
1.6.2.7. Later effects
1.6.2.7.1. Mental retardation
1.6.2.7.2. Seizures
1.6.2.7.3. Death
1.6.3. Diagnosis
1.6.3.1. Want to prevent intellectual disability
1.6.3.1.1. Progresses within few weeks of life
1.6.3.1.2. Takes a long time for onset
1.6.3.2. Mandatory heel-stick at birth
1.6.3.2.1. Mandatory by law in all 50 states
1.6.3.2.2. Feed newborn before specimen collection
1.6.3.2.3. Screen no sooner than 48 hrs after birth
1.6.3.2.4. If positive, repeat test; then, refer for treatment
1.6.3.3. Guthrie test with phenylalanine >4
1.6.4. Management
1.6.4.1. Early treatment = improved prognosis
1.6.4.2. Diet with no high protein foods
1.6.4.2.1. Very limited selection
1.6.4.2.2. Need lots of education
1.6.4.2.3. Nutritional consult
1.6.4.2.4. High diet costs
1.6.4.2.5. Especially important for females
1.6.4.3. Special infant formulas
1.6.4.4. Goal is to maintain levels
1.6.4.4.1. 2-6 mg/dL in infants
1.6.4.4.2. 2-10 mg/dL in kids +12
1.6.5. Nursing care
1.6.5.1. Early detection**
1.6.5.2. Extensive diet education
1.6.5.3. Manage diet for life
1.6.5.4. Nutritional consult
1.6.5.5. Genetic counseling
2. Renal
2.1. Pediatric Differences
2.1.1. Most growth in first 5 yrs
2.1.2. Less efficient regulation
2.1.2.1. Acid-base
2.1.2.2. Electrolytes
2.1.2.3. Drug elimination
2.1.3. Smaller bladder
2.1.3.1. 20-50 mL at birth
2.1.3.1.1. Little return on cath
2.1.3.2. Add to child's age in oz
2.1.4. Urine output
2.1.4.1. 2 ml/kg/hr (infants)
2.1.4.2. 0.5-1 ml/kg/hr (children)
2.1.4.3. 40-80 ml/hr (teens)
2.1.4.4. 1-2 ml/kg/hr (children)
2.1.5. Fluid requirements
2.1.5.1. 1-10 kg: 100 ml/kg
2.1.5.2. 11-20 kg: 1000 + 50 mL/kg
2.1.5.3. 20+ kg: 1500 mL + 20 ml/kg
2.2. Urinalysis
2.2.1. Pale yellow color
2.2.1.1. Red
2.2.1.2. Dark
2.2.1.3. Orange (AZO)
2.2.2. Clear turbidity
2.2.3. 1.010-1.030 SG
2.2.3.1. Higher if dehydrated
2.2.4. Negative or rare components
2.2.4.1. RBC
2.2.4.2. WBC
2.2.5. Few epithelial cells
2.2.6. pH of 4.5 - 8
2.2.6.1. Elevated: UTI, stones, bacteria
2.2.7. Low creatinine r/t low muscle mass
2.3. External Genital Abnormalities
2.3.1. Bladder exstrophy
2.3.1.1. Eversion, protrusion
2.3.1.2. Males > females
2.3.1.3. Diagnostics
2.3.1.3.1. Appearance
2.3.1.3.2. Ultrasound
2.3.1.4. Nursing care
2.3.1.4.1. Sterile plastic wrap for 48-72 hrs
2.3.1.4.2. Skin assessment with protectant
2.3.1.4.3. Immobilize pelvis
2.3.1.4.4. UO
2.3.1.4.5. 2-person diaper change
2.3.2. Hypospadias, epispadias
2.3.2.1. Abnormal location of urinary meatus
2.3.2.2. Circumcision
2.3.2.2.1. Hard to if uncircumcised
2.3.2.2.2. Cannot have procedure
2.3.2.2.3. Foreskin used to repair defect
2.3.3. Phimosis
2.3.3.1. Cannot retract foreskin
2.3.3.2. Be careful during cleaning
2.3.3.3. Can be fully retracted by age 2-3
2.3.4. Cryptorchidism
2.3.4.1. Undescended testicle(s)
2.3.4.2. Spontaneous remission @ 3months
2.3.4.2.1. If not, surgery @ 12 months
2.3.4.2.2. Infertility/malignancy
2.3.5. Hydrocele
2.3.5.1. Fluid-fill scrotal mass
2.3.5.1.1. Communicating (resolving)
2.3.5.1.2. Non-communicating
2.3.5.2. Spontaneous resolution @ 1 year
2.3.5.3. Transillumination
2.3.6. Testicular torsion
2.3.6.1. Spermatic cord twists, cuts of blood flow
2.3.6.2. Manifestations
2.3.6.2.1. Usually when asleep
2.3.6.2.2. No cremasteric reflex
2.3.6.2.3. Severe pain
2.3.6.2.4. N/V
2.3.6.2.5. Scrotal swelling
2.4. Lower Urinary Tract Disorders
2.4.1. Patent urachus
2.4.1.1. Should close during development
2.4.1.1.1. Umbilical cord
2.4.1.1.2. Bladder
2.4.1.2. Suspect when UC fails to drop off
2.4.1.2.1. After 1-2 weeks
2.4.1.3. Surgical repair
2.4.2. Obstructive uropathy
2.4.2.1. Impedes urine flow >> backflow to kidneys
2.4.2.1.1. Hydronephrosis
2.4.2.1.2. Renal scarring
2.4.2.2. Suspect if pediatric UTI
2.4.2.2.1. Renal ultrasound
2.4.2.2.2. Hydronephrosis
2.4.3. Vesicoureteral reflux
2.4.3.1. Backflow from bladder into ureter
2.4.3.1.1. Incomplete emptying
2.4.3.1.2. Stagnant, infected urine
2.4.3.1.3. Spread of bacteria to kidney
2.4.3.2. Diagnostics
2.4.3.2.1. Renal ultrasound
2.4.3.2.2. VCUG
2.4.3.3. Treatment
2.4.3.3.1. Surgery
2.4.3.3.2. Prophylactic ABX
2.4.4. Cystitis
2.4.4.1. Lower UTI
2.4.4.2. Females > males
2.4.4.2.1. Over age 3 months
2.4.4.2.2. Increased risk if not circumcised
2.4.4.3. Causes
2.4.4.3.1. E. coli
2.4.4.3.2. Hygiene
2.4.4.3.3. Constipation
2.4.4.3.4. Sexual activity
2.4.4.3.5. Urinary stasis
2.4.4.4. Manifestations
2.4.4.4.1. Fever
2.4.4.4.2. FTT
2.4.4.4.3. V/D
2.4.4.4.4. Urinary odor
2.4.4.4.5. GU symptoms
2.4.4.5. Diagnostics
2.4.4.5.1. UA/UCX
2.4.4.5.2. Renal ultrasound or VCUG
2.4.4.6. Treatment
2.4.4.6.1. Antibiotics
2.4.4.6.2. Antipyretics
2.4.4.6.3. Prophylaxis
2.5. Upper UT Disorders
2.5.1. Pyelonephritis
2.5.1.1. Manifestations
2.5.1.1.1. Very high fever
2.5.1.1.2. Chills
2.5.1.1.3. CVA tenderness
2.5.1.1.4. Very ill
2.5.1.2. True kidney infection
2.5.1.3. PO & IV antibiotics
2.5.1.3.1. IV first 3 days
2.5.1.3.2. Then two wks of PO
2.5.2. Acute glomerulonephritis
2.5.2.1. Secondary to strep
2.5.2.1.1. Nephrogenic strain
2.5.2.1.2. Toxin damages kidney
2.5.2.2. Manifestations
2.5.2.2.1. Abrupt onset of pain
2.5.2.2.2. Hematuria, proteinuria, azotemia
2.5.2.2.3. HTN
2.5.2.2.4. Tea-colored urine
2.5.2.2.5. Edema
2.5.2.2.6. Eelvated BUN, C, WBC, ESR
2.5.2.2.7. Positive ASO titer
2.5.2.2.8. Anti-Dnase B
2.5.2.2.9. Anemia
2.5.2.3. Treatment
2.5.2.3.1. BEDREST
2.5.2.3.2. Na, K restriction
2.5.2.3.3. Diuretics
2.5.2.3.4. Anti-HTN
2.5.2.3.5. ABX
2.5.2.3.6. High recovery rate
2.5.2.3.7. Education
2.5.3. Hemolytic uremic syndrome
2.5.3.1. R/T E. coli
2.5.3.1.1. Uncooked meat
2.5.3.1.2. Not regular E. coli
2.5.3.1.3. Damage to glomerulus
2.5.3.1.4. More common in summer
2.5.3.2. Most CC of ARF in kids
2.5.3.3. Triad
2.5.3.3.1. Hemolytic anemia
2.5.3.3.2. Thrombocytopenia
2.5.3.3.3. Renal insufficiency
2.5.3.4. Manifestations
2.5.3.4.1. Severe GE
2.5.3.4.2. HTN
2.5.3.4.3. Pallor
2.5.3.4.4. Oliguria
2.5.3.4.5. V/D/A/P
2.5.3.4.6. Jaundice, edema
2.5.3.4.7. Urine alterations
2.5.3.4.8. Metabolic acidosis
2.5.3.5. Dietary care
2.5.3.5.1. Fluid restriction
2.5.3.5.2. High cal, carb diet
2.5.3.5.3. Low protein, Na, K, P
2.5.3.6. Meds
2.5.3.6.1. Kayexalate
2.5.3.6.2. Anti-HTN
2.5.3.6.3. Calcium gluconate
2.5.3.6.4. Plasma, then blood
2.5.3.6.5. Dialysis*
2.5.4. Nephrotic syndrome
2.5.4.1. Massive proteinuria
2.5.4.1.1. Hypoalbuminemia
2.5.4.1.2. Hypoproteinemia
2.5.4.1.3. Hyperlipidemia
2.5.4.1.4. Altered immunity
2.5.4.2. Never have hematuria
2.5.4.3. Manifestations
2.5.4.3.1. Gradual edema
2.5.4.3.2. Pallor
2.5.4.3.3. HTN
2.5.4.3.4. Anorexia
2.5.4.3.5. Malaise
2.5.4.3.6. Frothy urine
2.5.4.3.7. Pale, shiny skin
2.5.4.3.8. Prominent veins
2.5.4.3.9. Brittle hair
2.5.4.4. Treatment
2.5.4.4.1. Steroids
2.5.4.4.2. Albumin + lasix
2.5.4.4.3. Limit salt, protein in diet
2.5.5. Renal failure
2.5.5.1. Acute
2.5.5.1.1. May be reversible
2.5.5.1.2. Onset of days to weeks
2.5.5.1.3. Types
2.5.5.1.4. Manifestations
2.5.5.1.5. Treatment
2.5.5.2. Chronic
2.5.5.2.1. Progressive, irreversible
2.5.5.2.2. Manifestations
2.5.5.2.3. Treatment
2.6. Renal Transplantation
2.6.1. Immunosuppressants
2.6.2. HLA typing & match
2.7. Enuresis
2.7.1. Involuntary voiding that is abnormal
2.7.1.1. Age 5-6 years
2.7.1.2. Primary (control) or secondary (stressed)
2.7.2. Lack of vasopressin (ADH)
2.7.3. Meds: DDAVP, oxybutynin
3. Fluids & Electrolytes
3.1. Overview
3.1.1. Fluid distribution
3.1.1.1. 2/3 IC
3.1.1.2. 1/3 EC
3.1.2. pH
3.1.2.1. 7.35-7.45
3.1.2.2. Homeostasis
3.1.2.3. Natural acids
3.1.2.3.1. Carbonic (lung)
3.1.2.3.2. Metabolic (kidneys)
3.1.3. Fluid distribution
3.1.3.1. Infant
3.1.3.2. Baby
3.2. ECFVD
3.2.1. Hypovolemia or dehydration
3.2.2. Not enough fluid in EC space
3.2.3. Three types
3.2.3.1. Isotonic
3.2.3.1.1. Most common
3.2.3.1.2. Equal loss of Na, water
3.2.3.2. Hypertonic
3.2.3.2.1. Water loss > salt
3.2.3.2.2. Causes
3.2.3.3. Hypotonic
3.2.3.3.1. Loss of Na > water
3.2.3.3.2. Severe or prolonged V/D
3.2.3.3.3. Burns or renal disease
3.2.3.3.4. Treated with IVF w/o electrolytes
3.2.4. Nursing care
3.2.4.1. % weight loss
3.2.4.2. LOC
3.2.4.3. Treatment
3.2.4.3.1. Oral
3.2.4.3.2. IVFs
3.2.4.4. Monitoring
3.2.4.4.1. Electrolytes
3.2.4.4.2. Urine appearance, SG
3.2.4.5. I&O
3.2.4.5.1. UAP + RN
3.2.4.5.2. INTERPRET IT
3.2.4.6. Emergency
3.2.4.7. Address cause
3.2.4.7.1. Neglect
3.2.4.7.2. Improper formula
3.3. ECFVE
3.3.1. General
3.3.1.1. Saline retention r/t aldosterone
3.3.1.2. Dependent edema
3.3.1.3. Causes
3.3.1.3.1. Disease processes
3.3.1.3.2. Glucocorticoids
3.3.1.3.3. Excess IVFs
3.3.1.4. Nursing care
3.3.1.4.1. I&O
3.3.1.4.2. IVF administration
3.4. IFVE
3.4.1. Edema
3.4.1.1. Increased BHP
3.4.1.2. Decreased BOP
3.4.1.3. Increased IFOP
3.4.1.4. Blocked lymphatics
3.4.2. Treat cause
3.4.3. Nursing care
3.4.3.1. Daily wts, measures
3.4.3.2. I&O
3.4.3.3. Skin care
3.4.3.4. Body image
3.4.3.5. Pain
3.4.3.6. Fluid restriction care
3.4.3.7. Meds
3.4.3.7.1. Albumin + Lasix
3.4.3.7.2. Never Lasix alone
3.5. Sodium
3.5.1. Hyper
3.5.1.1. >145-156
3.5.1.2. "Shrinking"
3.5.1.3. Na > Water
3.5.1.3.1. Thirst
3.5.1.3.2. DUO
3.5.1.4. Treat w/hypotonic IVF
3.5.1.4.1. Isotonic, then hypotonic
3.5.1.4.2. Dehydration, then salt imbalance
3.5.1.5. Nursing care
3.5.1.5.1. Infant feeding
3.5.1.5.2. Weight checks
3.5.1.5.3. Water deprivation abuse
3.5.1.5.4. Water flushes for ages +6mo
3.5.2. Hypo
3.5.2.1. 131-132
3.5.2.2. "Fat"
3.5.2.3. Nursing care
3.5.2.3.1. IVF
3.5.2.3.2. Anticipatory guidance
3.5.2.3.3. Safety
3.6. Potassium
3.6.1. Normal range: 3.3-5.5
3.6.2. Hyper
3.6.2.1. Causes
3.6.2.1.1. PO intake
3.6.2.1.2. Renal failure
3.6.2.1.3. Older blood transfusions
3.6.2.1.4. Crush injuries
3.6.2.1.5. SCD
3.6.2.1.6. Chemo
3.6.2.1.7. Renal insufficiency r/t excretion****
3.6.2.2. Muscle dysfunction
3.6.2.2.1. Ascending weakness
3.6.2.2.2. Hyperactive gut
3.6.2.2.3. Cardiac: tachy, arrythmias, arrest!
3.6.2.3. Treatment
3.6.2.3.1. Limit intake
3.6.2.3.2. Excretion
3.6.2.3.3. Drive it back into cells
3.6.2.4. Nursing care
3.6.2.4.1. UO before any IVF
3.6.2.4.2. Safety
3.6.2.4.3. Diet restriction
3.6.2.5. MOST LETHAL!
3.6.3. Hypo
3.6.3.1. Muscle dysfunction
3.6.3.1.1. Underactive gut
3.6.3.1.2. Weakness
3.6.3.1.3. Problems w/RR
3.6.3.1.4. Arrhythmias
3.6.3.2. Replacement therapy
3.6.3.2.1. Tastes awful
3.6.3.2.2. Mix with juice*
3.6.3.3. Nursing care
3.6.3.3.1. ASSESS
3.6.3.3.2. Safety
3.6.3.3.3. K supplement education
3.6.3.3.4. IV infusion care
3.6.3.4. Etiology
3.6.3.4.1. NPO, intake problem
3.6.3.4.2. Hyperinsulinemia
3.6.3.4.3. Alkalosis
3.6.3.4.4. Hyperalimentation
3.6.3.4.5. V/D or NGS
3.6.3.4.6. High aldosterone
3.6.3.4.7. Albuterol continuous
3.7. Calcium
3.7.1. 8.4-10.6 range
3.7.2. Hyper
3.7.2.1. Etiology
3.7.2.1.1. Antacids
3.7.2.1.2. Hyperparathyroidism
3.7.2.1.3. Bedrest
3.7.2.1.4. HCTZ
3.7.2.2. Manifestations
3.7.2.2.1. Decreased DTR
3.7.2.2.2. FTT
3.7.2.2.3. N/V/C
3.7.2.2.4. Cardiac arrest
3.7.2.3. Treatment
3.7.2.3.1. Push fluids
3.7.2.3.2. Lasix
3.7.2.3.3. Glucocorticoids
3.7.2.3.4. Calcitonin
3.7.2.3.5. Phosphate (inverse relationship)
3.7.2.3.6. Acidify urine r/t stone formation
3.7.2.3.7. Safety re: weakness
3.7.3. Hypo
3.7.3.1. Etiology
3.7.3.1.1. Poor diet
3.7.3.1.2. Eating disorders
3.7.3.1.3. Uremic syndrome
3.7.3.1.4. Blood transfusions
3.7.3.1.5. Liver dysfunction
3.7.3.1.6. Burns
3.7.3.1.7. Wound drainage
3.7.3.1.8. Steatorrhea
3.7.3.2. Manifestations
3.7.3.2.1. Tetany
3.7.3.2.2. Spontaneous frxs
3.7.3.2.3. Low Mg*
3.7.3.3. Treatment
3.7.3.3.1. Replacement
3.7.3.3.2. Vitamin D
3.7.3.3.3. Diet
3.7.3.4. Nursing care
3.7.3.4.1. C or T signs
3.7.3.4.2. Diet ed
3.7.3.4.3. No IM calcium
3.8. Magnesium
3.8.1. Hyper
3.8.1.1. Etiology
3.8.1.1.1. increased intake
3.8.1.1.2. Mag sulfate for labor
3.8.1.1.3. Laxatives or enemas
3.8.1.1.4. Altered renal function
3.8.1.2. Manifestations
3.8.1.2.1. Decreased muscle irritability
3.8.1.2.2. hTN or bradycardia
3.8.1.2.3. Absent DTR
3.8.1.3. Treatment
3.8.1.3.1. Prevention
3.8.1.3.2. Excretion
3.8.2. Hypo
3.8.2.1. Manifestations
3.8.2.1.1. Tetany
3.8.2.1.2. Hyperactive DTRs
3.8.2.1.3. Cardiac arrest
3.8.2.1.4. Seizures
3.8.2.2. Treatment
3.8.2.2.1. IV Mg
3.8.2.3. Etiology
3.8.2.3.1. NPO
3.8.2.3.2. Long term IVF
3.8.2.3.3. Malnutrition
3.8.2.3.4. Severe diarrhea
3.8.2.3.5. Large transfusions
3.8.2.3.6. Loss via diuretics, DKA, NGS
3.8.3. Nursing care
3.8.3.1. Diet
3.8.3.2. Emergency equipment during admin
3.8.3.3. DTRs
3.8.4. 1.5 - 2.7