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Special Considerations in IV Therapy: The Pediatric and Geriatric Population. Principles of IV Therapy BSN470. Pediatric IV Therapy. - PowerPoint PPT Presentation
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Special Considerations in IV Therapy:
The Pediatric and GeriatricPopulation
Principles of IV TherapyBSN470
Pediatric IV Therapy
Neonate: Extra uterine life up to the first 28 days. Low-birth-weight and premature infants have decreased energy stores and increased metabolic needs compared with those of full-term and average-weight newborns.
Pediatric IV Therapy (cont) Premature Infant: body made up of
approximately 90% water Newborn Infant: body made up of
70-80% water Adult is about 60% Infants have proportionately more
water in the extracellular compartment than do adults
Pediatric IV Therapy (cont) Infants are more vulnerable to fluid
volume deficit because the ingest and excrete a relatively greater daily volume of water than adults.
Any condition that interferes with normal water and electrolyte intake or that produces excessive water and electrolyte losses will produce a more rapid depletion of water and electrolyte stores.
Pediatric IV Therapy (cont) Illness, increases muscular activity,
thermal stress, congenital abnormalities, and respiratory distress syndrome influence metabolic demands
Metabolic demand of infant is 2 times higher per unit of weight than that of an adult.
For high-risk infants, calorie requirement is up to 100% higher than normal newborn
Pediatric IV Therapy (cont) Immature homeostatic regulating
mechanisms Renal function, acid-base balance, body
surface area differences, and electrolyte concentrations must be taken into consideration when planning fluid needs
Renal function not completely developed; Kidneys have limited concentrating ability and require more water to excrete a given amount of solutes.
Pediatric IV Therapy (cont) Integumentary system in neonates
important route of fluid loss Gastrointestinal membranes are an
extension of the body surface area, greater losses occur from the GI tract in sick infants
Plasma electrolyte concentrations do not vary strikingly among infants, small children, and adults.
Pediatric IV Therapy (cont) Candidates for Neonatal IV Fluids
Congenital cardiac disorders GI defects Neurologic defects
Candidates for Infant IV Fluids Dehydration (FVD) Diarrhea(Electrolyte imbalance Antibiotic therapy Nutritional support Antineoplastic therapy
Components of the Pediatric Physical
Assessment Measurement of the head circumference (up to
1 year) Height or length Weight Vital Signs Skin Turgor Presence of tears Mucous membranes Urinary output Fontnaelles Level of acitivity
Assessment of Fluid Needs Meter Square Method (body surface
area) Nomogram used
Weight Method 100-150mL/kg to estimate fluid
requirements Caloric Method
Calculates the usual metabolic expenditure of fluid
Site Selection Age of Child Size of Child Condition of vein Reason for therapy General patient condition Mobility and level of activity Gross and fine motor skills Sense of body image Fear of mutilation Cognitive ability of the child
Selecting Equipment Electronic infusion device Solution container with a volume based
on the age, height and weight; containing no more than 500ml perferably 250m/L
Volume control chamber Plastic fluid container Microdrip tubing Visible cannula site 0.2 micron air eliminating filter set
Medication Administration
Intermittent Infusion Retrograde Infusion Syringe Pump Alternaitve Administration Routes
Intraosseous Route Umbilical Vein and Arteries
Geriatric IV Therapy “Loss of cells and loss of
physiologic reserve make up the dominant processes of aging”
Major Changes Homeostatic changes Immune system Cardiovascular changes Skin and Connective tissue changes
Geriatric IV Therapy (Cont) Older persons do not possess the fluid
reserves of younger individuals Less ability to adapt readily to rapid
changes Renal changes: decreased glomerular
filtration rate Total body water reduced by 6% Cardiovascular and respiratory changes
combine to contribute to a slower response to blood loss, fluid depletion, shock, and acid-base imbalances
Assessment Guidelines for the Geriatric Patient
Skin turgor forehead or sternum Temperature Rate and Filling of veins in had or foot Daily weight Intake and output Tongue Orthostatic Swallowing ability Functional assessment
Tips for Fragile Veins To prevent hematoma, avoid
overdistention Avoid multiple tapping of the vein Use the smallest gauge needle
necessary Lower the angle of approach Pull the skin taut and stabilize the
vein Use the one handed technique
Other Special Problems
Alterations in Skin Surfaces Hard Sclerosed Vessels Obesity Edema