When is it necessary?

~Mi Vida Loca~RN, ASN, RN · Apr 30, 2017

I have a five year old patient I am taking care of that came in with dehydration. The dehydration has since been resolved however the patient is not wanting to drink anything. The fluid rate was set at 75 ml/he on admit. Day 3 he is still not drinking but has developed non-pitting edema in his lower extremities. He is about 15 kg. I'm starting to think that he is getting too much fluid and that this may be the reason he doesn't want to drink and the reason for the non-pitting edema. His lungs sounds, however,are clear. I was wondering at what point would a patient need to be put on a maintenance rate (which would be 50 ml/hr for his weight). But I wonder if he still needs to be at 75ml/he since he is not drinking. I'm so lost.

Not to sound like an orifice, but have you discussed this with your doctor or charge? I mean this site can be a great resource but you're bringing up concerns for a current patient in your care that you are worried might be getting too much fluid, (the lungs being clear does not mean they aren't getting too much) so it seems to me that this is a matter you need to discuss with your charge and the doctor. Have you reported the new onset edema to the doctor?

There is not enough information for us to tell you what you need to do, we don't know the patients history and vital signs and labs and so on.

It's one thing if this was a previous patient and you wanted to give the story and see what could have been done or advice on how to handle something. But an active current pediatric patient that you are concerned about?? I would get off here and page the doc and talk to your charge.

CarlaHawk22 · Apr 30, 2017

I'm sorry, you are right. I should ask my instructor as I am a nursing student. I was told by his nurse that it's fine bc he isn't drinking. But the mom told me that he'd just developed the edema. The LPN said it's probably d/t position bc he is disabled and has been sitting in a sitting position for a while. As part of my assignment I have to also interpret his labs. His BUN and creatinine was normal on admit and now it is low. Mom said he'd also vomiting once after she gave him sprite. I'm just thinking all of this are signs that his fluid rate may be high. Just trying to get advice on whether I make any sense in my thinking.

~Mi Vida Loca~RN, ASN, RN · Apr 30, 2017

I'm sorry, you are right. I should ask my instructor as I am a nursing student. I was told by his nurse that it's fine bc he isn't drinking. But the mom told me that he'd just developed the edema. The LPN said it's probably d/t position bc he is disabled and has been sitting in a sitting position for a while. As part of my assignment I have to also interpret his labs. His BUN and creatinine was normal on admit and now it is low. Mom said he'd also vomiting once after she gave him sprite. I'm just thinking all of this are signs that his fluid rate may be high. Just trying to get advice on whether I make any sense in my thinking.

Well see now a whole lot more of the story comes out. From your initial post it was presented like you were actively taking care of this kiddo that you were starting to have concerns on and instead of talking to the doc and charge nurse you were asking us. Now there are a lot more pieces to the puzzle and it would appear you are a student and working on an assignment related to this case. It's important when you are seeking advice and help that you present the entire story so we can better help you.

Is this in a hospital or home care? The pt is disabled so I am assuming he has a lot more hx going on, that could definitely change things up and could change what is normal for him but might not be normal in others.

Esme12, ASN, BSN, RN · May 1, 2017

Think about fluid and electrolytes. Think about third space edema. What else could cause a patient to hang onto water and develop edema? What is this patients albumin level? What is this patient disability?