Why do they always start with IV fluids?

Fiona59 · Mar 15, 2014

Is this a homework question?

Why do you think they are given an IV?

Think weight, body mass, dehydration

Esme12, ASN, BSN, RN · Mar 15, 2014

We are happy to help....why do YOU think they need IVF? What has your research revealed to you?

Thread moved for best response

rosemary_petals · Mar 15, 2014

No it's not homework. I understand if the person loss a lot of fluid/ lytes due to vomiting or diahrrea, or if they are dehydrated because of this, but, I don't understand why it would be given to someone with sleep apnea, or with a knee abscess.

Esme12, ASN, BSN, RN · Mar 15, 2014

Think ABC's. Think about sepsis. Think about a lifeline. Think about medication administration.

I know you recently had a patient with a knee abscess in peds and that parent wanted the IVF stopped. In children the danger for sepsis is very important because of immature immune systems. Once the abscesses was present .....the danger of sepsis increases a ten fold. Sepsis in children, or anyone for that matter, can be fatal. IV antibiotics are the treatment. Think about children and how fast they breathe and how small they are. When they are ills they do not eat well. They are much more sensitive to fluid loss and dehydration. They lose a TON of hydration through incidental loss like breathing, fever, and BSA. They have much higher caloric requirements during an infective process and illness. IVF supply that.

Sleep apnea...I would think about life line. Why do they have sleep apnea. Are they ill other wise? Why does the child have sleep apnea? Again the body is under stress the caloric requirement for wellness increases exponentially.

I think this link will help.

http://www.utmb.edu/pedi_ed/CORE/Fluids&Electyrolytes/page_01.htm

nurseprnRN, BSN, RN · Mar 15, 2014

This thread reminds me a little bit of when I was very new in critical care, and we had some hemodynamic drips that increased BP (dopamine, chiefly) and some that decreased BP (nitroprusside, at the time). Because I didn't know much (umm, anything) about their mechanisms of actions, I thought it illogical to give both to the same patient at the same time. I mean, really, why would we do that?

(Extra points for any bona fide first-program student who can tell me why that is ... not you, Esme!)

I learned from that not to jump to conclusions when I see something that doesnt make sense, especially if I am not too knowledgable in the specialty (yet).

So here we are: often a kid who's sick enough to admit ought to have an IV because he's at higher risk for doing something bad, at which point it will be really hard to get one in. Look beyond the surface, see into the possibilities ... be prepared.

Been there,done that, ASN, RN · Mar 15, 2014

I do not have pediatric experience.

However, your question reminded me that the little ones are 70% H20... adults 60 %. Therefore much more susceptible to dehydration.

As they are much more prone to dehydration with any disease process .. any fluid administration is prophylactic.

Excellent question. I applaud your critical thinking skills.

Esme12, ASN, BSN, RN · Mar 15, 2014

I do not have pediatric experience.
However, your question reminded me that the little ones are 70% H20... adults 60 %. Therefore much more susceptible to dehydration.
As they are much more prone to dehydration with any disease process .. any fluid administration is prophylactic.
Excellent question. I applaud your critical thinking skills.

Bingo! I applaud yours!

missmollie, ADN, BSN, RN · Mar 15, 2014

This thread reminds me a little bit of when I was very new in critical care, and we had some hemodynamic drips that increased BP (dopamine, chiefly) and some that decreased BP (nitroprusside, at the time). Because I didn't know much (umm, anything) about their mechanisms of actions, I thought it illogical to give both to the same patient at the same time. I mean, really, why would we do that?

(Extra points for any bona fide first-program student who can tell me why that is ... not you, Esme!)

I'm going for the extra credit. The vasopressin and nitroglycerin are synergistic because they help improve blood flow to vital organs. I don't know why or how though, but if I had to venture a guess, I would say because you don't want an immediate increase in blood pressure on affected fragile arteries, but you also want to ensure that blood flow is good to other organs. Is the goal to ensure that ANP does not flood the system? That would lead to a decrease in Na+, a decrease in water through kidney filtration and ADH, which could lead to a lower BP, less blood flow to vital organs, and possible ischemia and dehydration.

Am I close? Teach me!

Been there,done that, ASN, RN · Mar 16, 2014

This thread reminds me a little bit of when I was very new in critical care, and we had some hemodynamic drips that increased BP (dopamine, chiefly) and some that decreased BP (nitroprusside, at the time). Because I didn't know much (umm, anything) about their mechanisms of actions, I thought it illogical to give both to the same patient at the same time. I mean, really, why would we do that?

(Extra points for any bona fide first-program student who can tell me why that is ... not you, Esme!)

I learned from that not to jump to conclusions when I see something that doesnt make sense, especially if I am not too knowledgable in the specialty (yet).

So here we are: often a kid who's sick enough to admit ought to have an IV because he's at higher risk for doing something bad, at which point it will be really hard to get one in. Look beyond the surface, see into the possibilities ... be prepared.

Too old for extra credit. I do , however remember questioning administering drips with seemingly opposing actions regarding the patients treatment. Dopamine is titrated to different responses in the cardiovascular system.

Bottom line is we had the smarts to ask.

Also known as .. critical thinking skills

Been there,done that, ASN, RN · Mar 16, 2014

I'm going for the extra credit. The vasopressin and nitroglycerin are synergistic because they help improve blood flow to vital organs. I don't know why or how though, but if I had to venture a guess, I would say because you don't want an immediate increase in blood pressure on affected fragile arteries, but you also want to ensure that blood flow is good to other organs. Is the goal to ensure that ANP does not flood the system? That would lead to a decrease in Na+, a decrease in water through kidney filtration and ADH, which could lead to a lower BP, less blood flow to vital organs, and possible ischemia and dehydration.
Am I close? Teach me!

Getting to the cellular level response to the medication being administered.. priceless!

LightMyFire · Mar 17, 2014

Disclaimer first: I don't work in peds. My main thought is that in the absence of heart or kidney disease, extra fluids simply prevent dehydration and cannot hurt? Of course, this also implies a normal rate (though I don't know what that would be for a ped pt). Anyone could be overloaded by a high enough rate; if it's "normal" the body would simply process it, ie increased UOP and you'd head off any possible problems with dehydration.

Also, encouraging fluids would not likely be as successful as with an adult. If a kid feels crappy you can't just say, "drink lots of fluids" and expect it to happen. Kids do what they feel like. Just guesses though.