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Nursing

Hydration Assessment

Urinary Output in Paediatric Patients

  • Normal: 1 – 2ml/kg/hr
  • Oliguria: <1.0ml/kg/hr
  • Anuria: no urine output
  • Polyuria: > 3ml/kg/hr
  • Older children: 30 ml/hr is the minimum normal output

Fluid Volume Excess

Causes Signs and Symptoms
  • Renal/liver failure
  • Congestive Heart Failure (CHF)
  • Over administration of fluids
  • High sodium intake






 
  • Peripheral edema
  • Puffy eyes
  • Full/bulging fontanels
  • Crackles / wet chest
  • Pulmonary edema
  • Pleural effusions
  • Ascites (fluid accumulation within the abdominal cavity)
  • Distended neck veins
  • Bounding pulses
  • Decreased urinary output

Fluid Volume Deficit

Causes Signs and Symptoms

Loss of water and electrolytes due to:

  • Fever
  • GI suction (e.g. low intermittent Gomco)
  • Vomiting and diarrhea
  • Diaphoresis (sweating)
  • Increased urine output


 
  • Irritability
  • Dry mucous membranes
  • Increased thirst
  • Decreased skin turgor
  • Urine output less than 1ml/kg/hr
  • Dark colored urine, high urine specific gravity
  • Sunken eyes
  • Decreased tearing
  • Lethargy
  • Depressed fontanels
  • Hypotension
  • Tachicardia

Insensible Fluid Losses in Hospitalized Children

The following factors can influence the fluid balance of hospitalized children and infants and need consideration when calculating fluid requirements:

  • Suctioning
  • Fever
  • Diaphoresis
  • Hyperventilation
  • Radiant warmers
  • Phototherapy