Provincial PEWS Flowsheet: Fluid Balance Review for Pediatric Nurses, Study notes of Pediatrics

Download Provincial PEWS Flowsheet: Fluid Balance Review for Pediatric Nurses and more Study notes Pediatrics in PDF only on Docsity! Child Health BC Edu-quick May 4, 2016 Page 1 of 5 Provincial PEWS Flowsheet: Fluid Balance Purpose The purpose of this edu-quick is to: - Review the principles of pediatric fluid balance - Review the Intake/Output section of the Provincial PEWS flowsheet - Review documentation standards for pediatric fluid balance Equipment and Materials - Copy of Provincial PEWS Flowsheet - Copy of Instructions for using the Provincial PEWS Flowsheet - Copy of Provincial PEWS Vital Sign Assessment and Documentation - Provincial Pediatric Vital Sign Lanyard - Copy of CHBC Provincial PEWS Flowsheet Fluid Balance Example Facilitator Instructions This edu-quick should only take 20 minutes to complete and is meant to be delivered as an open dialogue. It can be completed with one person, a small group or by an individual as a self-guided review. Review pediatric fluid balance calculations with participants. Facilitate participants through a review of pediatric fluid balance calculations. Next have participants review how to document in the Intake/Output section of the flowsheet using the attached case study as an example. What’s new? Provincial standards have been developed for documenting pediatric fluid balance. The concepts, calculations and documentation requirements should be familiar to those who care for pediatric patients. However, the format of the Intake/Output section of the Provincial PEWS flowsheet may be different then the fluid balance record you are used to using on your unit. You will continue to calculate fluid balances at the times you currently do on your unit. For example if your unit does them at 0400/1600, 0600/1800, 0700/1900, please continue to follow your current practice. The Provincial PEWS Vital Sign Assessment and Documentation Guidelines state: Intake and Output are to be monitored and documented per:  Minimum every 12 hours  Physicians orders (if different from minimum standard)  Nursing Care Plans  Nursing clinical judgment  As required for a particular procedure or medication  With any decline in patient status  At the discretion of the nurse How does this affect my nursing practice? Monitoring fluid balance on a Pediatric patient is a fundamental piece in all assessments. Because of children’s unique body composition and high percentage of body water, they are at higher risk for dehydration and fluid overload. In your pediatric assessment, you will need to ensure that you are familiar with the process of calculating the daily fluid requirements for each of your patients. Becoming confident in this essential part of daily care will assist you to complete comprehensive hydration assessments and accurate documentation of fluid balance. Child Health BC Edu-quick May 4, 2016 Page 2 of 5 Let’s Review…  Although the rate and IV solution will be ordered by a physician or the most responsible practitioner (MPR), the nurse should double check the rate is correct for the patient by calculating daily fluid requirements.  The daily fluid requirements tell you what your patient needs to take in, from all sources, in a 24 hour period.  If you are at all concerned about your patient’s fluid balance at any time throughout your shift please discuss with the physician or MRP Intake includes:  IV fluids  Medications (IV, NG/GT)  Oral Solids & Fluids  NG/GT feeds  All flushes (NG, GT etc.)  Blood Products  TPN & Lipids Output includes:  Emesis  Stool  Urine  Blood  NG/GT output  Combo diapers: cannot calculate urine output based on combo diaper  Insensible losses(not measurable but important to think about, especially if patient has a fever) Calculation Practice *Please note that depending on what calculation you use (Fluid Requirements Per Day vs. Per Hour), you may see variation in rates by a few mL. What is the hourly fluid requirement for a patient weighing 13.8 kg? = 4mL/h X 1st 10kg 40mL plus = 2mL/h X next 10kg 3.8 kg X 2mL =7.6 cc Therefore, run the IV at 47.6 cc/hr What is the 24 hours fluid requirement for a patient weighing 13.8kg? 1st 10kg = 100mL/kg/24 hrs 1000mL Next 10 kg = 5-mL/kg/24 hours 3.8 kg X 50 mL/24 hr = 190 mL Therefore, run the IV at 1190 cc/24 hours, which means 49.58 mL/hr