Water-salt metabolism in the body in children

Algorithm for determining water balance

Prepare:
- establish a trusting relationship with the patient, make sure that the patient has not taken diuretics during the last 3 days;

— explain the mechanism of the procedure and obtain consent to carry it out;

— medical scales;

— graduated glass containers for collecting urine, vomit and feces;

— water balance sheet;

- handle;

— container with disinfectant solution;

— container for waste;

— disposable wipes and gloves:

Action:

Explain to the patient that at 6.00 it is necessary to release the night portion of urine into the toilet; after this, the patient must collect urine after each urination into a graduated container, record the time and amount of urine, and must also indicate the time of intake and the amount of liquid taken and record the data on a record sheet until 6.00 the next morning; at 6.00 the next day the patient must hand over the registration sheet to the nurse; remove gloves and place them in a container, wash (hygienic level) and dry your hands; record the received data in the medical documentation:

Attention:

— Diuresis is the process of formation and excretion of urine.

— Daily diuresis is the total amount of urine excreted by the patient during the day; in adults it ranges from 800 ml to 2000 milliliters.

— Daily water balance is the ratio between the amount of fluid introduced into the body and the amount of fluid excreted from the body during the day.

— In addition to the liquid drunk, the liquid contained in fruits, soups, vegetables, etc., as well as the volume of parenterally administered solutions, must be taken into account.

— Not only urine, but also the patient’s vomit and bowel movements should be taken into account.

— The expected fluid excreted in urine is calculated using the formula (the amount of fluid drunk is multiplied by 0.8).

— Water balance is considered positive if more fluid is released than introduced and vice versa.

— A positive water balance indicates the effectiveness of treatment.

studopedia.ru

Determination of daily diuresis

Manipulation No. 38
“Study of arterial pulse (PS).”

Target:

assessment of the functional state of the cardiovascular system, an idea of ​​the general condition of the patient, determination of the basic properties of the pulse.

Indications:

diseases of the cardiovascular system, examination, assessment of the general condition of the patient.

Contraindications:

No.

Equipment:

stopwatch (or clock with a second hand), red pen, temperature sheet, observation sheet, nursing history.

Algorithm:

Manipulation No. 39

"Measurement of blood pressure (BP)."

Target:

assess the state of the cardiovascular system, the general condition of the patient, determine blood pressure indicators and evaluate the results of the study.

Indications:

diseases of the cardiovascular system, kidneys, examination of the patient.

Contraindications:

No.

Equipment:

tonometer, phonendoscope, pen with a red rod, temperature sheet (outpatient card, nursing medical history), roller, napkins, 70% ethyl alcohol or disinfectant solution approved for use in this healthcare facility.

Algorithm:

Manipulation No. 40

“Counting the number of respiratory movements (RR).”

Target:

determine the main characteristics of breathing.

Indications:

diseases of the respiratory system and cardiovascular system.

Contraindications:

No.

Equipment:

watch (stopwatch), temperature sheet or nursing observation sheet, pen and paper.

Algorithm:

Manipulation No. 41

“Filling out the temperature sheet.”

Target:

rules for filling out medical documentation.

Indications:

registration of patient examination results.

Contraindications:

No.

Equipment:

temperature sheet, pens (or pencils) with red and blue paste.

Algorithm:

Manipulation No. 42

“Drawing up a portion plan and portion requirements.”

The required diet and the duration of its use are determined by the doctor and depend on the disease, the patient’s condition and the tolerability of the prescribed diet. The doctor writes down the diet number in the medical history and prescription sheet. The ward nurse, checking the data on the appointment sheet, collects information daily on the number of different dietary tables (diets), types of fasting and individual diets. She submits this information to the senior nurse, who, based on it, draws up and approves the portion plan (see sample). The portion maker is also approved by the manager. department, after which it is served to the food department.

Information about patients discharged from the department is not included in the portion plan. If patients are admitted in the evening or at night, the nurse on duty prepares the portion plan.

Portion sample

_______________________

(name of institution) f No. 1

PORTION MAN

2. Individual supplementary nutrition

Disabled people of the Great Patriotic War (WWII) - full name. and ID number

Head of Department______________

Senior med. sister__________________

A nutritionist and nutritionist are responsible for drawing up the menu, monitoring the quality of products and storing them.

Manipulation No. 43

"Feeding a patient on bed rest."

Target:

providing dietary nutrition.

Indications:

inability to eat independently.

Contraindications:

No

Equipment:

spoon, bedside table or portable (bedside) table, napkin (towel), cup with cooled boiled water, basin, jug with warm water, soap, kidney-shaped tray, towel.

Algorithm:

Sippy cup feeding Purpose:

providing individual dietary nutrition.
Indications:
inability to eat independently.

Contraindications:

unconscious state; lack of swallowing reflex.

Equipment:

sippy cup, napkin, liquid food, towel, boiled water.

Algorithm:

Manipulation No. 44

"Feeding the patient through a nasogastric tube."

Target:

providing individual dietary nutrition.

Indications:

- violation of the act of swallowing;

— unconscious states;

- lack of sucking and swallowing reflex in premature newborns;

- fracture of the jaw bones, diseases of the oral cavity;

- refusal of food in case of mental illness.

Equipment:

sterile nasogastric tube, funnel or Janet syringe, clamp, towel, napkins, gloves, mask, nutritional mixture (t -38-40°C), boiled water (50-100 ml), container with disinfectant. solution, phonendoscope, syringe.

Algorithm

Manipulation No. 45

"Feeding a patient through a gastrostomy tube."

Gastrostomy - (gaster - from Greek stomach, stoma - from Greek opening) is an artificial opening in the stomach, created surgically for the purpose of artificial feeding of the patient in case of obstruction of the esophagus or for its functional shutdown.

To feed the patient through a gastrostomy tube, a sterile tube is inserted into the opening of the stomach, which must be fixed. A clamp is placed on the free end of the probe.

Target:

providing individual dietary nutrition.

Indications:

- narrowing or obstruction of the esophagus;

- pyloric stenosis; injuries of the larynx and esophagus;

- severe burns;

- inoperable tumors.

Equipment:

funnel (Zhanet syringe), container with pureed or liquid food (t 50°C), boiled water, sterile wipes, Lassar paste, adhesive plaster, clamp, container with disinfectant solution, gloves (2 pairs).

Algorithm:

Question 7. Measuring daily urine output and assessing water balance

Water balance is the ratio between the amount of fluid introduced into the body and the amount of fluid excreted from the body during the day. Normally, 1.5–2 liters of water should be consumed per day, and 75–80% of what you drink should be excreted.

Purpose: determination of hidden edema, monitoring the effectiveness of diuretics.

Equipment: medical scales, graduated glass container for collecting urine, water balance sheet.

Algorithm of actions:

1. Explain to the patient the procedure for the procedure the day before. Make sure that the patient has not taken diuretics for three days.

2. Ask the patient in the morning at 6:00 to empty the bladder into the toilet.

3. Weigh the patient and record the result on the water balance sheet.

4. Explain to the patient:

§ collect urine at each urination until 6 o’clock the next day inclusive in a graduated container, and record the amount in the column “Excreted liquid”;

§ count the amount of liquid consumed during the day, including first and third courses, raw vegetables and fruits (at the rate of 100 g of raw fruit corresponds to 100 ml of liquid), intravenous drips, jet infusions, and record the amount in the “Fluid administered” column.

5. Weigh the patient the next morning (at the same time), and record the result on the water balance sheet.

6. Determine the amount of urine excreted per day and liquid drunk per day.

7. Enter all data into the water balance sheet.

8. Calculate the water balance using the formula: multiply the amount of fluid administered by 0.8 (80%), which is equal to the amount of urine that should be excreted normally.

9. Consider the water balance negative if less fluid is released than calculated (normal).

10. Consider the water balance positive if more fluid is released than calculated.

Assessment: a positive water balance indicates the effectiveness of treatment and the resolution of edema. Negative water balance indicates an increase in edema or ineffective dosage of diuretics.

Question 8. Conclusions

The modern level of development of nursing requires the nurse to be able to independently assess the patient’s condition, conduct proper monitoring of him, and make informed decisions associated with a certain responsibility.

Constant monitoring of the patient will allow the nurse to promptly notice changes in the body and provide competent, systematic care for him.

MINISTRY OF HEALTH OF KHABAROVSK REGION

Regional state budgetary educational institution

studopedia.ru

Taking urine for a sample according to Amburge

Target. Determination of the number of shaped elements and cylinders. Indications. Inflammatory kidney diseases. Equipment. A clean, dry, clear glass jar; referral to a clinical laboratory; a clean, dry potty (or bedpan for patients on bed rest). Technique for collecting urine for a sample according to Amburge : 1. After selecting prescriptions from the medical history, prepare the dishes and directions. 2. The patient is prepared as follows: “Tomorrow you need to collect urine for research according to Amburge. To do this, at 6.00 am, urinate in the toilet and hold urination for 3 hours until 9.00. At 9.00, after thoroughly toileting your genitals, urinate in the potty and pour all the urine into a jar with a direction. The pot and jar are on the shelf in the toilet.” 3. All urine is sent to the laboratory immediately after urination in a warm state. 4. The result of the study is pasted into the medical history. Notes. If the patient is on bed rest, the nurse performs the washing. Normally, urine when examined using the Amburger test contains: leukocytes - up to 2.5 * 10″3; erythrocytes - up to 1x10″3; cylinders - up to 15.

Determination of water balance

Target:

identification of hidden edema, determination of the amount of urine excreted per day, assessment of the adequacy of therapy, primarily diuretic (diuretic).
Equipment:
medical scales, clean dry 2-3 liter jar, two graduated vessels, water balance sheet, temperature sheet.
Methods:
systematic weighing of the patient, measuring daily diuresis and comparing it with the amount of fluid drunk, repeated measurements of the circumference of the legs, abdomen, palpation.

Measuring daily diuresis and amount of fluid consumed

Algorithm of actions

1. The day before, warn the patient about the upcoming procedure and the rules for collecting urine, give him detailed information about the order of entries in the water balance sheet.

2. At 6 a.m., wake up the patient so that he urinates on his own in the toilet, or releases his urine with a catheter; this portion of urine is not taken into account.

3. The patient must collect all subsequent portions of urine in a jar until 6 a.m. the next day inclusive.

4. During the day, the patient or nurse keeps a record of the fluid introduced into the body in milliliters, including what was drunk, including first courses, parenterally administered and fruits and vegetables eaten in a 1:1 ratio.

5. Using a graduated vessel, calculate the amount of urine excreted per day.

6. Enter the measurement data in a special column on the temperature sheet.

Help with heart pain (angina attack)

Target:

relieve pain immediately.

Algorithm of actions

1. Provide access to fresh air, complete physical and mental rest.

2. Call a doctor immediately.

3. Sit the patient down.

4. Give 1 tablet of nitroglycerin under the tongue.

5. If after 3 minutes the pain has not stopped, repeat sublingual nitroglycerin, but no more than 3 times with an interval of 10 minutes.

6. Place a mustard plaster on the site of the pain projection.

7. Constantly monitor the patient’s condition: respiratory rate, pulse, blood pressure level, skin color.

8. Follow doctor's orders.

studopedia.ru

Is it necessary to supplement a newborn's diet?

- Whether the baby is fed exclusively breast milk or formula, or is on mixed feeding - in any case, he needs an exclusively individual approach. The question about supplementation should be asked to the pediatrician who is observing the child.

Typically, a breastfed baby gets enough fluids through breast milk. If he needs additional fluid, he will simply ask for additional breast milk and quench his thirst with “foremilk,” that is, thinner milk.

The situation with artificial feeding is somewhat more complicated. If there is a lack of fluid, the child should not be given additional formula - this way you can overfeed the child. Therefore, in some situations, a pediatrician may recommend supplementing a bottle-fed baby.

We should not forget that there are certain individual conditions, for example, a hot and dry climate, the special qualities of the mother’s breast milk, as well as various developmental characteristics and health conditions (chronic and acute pathology accompanied by fluid loss). In such cases, the doctor may recommend supplementing the breastfed child with food.

How to understand that a child does not have enough water?

— Water balance disorders in children can occur in various situations. Overheating, heat stroke, fever (increased body temperature) due to various infections, diarrhea, vomiting are the most common causes of dehydration in children. A child's fluid needs are higher than those of an adult, so dehydration can occur much faster.

Signs of dehydration may include lethargy, drowsiness of the child, dry lips and mucous membranes. A deterioration in the child’s condition can develop very quickly. Therefore, if you see that your child has one of these symptoms, you need to see a doctor as soon as possible.