How to manage the care of a dehydrated child

Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

Caring for a child with dehydration is a common occurrence in acute paediatric settings and as such the
ability to recognise and treat this condition is a vital skill for nurses who care for children. Failure to appropriately recognise dehydration when it occurs can lead to fast deterioration of the child’s clinical condition and can be fatal. Children are more likely to become dehydrated than adults and often
deteriorate quicker than adults when unwell, so the nurse caring for this patient group is
required to respond with speed and skill to provide the appropriate care at the right time.

Dehydration in children:

how and why

The NHS defines dehydration as the body losing more fluid than it is taking in (NHS website, 2019). Dehydration in children is usually caused by diarrhoea and vomiting or systemic infection, but can also be the result of a number of other underlying conditions (Forman et al, 2012).

Nurses caring for children are likely to be required to treat numerous cases of dehydration throughout their careers as febrile illnesses and diarrhoea with or without vomiting are the second and third most commonly presented medical problems to emergency departments for children aged 0–15 years (Sands et al, 2012). Inadequate treatment of dehydration in children can lead to acidosis, electrolyte disturbances, kidney damage or hypovolaemic shock (Mecham, 2006; Pringle et al, 2011). Hypovolaemic shock is the clinical state in which the loss of blood volume causes inadequate tissue perfusion in the body; it is the most common cause of shock in children and can be fatal if not detected early and
treated appropriately (Mecham, 2006; Nolan and Pullinger, 2014).

Children are more likely to experience dehydration than adults because water How to manage the care of the dehydrated child Leah Rosengarten, Lecturer in Children’s Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle upon Tyne, Leah.rosengarten@northumbria.ac.uk
constitutes a greater proportion of bodyweight in children than in adults (World Health Organization (WHO), 2009).

Furthermore, the younger the child, the poorer the ability of their kidneys to conserve water, and children use more water over the course of 24 hours than adults due to their higher metabolic rates (WHO, 2009). This article aims to aid nurses caring for children with dehydration in recognising and
treating dehydrated children.

Recognition

Recognition of the dehydrated child is a key skill for nurses caring for this patient group.
Assessment of all deteriorating or critically ill patients should always follow the ABCDE approach: airway, breathing, circulation, disability, exposure (Resuscitation Council UK, 2019). How To Manage The Care Of The Dehydrated Child Essay During ABCDE assessment, if the nurse suspects dehydration, they should consider whether the child appears unwell, has altered responsiveness (for example, is irritable or lethargic), has decreased urine output or has an increased heart or elevated respiratory
rate (National Institute for Health and Care Excellence (NICE), 2009). Recognition of the seriousness of the condition of a child with dehydration can sometimes be difficult on initial presentation as the child may at first appear to be quietly sleeping or undisturbed by assessment. Caution should be taken in
these circumstances to ensure that the sleep is not a symptom of altered responsiveness and that the child receives a full and thorough assessment.

Table 1 displays the clinical features of dehydration and hypovolaemic shock, which can be used to aid in the assessment and differentiation of these conditions (NICE, 2015). The clinical features in red are ‘red flags’ for medical professionals and should prompt an escalation in treatment (NICE, 2015). When assessing dehydration it is important to note that the severity of the dehydration can be judged by an increased number of or an escalation in any of the clinical features (NICE, 2015).

Symptoms to note

A child or baby who ‘appears unwell’ due to dehydration may present with any of the following:
■ Increased irritability, lethargy or a change in normal behaviour
■ Sunken eyes or dark circles under the eyes
■ Dry mouth and lips
■ Low blood pressure
■ High heart rate
■ Weak peripheral pulses
■ Reduced elasticity of skin
■ Capillary refill time of more than 2 seconds
■ Urine output less than 1ml per hour in children or 2ml per hour in infants
■ Loss of skin colour or mottled skin
■ Cooler than usual extremities.

Children particularly at risk

It is important that nurses caring for children recognise that the following groups are at increased risk of dehydration (NICE, 2009):

■ Children younger than 1 year, particularly those younger than 6 months
■ Infants who were of low birthweight
■ Children who have had more than five episodes of diarrhoea in the previous 24 hours How To Manage The Care Of The Dehydrated Child Essay
■ Children who have vomited more than twice in the past 24 hours
■ Children who have not been offered or have not been able to tolerate supplementary fluids to maintain hydration (see Box 1 and Box 2)
■ Infants who have stopped breast or bottle feeding during the illness
■ Children with signs of malnutrition.

Dehydration is a term which refers to the significant depletion of water in the body. It is a common condition among children and infants and accounts for a significant percentage of child morbidity and mortality worldwide. Dehydration results from decreased fluid intake or increased fluid loss. In children, these occur when they excrete body wastes in excessive amounts, exercise or engage in physical activities too intensely without adequate fluid intake, or suffer from another medical condition such as fever, diarrhea, or vomiting. Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

Dehydration, in itself, is a medical condition that may develop from regular activities that reduce fluid intake or facilitate fluid loss. However, it could also be a symptom of other medical conditions. Research suggests that dehydration is the most common symptom of diarrhea.

Because dehydration is common among children, various methods of diagnosis and treatment that are appropriate for younger age groups have been developed.

5 months old baby with dehydration, receiving medication through intravenous fluid therapy while asleep in hospital bed. Image Credit: Vinnstock / Shutterstock
5 months old baby with dehydration, receiving medication through intravenous fluid therapy while asleep in hospital bed. Image Credit: Vinnstock / Shutterstock

Signs and Symptoms of Dehydration

Children with dehydration usually have observable symptoms. However, the particular signs and symptoms of the condition vary depending on its degree of severity which is determined by the degree of liquid deficit and the serum sodium levels. The severity of dehydration is usually classified as mild, moderate, and severe.

Children with mild to moderate dehydration typically show the following symptoms:

Nausea or headache
Dizziness or light-headedness
Dark yellow or brown urine color
Decreased physical activity
Dry lips, mouth, and throat
Urinates less frequently

Meanwhile, children with severe dehydration may have these symptoms as well as the following clinical signs:

Excessive sleepiness
Sunken eyes
Discolored hands and feet
Persistent wrinkling of the skin
Faster heart rate
Extreme thirst
Other medical conditions could also be risk factors for the progression of dehydration. Parents and caregivers should be careful to rehydrate the child in all cases, and even more when the child is also suffering from diabetes, vomiting, diarrhea, heat-related illnesses, or fever.

Diagnosing and Treating Dehydration

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Dehydration in children is usually diagnosed upon clinical evaluation. The healthcare provider would usually assess the child’s symptomatology coupled with physical evaluation and pertinent laboratory tests to come up with a diagnosis. The severity of dehydration is determined by the assessment of hemodynamic changes in the body, tachycardia, and the presence of hypotension.

In diagnosing dehydration associated with other medical conditions, some doctors also use the World Health Organization’s dehydration scale (see below) as a supplemental measure to assess the condition.

General appearance

Well, alert

Restless, irritable

Lethargic or unconscious

Eyes

Normal

Sunken

Thirst

Drinks normally, not thirsty

Thirsty, drinks eagerly

Drinks poorly, or not able to drink

Skin turgor

Goes back quickly on pinching up and releasing a skin fold

Goes back slowly

Goes back very slowly

Fig. 1. WHO assessment for degree of dehydration associated with diarrhea
(retrieved from http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20150429170155509743) Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

In treating dehydration, clinicians must consider requirements for fluid replacement, the current level of fluid loss, any ongoing medical issues, and the maintenance plan. The World Health Organization and the American Academy of Pediatrics strongly recommend oral replacement therapy for children with mild to moderate levels of dehydration. On the other hand, children with severe dehydration should be rehydrated by IV fluids.

Can Dehydration in Children be Prevented?

Children are particularly susceptible to dehydration because they have a higher metabolism and greater evaporative losses compared to adults. However, dehydration can be readily prevented by careful attention. The following are best practices to avoid dehydration among children. Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

Ensure that a child’s daily fluid intake is sufficient, especially when the child is regularly engaging in physical activities or suffering from other medical conditions
Be mindful of weather conditions and increase a child’s fluid intake when necessary.
Mild dehydration can be treated at home, but moderate to severe dehydration would require clinical evaluation, treatment, and monitoring. Assignment: How To Manage The Care Of The Dehydrated Child Nursing Essay

ADDITIONAL INFORMATION;

Introduction

Dehydration in children is a serious medical condition that can lead to serious consequences if left untreated. This article provides you with advice on how to manage the care of a dehydrated child as well as information about how dehydration affects your child’s health, how it can be prevented and what you should look for when caring for your child.

Make sure your child’s fluid intake is adequate.

If your child is dehydrated and not drinking enough water, you may need to increase the amount of fluids they are getting. For example, if a child who has been given breast milk for two weeks is still not drinking any more than half a cup (120 mL) per day and their urine output is less than half of what it should be, they likely have become dehydrated. The dehydration can also cause constipation or diarrhea because the body cannot properly absorb nutrients from food if there isn’t enough water in your system.

Continue to breast-feed or use formula.

If your child is dehydrated and has stopped breast-feeding or using formula, continue to provide fluids until they have regained their normal weight.

If your child has stopped breastfeeding or formula feeding because of dehydration, consider starting again once you feel that the dehydration has been corrected. Do not stop giving liquids unless advised by a doctor or nurse.*

Allow your child to drink as much as he or she wants.

When your child is dehydrated, it’s important to make sure that he or she drinks enough fluids. The most common way this can happen is if your child doesn’t want to drink because he or she feels sick, or if the dehydration was caused by a medical condition (like an illness).

If you’re unsure whether your child should be drinking more often than usual, check with his or her doctor. Even if you think it’s okay for them to take on more fluid than usual, there may be certain circumstances where they shouldn’t—for example, if they are vomiting and have lost too much water in their body already; or if their kidneys are not functioning properly due to kidney disease (nephritis).

Offer popsicles, ice chips or water with meals.

Offer popsicles, ice chips or water with meals.
Offer water between meals and before bedtime.
If your child cannot tolerate liquids, consider giving them some type of nutritional supplement such as a homemade smoothie or juice made from scratch (avoid commercially prepared juice).

Add more liquids between meals and before bedtime.

Add more liquids between meals and before bedtime.
Why this is important: Dehydration can cause reduced appetite, which can lead to less food being eaten at a meal. This can mean that the child will not be getting enough calories in their diet, especially when they are young.
How much liquid? If your child is breastfeeding, aim for two ounces of water every three hours (or one ounce every four hours). For formula fed babies, give them two ounces of milk or juice per ounce of liquid you drink yourself—so if you’re drinking 8 oz of water per day then add an extra 2 oz for each additional day that week until you reach 10x your original intake. You’ll want to monitor how much water your baby needs because dehydration increases risk for serious health problems like pneumonia and kidney stones over time; keep an eye out for any signs such as thirstiness or lethargy!

Don’t delay seeking care.

If you suspect your child is dehydrated, seek medical attention immediately. If the dehydration is severe, call 911 or take your child to the emergency room at once.

If you have any doubt that an illness or injury may be responsible for the dehydration and need more time before making a decision about treatment, wait 24 hours before seeking help (unless there are signs of shock).

It’s important to keep a dehydrated child hydrated until the illness causing the dehydration resolves.

The right amount of fluids is critical for your child’s health. Dehydration can lead to serious health problems, including kidney and brain damage and death.
You should get in touch with your pediatrician if you suspect that your child has been exposed to any illness or injury that could cause dehydration; then have him or her checked out by a doctor as soon as possible so they can determine if he/she needs medical treatment (e.g., intravenous fluids).

Conclusion

Dehydration is a serious condition for infants and children, so it’s important to monitor your child’s fluid intake and seek medical help if symptoms persist. If you suspect your infant or toddler has been dehydrated, contact emergency services immediately.

Nursing Worker