TAGUM DOCTORS COLLEGE, INC

Mahogany St.Rabe Subd, Visayan Village, Tagum City

Case Analysis

About

Fluid and Electrolyte Alteration (Dehydration)

(NCM – 109)

Submitted to:
Donna B. Auza, RN, MAN
Clinical Instructor

Submitted by:
Christie V. Montano
BSN – 2

June 02, 2020

 I. INTRODUCTION

Dehydration, or fluid loss in excess of fluid intake, is one of the common causes

of hospitalization in infants and children. Decreased fluid intake or increased fluid loss

may cause it. Dehydration produces both fluid and electrolyte deficiencies. This might

happen when the child does not drink enough water or loses large amounts of fluids

from the body because of diarrhea, vomiting, or sweating. Severe dehydration can be

life-threatening. But, even moderate dehydration can be serious and might lead to

another hospital stay.

Globally, report in the context of the 2030 agenda for sustainable

development synthesizes data on the current situation and trends in reproductive,

maternal, newborn and child health and nutrition from a wide array of sources including

the profiles on the 81 Countdown priority countries, which together account for 95% of

maternal deaths and 90% of deaths among children under age 5. (WHO,2019).

Identification of the leading causes of children mortality rate particularly those under 5

years old is important as an index for improving health care facilities in those affected

countries.

In the Philippines, addressing to the problem regarding children health and

wellness, parents and caregivers need a facilitating environment of laws, policies,

services and community support to assist them in providing their young children with

nurturing care especially in times of illnesses outbreak. Excessive sweating due to very

warm weather, cholera, diarrhea and food poisoning are the leading causes of

dehydration among children.

 In our locality, particularly in Tagum City, Davao del Norte, and the City Health

Office along with its satellite barangay health centers are continually monitoring current

status of leading diseases which affected much of the children and one of this is

diarrhea which usually leads to dehydration. Consultations and regular immunizations

have been done weekly to ensure that children are protected against communicable

diseases. Also, the health center provides and gives Oral Rehydration Solution (Oresol)

for free as a remedy for diarrhea to prevent possible dehydration.

The student nurse conducted a case analysis about dehydration among children

and identifies the underlying causes and effects of this electrolyte imbalance which if not

treated could be fatal. Applying the approach suitable and applicable for the children

based on the child’s developmental stage and individual needs, the student nurse

adhere on her duty as the child’s advocate for health and wellness.

This case analysis aims to review and gather more information about how

dehydration, which is commonly, affects young children, how extensive it is if not being

treated and the interventions to prevent complications. Guided by its objectives, at the

end of this case analysis, the student nurse will be able to;

 Define dehydration, its causes, classifications and effects on children.

 Trace the anatomy and physiology of the systems affected by this illness.
 Present a pathophysiology about dehydration.
 Identify the signs and symptoms of dehydration.
 Formulate a nursing care plan for a child having a fluid and electrolyte imbalance.
 Identify medications that will treat dehydration.
 Give health teaching to the parent and to the child as well.
II. DEFINITON OF TERMS

1. Dehydration – excessive loss of water from body tissues accompanied by a

disturbance in the balance of essential electrolytes, particularly sodium,
potassium, and chloride.
2. Extracellular fluid ( ECF)– fluid from outside the cell composing approximately
one third of the body’s fluid in older children and about one half of the body’s fluid
in infant.
3. Hypernatremic (hypertonic) dehydration – state in which the sodium
concentration is above that normal body fluids ( i.e., 150/mEqL)
4. Hyponatremic (hypotonic) dehydration – state in which the sodium
concentration is below that of normal body fluids (i.e.,130/mEq/L)
5. Hypovolemic shock – a state of physical collapse and prostration caused by
massive blood loss, about one fifth or more of total blood volume related to
severe dehydration from excessive perspiration, diarrhea, and vomiting.
6. Interstitial fluid – ecxtracellular fluid surrounding the cell, including lymph fluid.
7. Intracellular fluid (ICF) – fluid found within the cells, composing approximately
two thirds of the body’s fluid in older children and about one half of the body’s
fluid in infants.
8. Intravascular fluid – extracellular fluid contained within the blood vessel
(e.g.,plasma)
9. Isonatremic (isotonic) dehydration – state in which the sodium concentration
is practically identical to that of body fluids (between 135 – 145 mEq/L
10. Oliguria – diminished urine output
11. Skin turgor – the resilience of the normal skin hen subjected to physical
distortion such as pinching or pressing; the relative speed with which the skin
resumes its normal appearance after stretching.
 III. Anatomy and Physiology

Different characteristics are unique to children and it affect fluid and electrolyte

balance. Infants and young children are more vulnerable than adults to alterations in

fluid and electrolyte balance. Under normal conditions, the amount fluid ingested during

a day should equal the amount of fluid lost through sensible water loss (e.g., urine

output) and insensible water loss (through respiratory tract and skin). Insensible water

loss per unit of body weight is significantly higher in infants and children. The faster the

respiratory rates of infants and young children also result in higher evaporative water

losses. Any condition that prevents normal oral fluid intake such as vomiting or results in

fluid losses such as in having diarrhea, hyperventilation, excessive sweating, burns and

hemorrhage is specially significant because it depletes the body’s store of water and

electrolytes among children than adults. Features of body fluid balance in children which

require water include;

 Due to grow quickly, need 0.5% - 3% water for growth

 Insensible water loss is two times more than the adult

 Fluid exchange of digestive tract quicker

 Water metabolism is higher ; infant ½ by total fluid ;adult 1/7 by total fluid

 Regulating function of water metabolism poorly in lungs and kidney

Body of water is located in two major components; within the cell, in the

intracellular compartment; and outside the cell, in the extracellular compartment. These

two compartments are separated by the cell membranes, across which body fluid is

continually exchange. Extracellular fluid (ECF) is located in several places; in interstitial

spaces (surrounding the cell, e.g., lymph fluid), intravascular (within the blood vessels or
plasma), and transcellular (e.g., cerebrospinal fluid, pericardial fluid, pleural fluid,

synovial fluid, sweat, and digestive secretions). A child is more likely to lose ECF than

intracellular fluid (ICF). ECF is lost first when fluid loss occurs through illness, trauma or

fever. The intracellular compartment is more difficult to dehydrate.

Body fluids are basically composed of two elements water and solutes. Water is

the primary constituent, with the infant’s weight being approximately 75% of water to the

adult’s 55% - 60%. In general, the volume of total body water to total boy weight

deceases with increasing age. An inverse relationship exists between total body water
and total body fat. Compared with adults, neonates, particularly premature infants, have

lower proportion of fat.

Solutes are composed of both electrolyte and nonelectrolytes. Most of the body’s

solutes are electrolytes, primarily sodium (Na+), potassium (K+), Chloride (Clꟷ),

calcium (Ca++), and magnesium (Mg++). The primary electrolyte of the ECF is sodium

while potassium and magnesium are the primary electrolyte in the ICF. The extracellular

compartment contains more sodium and chloride during infancy, which increases the

vulnerability of infants to electrolytes imbalances. Changes in the concentration of these

electrolytes may result in cellular dysfunction and illness. Problems of fluid and

electrolyte balance involve both water and electrolytes; thus treatment includes

replacement of both, calculated according to serum electrolyte laboratory values.

Pediatric Differences Related to Fluid and Electrolyte Balance

o Because of the higher percentage of water in the ECF,

Infants infants can lose fluids equal to their ECF within 2-3 days.

o Infants are less able to concentrate urine because of

immature renal function.

o Infants have higher rate of peristalsis than older children.

o Infants have immature lower esophageal reflux, which can

lead to dehydration and electrolyte disturbances.

o Infants have a harder time compensating for acidosis

because of their decreased ability to acidify urine.

o Infants and young children have higher metabolic turnover

Infants and
young children of water relative to adults because of a higher metabolic

rate. If losses are no replaced rapidly, imbalance occurs.

o Infants and young children are unable to verbalize or

communicate thirst

o In comparison with adults, infants and children have a

Infants and proportionately greater body surface area in relation to body

children
mass, resulting in a greater potential for fluid loss through

the skin and gastrointestinal tract.

o Infants and children have higher proportionate water content

(premature infants have 90%, term infants 75%- 80 %;

preschool children 60% to 65%, and adolescent

 approximately 55% - 60%, with a larger proportion of extra

cellular space.

o The immune system of infants and children is not as robust

as an adult’s immune system, rendering young children

more susceptible to infectious diseases, fever,

gastroenteritis, and respiratory infections, all of which can

result in fluid and electrolyte disturbances and fluid –

volume deficit.

o Infants and children are higher risk because of increased

exposure to infections in a day care or nursery setting.

Classifications of Dehydration

Dehydration is classified as:

1. Isonatremic dehydration – the most common type of dehydration in

children, water and electrolytes are lost in approximately the same proportion

as they exist in the body, and serum sodium levels remain within the normal

range of 138 to 145 mEq/L

2. Hyponatremic dehydration – the electrolyte loss is greater than the water

loss, resulting in a serum sodium concentration of less than 135mEq/L

3. Hypernatremic dehydration – the water loss is greater than the electrolyte

loss and the serum sodium concentration is more than 150 mEq/L

Dehydration has many varied causes. Common alterations that may lead to dehydration
reflect disturbances in the following systems:

 Gastrointestinal tract: vomiting, diarrhea, pyloric stenosis, malabsorption

 Endocrine system: fever, diabetes mellitus, cystic fibrosis
 Skin: burns
 Lungs: tachypnea
 Kidneys: renal failure
 Heart : congestive heart failure

Any age group can be affected, but neonates and infants are especially vulnerable to
the effects of dehydration.
Maintenance Fluid Requirements and Minimum Urine Output

Daily Fluid Requirements by Bod Weight

≤ 10 kg: 100 ml/kg

10 – 20 kg: 1000 ml + 50ml/kg for each additional between 10 and 20 kg

>20 kg: 1500 ml + 20 ml/kg for each additional kilograms over 20kg

Minimum Urine Output by Age Group

o Infants and toddlers: >2 – 3 ml/kg/hr.

o Pre-schoolers and >1 – 2 ml/kg/hr.

young school- age children:

o School – age children &: 0.5 – ml/kg/hr.

adolescents

IV. SIGNS and SYMPTOMS

MANIFESTATIONS of DEHYDRATION

For infants and young children with isonametric dehydration, the fluid deficit is

described as mild, moderate, or severe dehydration, depending on the percentage of

body weight lost:

 Minimal dehydration: <3% loss of body weight

 Mild dehydration: 3% to 5% loss of body weight; fluid volume loss of less

than 50 ml/kg

 Moderate dehydration: 6% to 10% loss of body weight; fluid volume loss of

50 to 100 ml/kg
  Severe dehydration: 10% or more loss of body weight; fluid volume loss of

100 ml/kg or more

One millilitre of body fluid is approximately equal to 1g of body weight, so a

weight loss or gain of 1 kg (2.2lb) in 24 hours represents a 1 – L fluid loss or gain. Older

children have a lower total body water content and ECF volume than do infants and

younger children. Therefore an equivalent percentage of body weight loss from

dehydration represents a more severe fluid depletion in the older child. Isonametric

dehydration in the older child is classified as mild if 3% of body weight is lost, moderate

if 6% of body weight is lost, and severe if 9% of body weight is lost. Laboratory testing

is usually reserved for moderately or severely ill children, in whom electrolyte

disturbances (e.g., hypernatremia, hypokalemia, metabolic acidosis or alkalosis) are

more common, and for children who need IV fluid therapy. Other laboratory

abnormalities in dehydration include relative polycythemia resulting from

hemoconcentration, elevated blood urea nitrogen (BUN), and increased urine specific

gravity.

In the early phases of dehydration, fluids, with some electrolytes, are lost from

the extracellular fluid; if the fluid loss continues, loss if intracellular can occur.

Dehydration can lead to shock. Because of the child’s ability to compensate and

maintain an adequate cardiac output, changes in heart rate, sensorium, and skin color

and turgor are earlier indicators of impending shock than is blood pressure.

Because dehydration can develop very quickly in infants and young children,

the nurse must be alert to early signs of dehydration in children with conditions in
which fluid losses are likely to occur, such as diarrhea, vomiting, burns, diabetes,

trauma, and fever. The condition of infants and young children can change rapidly

when fluid and electrolyte imbalances occur.

The general appearance of the child should be assessed as well as specific

parameters;

1. Intake and output – measure all fluid intake and losses accurately (including

vomitus, urine, stools, nasogastric drainage, and wound drainage). The

nurse must also consider insensible water loss.

2. Urine output and specific gravity – output less than 2 – 3 ml/kg/hr in infants

and toddlers, 1 – 2 ml/kg/hr in pre-schoolers and young school – age

children, and 0.5 – 1 ml/kg/hr in school –age children or adolescents or a

specific gravity greater than 1.020 may indicate dehydration. Glucose, large

amounts of protein, and radiographic dyes, however, elevate the specific

gravity and may interfere its accuracy.

3. Weight – weight is crucial indicator of fluid status. Accurate measurements of

the weight of the unclothed child, using the same scale at the same time of

the day, are essential. Changes in weight related to changes IV lines or

dressings should be identified by recording “with IV.” Weight gain during

illness may indicate fluid retention or pulmonary or generalized edema. The

weight should be rechecked, and the child should be assessed for pulmonary

crackles and periorbital edema.

4. Stool and vomitus – frequency, type, amounts, and consistency should be

assessed and recorded.

5. Sweating – estimate from dampness of clothing and linen.

6. Serum electrolytes –

7. Skin – asses color, temperature, turgor, moisture and capillary refill.

8. Mucous membranes and presence of tears – dry or sticky mucous

membranes and the absence of tears indicate dehydration. Absence of tears

is not significant in an infant younger than 2 to 4 months because infants of

this age often do not manufacture tears.

9. Anterior fontanel – a sunken or depressed fontanel in infants indicates

dehydration. Cranial suture lines may also become prominent with

dehydration.

10. Vital signs – fever increases the metabolic rate and fluid requirements. With

dehydration, the pulse rate is rapid, weak, and thread. An increase in the

respiratory rate compensates for metabolic acidosis, which often

accompanies dehydration. Blood pressure may be decreased in moderate

and severe dehydration, but it is a late sign of hypovolemia.

11. Behaviour – irritability, lethargy, confusion, or seizures may be present. The

child’s cry may be high pitched and weak.

 SYMPTOMOLOGY

Symptoms Actual Findings Effect to the

patient/Implication

Increased heart rate If the child is dehydrated, even


slightly, the heart has to work
harder to pump blood,
which can increase the heart
rate and cause an irregular
heartbeat or
palpitations. Dehydration thicken
s the blood and
makes blood vessel walls
constrict which can cause
hypertension, or high blood
pressure, and strain the heart.
Decreased blood pressure Dehydration can cause low blood


pressure due to a decrease
in blood volume. When the child
is very dehydrated, his
blood volume can decrease,
leading to a drop in blood
pressure. When blood
pressure drops too low, the
organs won't receive the oxygen
and nutrients they need.
Cold, clammy skin Lack of fluid in the skin can


cause dryness and
make skin feel cool
and clammy to touch. Skin that is
dry, cool and clammy may also
indicate dehydration.
Nausea Dehydration


can cause nausea and dizziness.
The nausea may lead to
vomiting. This makes the child
lose even more water,
worsening symptoms. Nausea
also is linked to low blood
pressure caused by dehydration.
 
Muscle cramps Being dehydrated can
cause your feet (and other
muscles) to cramp. The body
becomes dehydrated when the
child is not getting enough fluid
for the organs and tissues to
function properly.


Poor skin turgor Skin turgor is a sign of fluid loss
or dehydration. Diarrhea or
vomiting can cause fluid loss.
Infants and young children with
these conditions can rapidly lose
lot of fluid, if they do not take
enough water. Fever speeds up
this process.

ETIOLOGY

Etiology Actual Findings Effect to the

Patient/Implication
Predisposing The bodies of infants and
Factors: young children contain more
water (75%) than those of
Age adults and are more
vulnerable to dehydration.
They have a larger surface
area in relation to weight
(surface-to-volume ratio) than
do adult bodies, which allows
for greater water loss through
the skin. Moreover, since their
kidneys are not fully mature,
children excrete more diluted
urine, which means they lose
more water than they retain.
Furthermore, infants and
young children have a higher
risk of illness than adults.
Fever, vomiting and/or
diarrhea can rapidly result in
dehydration. Young children
also have more difficulty
recognizing and
communicating their need for
 water and rely on their
caregivers to supply sufficient
water to protect their health.

Family History If the child has congenital

(Maternal and anomalies acquired either
Paternal) from the paternal or maternal
side (e. g., renal disease)
basically it will expose the
child to illness and eventually
the higher the risk of
dehydration, compensating
that certain disease.
Hyponatremic
Hyponatremia dehydration with a sodium
concentration of less than 130
mEq/L (130 mmol/L) occurs
when diarrheal losses are
replaced with hypotonic fluids.
With solute and water loss,
ADH is secreted, triggering
the body to enhance water
absorption.
Precipitating Fever can worsen
Factors: dehydration. The higher the
Fever fever, the more dehydrated
the child may become. Unless
the child’s body temperature
decreases, the skin will lose
its cool clamminess and then
become hot, flushed, and dry
to the touch. Children and
infants lose more of their body
fluid to fever, and they are
more likely to experience
severe diarrhea and vomiting
from illness.
Malnutrition Malnutrition and dehydration,
caused by a lack of proper
nutrition and fluids, can lead
to infections, confusion and
muscle weakness. These
symptoms can result in
immobility, falls, pressure
ulcers, pneumonia and
a weak immune system and
 calories.

Decreased
sodium intake
Sodium is an essential
electrolyte that helps maintain
the balance of water in and
around your cells. It’s
important for proper muscle
and nerve function. It also
helps maintain stable blood
pressure levels. Normally,
your sodium level should be
between 135 and 145
milliequivalents per liter
(mEq/L).

Vomiting & The nausea may lead

diarrhea to vomiting. This makes you
lose even more water,
worsening symptoms when
accompanied with diarrhea.
V. PATHOPHYSIOLOGY

Predisposing factors: Precipitating factors:

Age Fever
Malnutrition
Family history (congenital illness) Decreased sodium intake
Hyponatremia (sodium <135mEq/L) Vomiting & diarrhea

Reduced fluid intake or fluid loss

Due to fever, diarrhea & vomiting

Sudden, rapid extracellular fluid loss

(ECF)

Imbalance in electrolytes

Loss of intracellular fluid (ICF)

Cellular dysfunction

Hypovolemic shock

Death
 VI. Diagnostic Evaluation

Key factors to consider in determining the type and severity of dehydration in

children include the following;

a. A history of acute or chronic fluid loss

b. Clinical manifestations

c. Child’s weight

d. Serum electrolyte values for moderate to severe dehydration

Abnormal serum electrolyte values, which include decreased bicarbonate, decreased

potassium, and decreased glucose, are not unusual in the dehydrated child, although in

isonametric dehydration, the sodium level remains within normal levels. Serum pH level

provide information about acid – base balance in an infant or child suspected having

acidosis or alkalosis. An elevated urine specific gravity (>1.020) suggests dehydration.

Common Diagnostic Tests for Fluid and Electrolyte Imbalance

Urine osmolality – is the osmotic pressure of the urine, usually greater than the

osmolality of serum. It’s a test used in the precise evaluation of the concentrating ability

of the kidney and used to monitor fluid and electrolyte imbalance.

Urine sodium – is a 24 hour urine test that evaluates sodium balance in the body by

determining the amount of sodium excreted in urine during a 24 – hour period.

Urine specific gravity – is a measure of the degree of concentration of a sample of

urine.

Urea nitrogen – is the amount of urea in grams produced by a person’s body over a

specific period of time. It is calculated as the sum of the urea excreted in the urine plus

that found in the blood by calculating blood urea nitrogen. Low urea nitrogen indicates

malnutrition or low protein intake.

Serum osmolality – is a measure of the osmotic concentration of blood serum,

expressed as the number of Osmoles of solute per kilogram of plasma water.

Assessment of the Severity of Dehydration

Clinical signs Mild Moderate Severe

Weight loss 3% - 5% 6% - 10% >10%

Vital signs:

o Blood pressure o Normal o Normal to low o Very low/orthostatic

o Pulse rate o Normal o Increased o Increased/weak
o Respiratory o Normal to o Rapid & deep
o Normal deep
rate
General appearance:

o Infants o Fussy & o Lethargic but o Drowsy, limp, cold,

thirsty arousable/ gray color, sweaty
o Older children o Thirsty, restless o Apprehensive, cold,
o Postural cyanotic, mottled
restless/alert
hypotension, skin, comatose
restless/thirsty

Mucous membranes Normal to slightly dry dry parched

Anterior fontanel Normal Sunken Markedly depressed

Eyes Normal Sunken Markedly sunken

Capillary refill <3 seconds 3 – 5 seconds >5 seconds

Skin turgor Normal Decreased Tenting

Urine output Mildly decreased, Decreased , diaper is Decreased, diaper is dry,

diaper may dry dry, concentrated urine decreased in the number of
with specific gravity of diaper change during the
1.020 – 1.030 day, concentrated urine
with specific gravity >1.030

Therapeutic management is directed toward correcting the fluid and electrolyte

imbalance and then treating the causative factors.

 VII. DRUG STUDY

Drug Classification Route/dosage Indication Mechanism Side Nurse

of action effects responsibilities

Generic Antidiarrheal Infants >1 Acute Contributes No - Always read

Name: month ( 1 -2 diarrhea to the Known the label 3X
Bacillus vials of 2 with recovery of side with the right
clausii billion/5mL duration of the intestinal effects patient and
suspension ≤14 days microbial check for the
Brand due to disorders of expiration date
Name: Children 2-11 infection, diverse and label.
drugs or origin. - Wash
Erceflora yrs. Old ( 1-2 poisons Produces hands before
various handling and
vials of 2 Chronic vitamins, administering
particularly the medicine.
billion/5ml persistent group B vit. - Check
Contributing for any
suspension diarrhea to correction discoloration or
of vit breakage of the
with disorders. vial.
Promotes - Have
duration of normalization your conurse
of intestinal check the
>14 days flora. medicine for
you.

-Monitor vital
signs, fluid and
electrolyte
level, urine
specific gravity

- Be alert
for any adverse
reactions.

- Monitor and
record I&O.-
- Check the IV
line before
infusion for
kinks and
swelling of the
site.
- Store properly
the medicine

- Report

immediately to

physician if the

patient reports

any

abnormalities
 VIII. MEDICAL INTERVENTION

Oral Replacement and Rehydration Therapy in Children with Vomiting or Diarrhea

Minimally Dehydrated Mild to Moderate Severe Dehydration

Dehydration

Not necessary unless not 50 – 100 ml/kg of ORS IV therapy; bolus of

ORT taking other fluids well plus replace continuing 20/ml/kg of normal
losses rapidly over 3 – saline or lactated
4 hr. period Ringer’s solution; begin
ORT for the remaining
deficit (100ml/kg over 4
hour) when child is
stable and alert and
can take oral fluids;
alternately infuse 5%
dextrose in half
strength normal saline
solution; keep IV line in
place until child is
drinking well.

Continuing 60 to 120 ml ORS for 60 – 120 ml ORS for 60 – 120 ml ORS for
losses child weighing <10kg, child weighing >10kg to child weighing <10kg,
120 – 240 ml for child replace fluid loss from 120 – 240 ml for child
weighing >10kg to each episode of weighing >10kg to
replace fluid loss from diarrhea or vomiting, or replace fluid loss from
each episode of diarrhea lost volume is each episode of
or vomiting, or lost accurately measured diarrhea or vomiting, or
volume is measured and and replaced (1ml/g lost volume is
replaced (1ml/g fluid fluid loss) accurately measured
loss) and replaced (1ml/kg
fluid loss); if unable to
drink, administer
replacement through
nasogastric tube or
infuse 5% dextrose and
quarter – strength
normal saline solution;
potassium 20 mEq/L
may be needed after
urination established.
Feeding Continue age – Continue Continue
appropriate diet breastfeeding; resume breastfeeding; resume
age – appropriate diet age – appropriate diet
as soon as dehydration as soon as dehydration
is corrected is corrected

Re – evaluate As necessary Every 1 to 2 hours Continuous evaluation;

hydration and must evaluate after
estimate each bolus of IV
continuing fluid solution
losses
 IX. NURSING CARE PLAN

Date/ Need Nursing Goal of

Cues Diagnosis Care Nursing Intervention Evaluation
05/30/20
Nutrition Deficient The child
7 fluid
al – will display 1. Monitor all 05/30/20
3
metaboli volume adequate fluid intake
related to and output. After 8 hours
Subjective c fluid
pattern gastric volume as 2. Monitor and
of
“Luya kayo infection evidenced measure urine
akong anak by normal output and intervention,
maam, electrolyte specific
unya walay levels. gravity. the child’s
gana 3. Monitor weight
accurately. temperature
mukaon
kay 4. Teach parents
normalizes
nagsige ug the signs and
suka,” as symptoms of from 38.5C
verbalized dehydration.
by the 5. Administer to 37C and
mother ORS over 3 to
4 hour period. urine specific

Objective: 6. Encourage the

gravity
mother to
Vomitus continue normalizes
present on breastfeeding.
linen 7. Perform from 1.000 –
sponge bath to
1.004.
Febrile lower the
38.5C increased
temperature.
Dry 8. Administer
mucous prescribed
membranes medicine for
infection.
Sunken
fontanel

Capillary
refill more
than 3
seconds

Very poor
skin turgor
X. Health Teaching

 Teach the parents about the signs and symptoms of dehydration.

 Instruct the parents how to prepare and replace fluids when the child is

mildly dehydrated with oral rehydration fluids such as pedialite and

oresol.

 Explain to the parents that during vomiting or diarrhea, water should

not be fed alone because important electrolytes are also diminished.

Thus, both water and electrolytes should be replaced.

 Instruct the parents and primary caregivers that proper handwashing

should be done all the time and especially before and after caring for

the sick child.

 Emphasize to the parents the proper disposal and cleaning of

contaminated waste disposals decreases the spread of infection.

 Advise the parents to avoid eating raw foods and suggest cooking the

food properly and boiling the water before drinking.

 Stress the importance of immunizations to protect from communicable

childhood diseases.

 Advise the parents to give the child nutritious foods rich in essential

nutrients such as carbohydrates, protein, fats, vitamins and minerals.

 Stress the importance of good hygiene and proper sanitation to

prevent the spread of diseases.

 XI. REFERENCES

Ashwill, J. W. (2014). Nursing Care of ChildrenPrinciples and Practice. Arlington, Texas: Saunders.

Doenges, M. M. (2016). Nurse's Pocket Guide 14th Edition. F.A Davis.

Elsevier, M. (2015). Mosby's Pocket Dictionary of Medicine, Nursing and Health Professions. Mosby, Inc.

Pillitteri, A., & Flag, J. S. (2018). Maternal and Cihld Health Nursing. Wolters Kluwer.