What is the primary purpose of administering oral rehydration therapy (ORT) in a child with moderate dehydration due to gastroenteritis?

B) To replace lost fluids and electrolytes

A) To quickly increase blood pressure and heart rate

B) To replace lost fluids and electrolytes

C) To reduce the frequency of diarrhea

D) To prevent the need for intravenous fluids

What is the primary nursing intervention for a child with moderate dehydration due to acute gastroenteritis?

B) Initiate oral rehydration therapy

A) Administer intravenous fluids

B) Initiate oral rehydration therapy

C) Provide anti-diarrheal medication

Which assessment finding in the child indicates effective rehydration therapy?

A) Decreased capillary refill time to under 2 seconds

B) Increase in heart rate to 120 bpm

What is the primary nursing intervention for a child with mild electrolyte imbalance due to gastroenteritis?

B) Encourage oral rehydration therapy

A) Administer intravenous potassium supplements

B) Encourage oral rehydration therapy

C) Start a sodium-restricted diet

D) Withhold all fluids until electrolyte levels normalize

What is the primary indication that the child's circulatory system is responding well to rehydration therapy?

C) Blood pressure of 100/60 mmHg

B) Respiratory rate of 20 breaths per minute

C) Blood pressure of 100/60 mmHg

A child with a mild rash is being monitored by the nursing team. What is the most appropriate immediate nursing action to maintain skin integrity?

B) Advise the parents to avoid using any new topical products

A) Apply a new topical cream to soothe the rash

B) Advise the parents to avoid using any new topical products

C) Cover the rash with a bandage to protect it

D) Use a warm compress to alleviate the rash

What is the primary reason for advising against the use of new topical products on a child's rash during recovery from a viral infection?

A) To prevent potential allergic reactions that can worsen the rash

B) To ensure the rash remains visible for accurate monitoring

C) To avoid interfering with the body's natural healing process

D) To maintain the child's comfort by avoiding unnecessary treatments

What is the primary reason for monitoring urine output in a pediatric patient receiving rehydration therapy?

B) To monitor for potential infections

D) To check for electrolyte imbalances

Which of the following vital signs observed in the child indicates stability and normal function for her age?

A) Heart rate of 110 beats per minute

B) Respiratory rate of 30 breaths per minute

C) Blood pressure of 120/80 mmHg

AGE WITH MODERATE DEHYDRATION - Nursing Case Study

Pathophysiology

• Primary mechanism: Acute Gastroenteritis (AGE) often leads to diarrhea and/or vomiting, which causes the body to lose essential fluids and electrolytes like sodium and potassium, resulting in moderate dehydration.

• Secondary mechanism: The loss of fluids decreases blood volume, leading to reduced perfusion of tissues and potential hypovolemia. The body compensates by increasing heart rate and constricting blood vessels to maintain blood pressure.

• Key complication: If untreated, moderate dehydration can progress to severe dehydration, causing more significant circulatory compromise and potential organ dysfunction, emphasizing the importance of timely fluid replacement.

Patient Profile

Demographics:

6-year-old female, student

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Diarrhea for 2 days

• Key symptoms: Mild abdominal discomfort, reduced urine output, dry lips

• Vital signs: Temperature 98.6°F, Heart rate 100 bpm, Respiratory rate 20 breaths/min, Blood pressure 100/60 mmHg, Oxygen saturation 98% on room air

Section 1

Initial assessment findings reveal a 6-year-old female presenting with moderate dehydration secondary to acute gastroenteritis. Upon a more thorough physical examination, the child appears lethargic, but responsive. Her skin turgor is slightly decreased, and capillary refill time is about 3 seconds, indicating reduced peripheral perfusion. Oral mucous membranes are dry, correlating with the parent's report of reduced oral intake over the past 48 hours. Despite these findings, her vital signs remain relatively stable, with mild tachycardia at 100 bpm, consistent with compensatory mechanisms for dehydration.

A focused nursing assessment further identifies that the child has been experiencing approximately four to five loose stools per day, with no episodes of vomiting. Her weight shows a slight decrease from her baseline, highlighting the need for close monitoring of fluid status. Given these findings, the primary nursing intervention involves initiating oral rehydration therapy with an appropriate oral rehydration solution (ORS), encouraging small, frequent sips to gradually restore fluid and electrolyte balance. Education is provided to the parent about the importance of hydration and recognizing signs of worsening dehydration, such as increased lethargy or decreased urine output. This foundational nursing care aims to address the dehydration while preventing escalation to more severe complications. The next phase of care will focus on evaluating the child's response to rehydration and monitoring for any changes in her clinical status.

Section 2

As the child progresses through the initial phase of rehydration therapy, the nursing team closely monitors her response to the interventions. Over the next few hours, the child shows signs of improvement. She becomes more alert, and her interaction with her environment increases, indicating effective rehydration. Her skin turgor begins to return to normal, and capillary refill time improves to under 2 seconds. These changes suggest that peripheral perfusion is stabilizing. The child reports feeling thirsty, which is a positive indicator of recovery, and she willingly takes small, frequent sips of the oral rehydration solution under the guidance of her caregiver.

Vital signs are reassessed, showing a heart rate decrease to 90 bpm, reflecting a reduction in compensatory tachycardia as fluid balance improves. Her respiratory rate remains stable, and there are no signs of respiratory distress. The nursing team notes a slight increase in urine output, which aligns with improving hydration status. However, the child continues to pass loose stools, albeit with slightly reduced frequency, underscoring the ongoing need for vigilant assessment and supportive care.

Throughout this period, education for the parent continues, emphasizing the importance of maintaining hydration and monitoring for potential signs of worsening dehydration, such as decreased urine output or return of lethargy. The nursing team discusses with the parent the possibility of introducing a bland diet gradually, as tolerated, while maintaining the focus on fluid intake. The collaborative efforts of the healthcare team and the parent are crucial in ensuring the child's steady recovery and preventing any further complications. The next step will involve ongoing evaluation of her nutritional status and readiness for potential discharge planning once she demonstrates consistent improvement.

Section 3

As the child continues to progress through the rehydration phase, the nursing team conducts a thorough assessment to evaluate her current status and identify any new developments in her condition. Upon examination, the child's heart rate remains stable at 88 bpm, and her respiratory rate is consistent at 20 breaths per minute, indicating ongoing cardiovascular and respiratory stability. Her blood pressure is measured at 100/60 mmHg, which is within the normal range for her age, further confirming that her circulatory system is responding well to the treatment. The child's skin appears more supple, and her mucous membranes are moist, reinforcing the signs of effective rehydration.

Laboratory results are received, showing a mild electrolyte imbalance, with a slightly decreased sodium level of 132 mEq/L, which is common in cases of gastroenteritis. The nursing team explains to the parent that this is a result of the body's adjustment to the increased fluid intake and that it is expected to normalize as the child's rehydration continues. They emphasize the importance of continuing the oral rehydration therapy and introduce the idea of a balanced diet to support her recovery. Her potassium levels are within normal limits, at 4.0 mEq/L, indicating no immediate risk of hypokalemia.

Despite these positive indicators, the child experiences a mild rash on her abdomen and back, which is evaluated by the nursing team. They determine it is likely a transient reaction to either the illness or a mild sensitivity to a topical product used during her care. The parent is reassured that this is a common occurrence and is advised to monitor the rash for any changes. The child is kept comfortable, and the team closely observes for any signs of allergic reaction or infection. With continuous support and monitoring, the child is expected to maintain her trajectory of recovery, and the team begins preliminary discussions on discharge planning, focusing on home care instructions and follow-up appointments.

Section 4

As the child progresses through the rehydration phase, the nursing team continues to monitor her closely, paying particular attention to her response to interventions. Throughout the day, the child's energy levels appear to have improved significantly; she is more alert and interactive, showing interest in her surroundings. Her appetite has gradually returned, and she eagerly consumes small, frequent meals as recommended. This positive response to oral rehydration therapy and dietary adjustments suggests that her gastrointestinal function is recovering well. Her parents are encouraged by her increased activity and improved mood, which are promising signs of her overall recovery.

However, during a routine assessment, the nursing team notices that the child's mild rash has slightly expanded, now extending to her arms. Despite this progression, the rash remains non-tender and non-itchy, showing no signs of weeping or blistering. The team hypothesizes that the rash may be related to a viral exanthem, common in children during viral infections like gastroenteritis. To ensure comprehensive care, they decide to consult with a pediatrician to confirm this assessment and to rule out other potential causes. The team explains the situation to the parents, reassuring them that the rash is being closely monitored and that any necessary adjustments to the treatment plan will be made promptly.

In light of the rash's expansion, the nursing team reinforces the importance of maintaining skin integrity by advising against the use of any new topical products that could exacerbate the condition. They continue to focus on keeping the child comfortable and hydrated, emphasizing the importance of ongoing monitoring for any new symptoms or changes in her condition. With the child's vital signs remaining stable and her electrolyte levels gradually normalizing, the team remains optimistic about her continued recovery. As they prepare for potential discharge, they outline home care instructions, including managing the rash at home and scheduling a follow-up appointment to ensure the child's health remains on track.

Section 5

As the day progresses, the nursing team conducts a follow-up assessment to evaluate the child's ongoing response to the treatment plan. They carefully document her vital signs: temperature at 98.6°F, heart rate at 110 beats per minute, respiratory rate at 22 breaths per minute, and blood pressure at 95/60 mmHg. These values remain within normal limits for her age, indicating stable vital signs. The child's weight is also checked, showing a slight increase, which is a positive sign of successful rehydration and nutritional intake. Her urine output has significantly improved, with clear and ample urine, suggesting that her kidneys are functioning well and that dehydration is resolving.

A review of her lab results reveals that her electrolyte levels are approaching normal ranges. Sodium levels have risen from initial low levels of 130 mmol/L to 134 mmol/L, and potassium levels are stable at 4.1 mmol/L, reflecting effective oral rehydration and dietary management. The team also notes that the mild rash, while slightly expanded, has not developed any concerning features such as vesicles or crusting. The pediatrician's input confirms the suspicion of a viral exanthem, reassuring the team and the parents that this is common and self-limiting in pediatric cases of viral infections.

The nursing team discusses these findings with the child's parents, emphasizing the continued improvement and stability of her condition. They provide education on recognizing any potential signs of dehydration or worsening rash and stress the importance of maintaining the current hydration and nutritional regimen. The parents express relief and gratitude for the care their child has received, feeling confident in the plan moving forward. With discharge anticipated soon, the team schedules a follow-up appointment with the pediatrician to ensure the child's full recovery and address any lingering concerns. This proactive approach ensures a smooth transition from hospital care to home, supporting the child's health and well-being.