Royal Medical Services Provider Unit

Nursing Continuing Education and Training Department

DEHYDRATION
 Dehydration
whenever the total output of fluid exceeds the total
intake
 Etiology:
 insensible losses: through the skin , respiratory tract.
 through increased renal excretion
 through the GI tract
 ketoacidosis and extensive burns.
 Massive injury
Why infants are more susceptible to dehydration?
Water Balance in Infants
Extracellular > intracellular
approximately 60% of fluid is lost from the ECF
High insensible loss through skin
 Body Surface Area

the BSA of the premature neonate is five times as great as older

child
New-born is two to three times as great as older child
Longer GI surface area

Basal Metabolic Rate
The basal metabolic rate (BMR) in infants and children is higher to
support growth.
High BMR high fluid loss
 greater BSA production of metabolic wastes that must be
excreted by the kidneys

 Kidney Function
 The infant is less able to handle large quantities of solute-free
water than is the older child

How to calculate Daily Maintenance Fluid
Requirements??????????
TYPES OF DEHYDRATION
1. Isotonic (isosmotic or isonatremic) dehydration, the primary
form of dehydration
2. in children occurs in conditions which electrolytes and water
are lost in equal proportions , Na between 130 and 150
3. mEq/L.
.
2. Hypotonic (hyposmotic or hyponatremic) dehydration-Occurs
when the electrolyte deficit exceeds the water deficit
-Serum sodium levels are typically less than 130 mEq/L (clinical
example-near drown)

3. Hypertonic (hyperosmotic or hypernatremic)
dehydration water loss
in excess of electrolyte loss and is usually caused by a
proportionately larger loss of water or a larger intake of
electrolytes
 Plasma sodium concentration is greater than 150 mEq/L

(neurologic disturbances, including alterations in consciousness, poor ability

to focus attention, lethargy, increased muscle tone with hyperreflexia, and
hyperirritability)
ASSESSMENT OF DEHYDRATION

 Reduced body weight Mild-5%

 Moderate 10%
 Severe-15%
 Weight is the most important determinant of the percent of
total body fluid loss in infants and younger children
SIGNS &SYMPTOMS

 changing level of consciousness (irritability to lethargy)

 Decrease response to stimuli
 decreased skin elasticity and turgor
 prolonged capillary refill
 increased heart rate
 Sunken eyes and fontanels.
S&S CONNECTION TO DEHYDRATION
DEGREE

1. Mild or less than 5% loss two of the above signs

2. Moderate 5%-9% 3- 5 signs

3. Severe 10% 6 or more signs

THERAPEUTIC MANAGEMENT
(1)assessment of fluid and electrolyte imbalance

(2) rehydration: oral rehydration therapy (ORT)

is more effective, safer, less painful, and less costly than intravenous (IV)
rehydration

(3) maintenance fluid therapy

(4) reintroduction of an adequate diet

 NURSING CONSIDERATION

1- observe for symptoms of dehydration

Urine/ stools/ vomitus/ sweating/ vital signs skin / mucus
membrane/ body weight/ fontanel/ sensory alteration
NURSING CONSIDERATION
2-Correcting the fluid loss or deficit
3-Treating the underlying cause
4. Measure intake & output accurately
5- Correction dehydration may be attempted with oral fluid
administration. Oral rehydration management consists of:
 Replacement of fluid loss over 4 to 6 hours
 Replacement of continuing losses
 Provision for maintenance fluid requirements
DIARRHEA
 Diarrhea is a symptom that results disorders involving
digestive,. Absorptive , and secretory function . diarrhea is
caused by abnormal intestinal water and electrolyte transport

 Involved organs:
1. Stomach+ intestine: (gastroenteritis)
2. Small intestine: (enteritis)
3. Colon: (colitis)
4. Colon+ intestine: (enterocolitis)
CLASSIFICATION OF DIARRHEA
 Acute diarrhea:
upper respiratory/ urinary tract infections/ Antibiotic therapy/
laxative use
self-limited (< 14days duration)
Acute infectious diarrhea caused by viral, bacterial, and parasitic
 Chronic diarrhea:

malabsorption syndromes/ inflammatory bowel disease (IBD) /

immune deficiency, food allergy, lactose intolerance.
duration of more than 14 days
ETIOLOGY
 Pathogen spread via fecal oral route by:
1. contaminated food or water
2. Crowding
3. Poor hygiene
4. poor sanitation

 It could be virus/ bacterial/ parasitic infection

 Rotavirus cause 70% to 80% of infectious diarrhea.
 bacteria: Salmonella, Shigella, Clostridium difficile

 Parasite: Cryptosporidium
Why antibiotic administration increase cause diarrhea?
 PATHOPHYSIOLOGY
Enteric pathogens-- affect
mucosal cells increase intestinal secretions toxins &
decreased intestinal absorption  intestinal damage or
inflammationEnteric pathogens attach to the
mucosal cells diarrhea

 The most immediate disturbances associated with diarrhea:

1. Dehydration
2. Acidbase imbalance with acidosis, and
3. shock that occurs when dehydration progresses to the point that circulatory status is
seriously impaired
DIAGNOSTIC EVALUATION
 History

symptoms such as the presence of fever, vomiting, frequency, and character of stools
 Neutrophils or red blood cells in the stool indicate bacterial
gastroenteritis or inflammatory bowel disease

 eosinophils and mucus suggests parasitic infection

THERAPEUTIC MANAGEMENT
(1)assessment of fluid and electrolyte imbalance

(2) rehydration: oral rehydration therapy (ORT)

is more effective, safer, less painful, and less costly than intravenous (IV)
rehydration

(3) maintenance fluid therapy

(4) reintroduction of an adequate diet

NURSING CONSIDERATION
 Physical assessment for signs & symptoms
 History taking about possible etiology
 Maintain careful handwashing to reduce risk of spreading
infection
 Give ORS frequently in small amounts, especially if child is
vomiting,
 Administer antimicrobial agents as prescribed
 After rehydration, offer child regular diet as tolerated
 Maintain a strict record of intake and output
 Weigh child daily to assess for dehydration
 Attempt to keep infants and small children from placing hands
and objects in contaminated areas
 Instruct family members and visitors in isolation practices,
especially handwashing, to reduce risk of spreading infection
 Change diaper frequently to keep skin clean and dry
 Cleanse buttocks gently with bland, nonalkaline soap and
water or immerse child in a bath for gentle cleansing
 Apply ointment such as zinc oxide to protect skin from
irritation
CONSTIPATION
 constipation as 3 or more days without the passage of stool,
painful bowel movements, with blood streaked.

 Obstipation: Having extremely long intervals between

defecation.
ETIOLOGY
 Structural disorders:
1. Strictures
2. ectopic anus
3. Hirschsprung disease
 Systemic disorders

1. Hypothyroidism
2. Hyperparathyroidism
 Others

1. Antacids
2. Diuretics
3. iron supplementation
4. Spinal cord lesion
NEWBORN PERIOD
 Intestinal atresia or stenosis,
 Hirschsprung disease (congenital aganglionic megacolon),
 hypothyroidism,
 meconium plugs,
 meconium ileus
INFANCY
 Hirschsprung disease, hypothyroidism, and strictures.
 Constipation in infancy is often related to dietary practices.
 less common in breast-fed infants
 In case of constipation, increase the amount of cereal,
vegetables, and fruit
CHILDHOOD
 A child who has experienced discomfort during bowel
movements may deliberately try to withhold stool.
 in school-age: stresses and changes in toileting patterns.
 Treatment in this case:

1. changing the diet to provide more fiber and

Fluids
2. establishing a bowel routine that allows for regular passage of
stool
3. Stool-softening agents
TREATMENT

 Treatment of the cause.

 -More amount of range juice or high fiber diet.
 -Symptomatic treatment: liquid paraffin oil, glycerin
suppositories, and local anaesthesia
 -ointment in painful defecation
 Stool softeners
 NURSING CARE MANAGEMENT
 -Nursing assessment begins with an accurate history of bowel
habits; diet; events.
 -Dietary modifications are essential in preventing constipation.
 -During infancy, simply increasing the carbohydrate (sucrose
or corn syrup).
 -During childhood, the diet should contain increased amounts
of fiber and fluid.
 Bowel training and environment modification
LT/1 ALAA AL-AWAMLAH 