DEFINITION

 Dehydration is defined as an excessive loss of body fluid

and electrolytes.
Output is more than output.
.
TYPES OF DEHYDRATION BASED ON SEVERITY

 MILD:
When the total fluid loss reaches 5% OR LESS

 MODERATE:
When the total fluid loss reaches 5-10%

 SEVERE:
When the total fluid loss reaches more than 10%, considered of an
emergency case.
TYPES OF DEHYDRATION BASED ON TYPE OF FLUID LOSS

 HYPONATREMIC:

Primarily a loss of electrolytes, particularly sodium less than 135

 HYPERNATREMIC:
Primarily a loss of water, sodium more than 158

 ISONATREMIC

Equal loss of water and electrolytes sodium 135-154

 CAUSES

 Diarrhea
 Vomiting
 Excessive sweating
 Diabetes mellitus or Diabetic ketoacidosis
 Burns
 Excessive blood loss caused by trauma or accident
 SIGNS AND SYMPTOMS
 MILD DEHYDRATION
 No dehydration
 Thirsty
 Conscious
 Less than 5% of body weight is lost

 MODERATE DEHYDRATION
 Dry skin
 Thirst
 Decreased urine output
 Crying baby with tears
 SEVERE DEHYDRATION
 Excessive thirst
 Very dry mouth, skin and mucous membranes
 Sunken eyes
 No tears
 An urea
 Dry skin that lacks elasticity and slowly “bounces back” when pinched into a fold
 Rapid heart beat
 Rapid and swallow breath
 Unconsciousness
 More than 10% of body weight is lost
 Delay capillary refill for more than 2 seconds
Continu…

 Muscle weakness
 Drowsiness
 Light headache
 Sunken fontanels
 Decreased BP [Hypotension]
 Increased pulse rate [ Tachycardia]
 5-10% of body weight is lost
 Decreased capillary refill
 Shallow rapid respiratory rate
PATHOPHYSIOLOGY OD DEHYDRATION

Decreased intravascular volume

Decreased venous return

Decreased ventricular filling

Decreased stroke volume

Decreased cardiac output

Inadequate tissue perfusion

Dehydration
 DIAGNOSTIC EVALUATION

 History collection

 Physical examination

 BLOOD TEST

 Serum electrolytes

 Renal function test

 URINE ANALYSIS

 Urine routine
 TREATMENT

 Dehydration treatment depends on age, weight, the severity of

dehydration and its causes.
 Oral rehydration solution (ORS) for mild and moderate dehydration.
 IV fluid replacement (for severe dehydration)
 Treating the cause of dehydration.
 A single dose of ondansetron (Zofran) orally (syrup)
 TREATMENT OF MILD AND MODERTE DEHYDRARTION

 ORAL REHYDRATION SOLUTION (ORS)

 ORS is a simple treatment for dehydration
 ORS composed of
 30ml of sugar
 2.5ml of salt
 1 liter of water
 CONTRAINDICATION FOR ORS
 Severe dehydration
 Unconsciousness
 Frequent vomiting attack
 TREATMENT OF SEVERE DEHYDRATION
 NPO
 IV fluids replacement
 DAILY MAINTENANCE FLUID REQUIREMENTS
 Calculate child weight in kg
 Allow 100ml/kg for first 10kg body weight
 Allow 50ml/kg for second 10kg body weight
 Allow 20ml/kg for remaining body weight
 CALCULATING REPLACEMENT
 Deficit in ml = (wt)* % dehydrated * 10 (ideally the pre-dehydration weight
should be used)
 For ex:
 14kg child who is 5% dehydrated has a deficit of
 14*5*10=700ml
 FLuID REQUIREMENTS(BURNS VICTIM)
 PARKLAND FORMULA
 TBSA burned (%) * wt *4ml
 Example: a child weight 15kg, he has his leg burned
 TBSA=18
 18*15*4=1080ML.
 Give half of total requirements in first 8 hours, second half over 16
hours
 Give IV fluid to the burned victim (child) if the TBSA is 10% or more.

 CALCULATING DROP RATE PER MINUTES

 solution)ml*15/hr *min
 Example:
 540ML*15/8 HR *60 =16 drops per minute
 540ml*15/16*60 = 8 drops per minute
NURSING MANAGEMENT

 Assess vital signs, noting peripheral pulses

 Monitor blood pressure.

 Monitor intake and output

 Observe the physical properties of urine

 Correctly infuse the right amount of IVF in case of severe dehydration.

 Encourage small, frequent feeding.

 Provide skin care.

 Administer medication as per doctors order.

 NURSING DIAGNOSIS

 Deficient fluid volume related to active fluid loss due to hemorrhage, vomiting,
Diarrhea, burns, wounds.

 Impaired skin integrity related to loss of fluid.

 Risk for electrolyte imbalance

 Risk for hypovolemic shock

 Risk for decreased cardiac output

 Ineffective peripheral tissue perfusion related to severe dehydration

 Risk for ineffective thermoregulation

PREVENTION AND HOME CARE
 If your child has vomiting or diarrhea more than four to five times in 24
consecutive hours, start fluid replacement and increasing fluid intake.
 Even when you are healthy, drink plenty of fluids every day and drink
more when the whether is hot.
 Begin fluid replacement as soon as vomiting and diarrhea start- DO NOT
wait for signs of dehydration.
 Remind family that fluid needs are greater with fever, vomiting, or
diarrhea.
 Notify physician immediately in case of continuous vomiting and diarrhea.
 Teach the mother how to prepare ORS at home in case of mild and
moderate dehydration if oral rehydration solution (ORS) was not available.
Cont….

 (6 tea spoon ) of sugar.

 (1/2 tea spoon ) of salt.
 (4.25 cups ) of water.
 DEATH CARE
 After death the body undergoes many physical changes. So care must
be provided as early to prevent tissue damage/disfigurement of body
parts.

 PURPOSE OF DEATH CARE

 To prepare the body for the morgue.
 To prevent discoloration or deformity of the body.
 To protect the body from post mortem discharge.
PROCEDURES
Care of dead body, often depends upon the customs and religious beliefs.
Nurses provide dignity and sensitivity to the patient and family members
1. Check orders for any specimen.
2. Ask for special requests to family(eg: shaving, a special gown, bible in hand)
3. Remove all equipment, tubes, supplies and dirty linens.
4. Cleanse the body thoroughly, apply clean sheets.
5. Brush and comb the hair.
6. The eyelids are closed and held in place for a few seconds, so they remain closed.
7. Dentures should be in the mouth to maintain facial alignment.
8. Mouth should be closed.
9. Remove all the ornaments.
Conti…

10. Absorbent pads are placed under the buttocks to take up any feaces and urine
released because of muscle sphincter relaxation.
11. All the orifices should be closed.
12. Cover with a clean sheet up to the chin.
13. Spray a deodorizer to remove unpleasant odor.
14. Apply name tag (wrist, right big toe)
15. Allow the family members to view the dead body.
16. The body is wrapped in a large piece or plastic or cotton material used to
enclose a body after death.
17. Identification is then applied outside of the wrapper.
18. Hand over all the belongings to the relatives.
Conti..

19. Do complete documentation in the nursing notes.

 Time of death and actions taken to prevent the death.
 Who pronounced the death.
 Any organ donation.
 Personal articles left on the body.
 Personal items given to family.
 Time of discharge and destination of the body.
 Location of name tags on the body.
 Special request by family.
20. Hand over the dead body to the relatives/sent to the mortuary.
THANK YOU