Pediatric Dehydration Management Quiz

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Questions and Answers

What is a sign that the child truly feels ill and that the condition is serious?

Not protesting advances by the health care worker (correct)

Seeking the parent’s comfort and attention

Protesting advances by the health care worker

Displaying purposeless movements

What is assessed by pinching the abdominal skin, chest, arm, or leg?

Capillary filling time (correct)

Blood pressure

Pulse

Temperature

What is the capillary filling time in mild dehydration?

Less than 1 second

2-3 seconds (correct)

3-4 seconds

More than 4 seconds

What should be obtained at the same time each day when assessing body weight?

Body weight Signup and view all the answers

What is important to use when weighing the child?

The same scale each time Signup and view all the answers

What is vital to the assessment of dehydration?

Accurate measurements of fluid intake and output Signup and view all the answers

What can alter capillary filling time?

Heart failure Signup and view all the answers

What is decreased in relation to the degree of dehydration?

Body weight Signup and view all the answers

What should parents be advised to observe regarding the child's voiding?

The frequency and volume of voiding Signup and view all the answers

What is assessed as often as every 15 to 30 minutes when caring for the ill child?

Vital signs Signup and view all the answers

What is effective for assessing dehydration in children of all ages?

Capillary filling time Signup and view all the answers

What is important to use when weighing diapers to estimate urine volume?

1 g wet diaper weight equals 1 mL urine Signup and view all the answers

What is dehydration?

A condition where total fluid output exceeds total intake Signup and view all the answers

What can cause dehydration in infants and children?

Diseases causing insensible losses through skin, respiratory tract, increased renal excretion, and GI tract Signup and view all the answers

What is a common cause of abnormal losses resulting in dehydration?

Vomiting Signup and view all the answers

What is a clinical manifestation of gastrointestinal dysfunction in children?

Growth failure Signup and view all the answers

What is the definition of hematemesis?

Vomiting of bright red or denatured blood from the upper GI tract Signup and view all the answers

What is the definition of melena?

Passage of dark-coloured, 'tarry' stools resulting from denatured blood Signup and view all the answers

What is the definition of encopresis?

Involuntary overflow of incontinent stool causing soiling or incontinence Signup and view all the answers

What is the definition of dysphagia?

Difficulty swallowing caused by abnormalities in the neuro-muscular function of the pharynx or upper esophageal sphincter Signup and view all the answers

What is the definition of diarrhea?

Increase in the number of stools with increased water content as a result of alterations of water and electrolyte transport by the GI tract Signup and view all the answers

What are hypoactive, hyperactive, or absent bowel sounds evidence of?

Intestinal motility issues Signup and view all the answers

What is a common manifestation of illness in children with GI disorders?

Fever Signup and view all the answers

What is the definition of abdominal distension?

Protuberant contour of the abdomen that may be associated with dehydration, infection, or inflammation Signup and view all the answers

What is the primary solute in extracellular fluid (ECF) and what does it determine?

Sodium, and it determines ECF volume Signup and view all the answers

What affects sodium concentration and what stops antidiuretic hormone secretion?

Water balance affects sodium concentration, with compensatory mechanisms in the kidney stopping antidiuretic hormone secretion Signup and view all the answers

How is dehydration classified based on osmolality?

Isotonic, hypotonic, and hypertonic Signup and view all the answers

In which type of dehydration does water and sodium loss occur in approximately equal amounts?

Isotonic dehydration Signup and view all the answers

When does hypotonic dehydration occur?

When the electrolyte deficit exceeds the water deficit Signup and view all the answers

What results in hypertonic dehydration?

Water loss in excess of electrolyte loss Signup and view all the answers

How is diagnosis of dehydration based?

On the percentage of body weight lost Signup and view all the answers

What is a more accurate means of describing dehydration?

Reflecting acute loss in milliliters per kilogram of body weight Signup and view all the answers

What aids in identifying dehydration?

A detailed history and clinical signs, including weight, level of consciousness, skin elasticity, and heart rate Signup and view all the answers

What is important for identifying dehydration?

Parental reports of fluid intake, urine output, diarrhea, and emesis Signup and view all the answers

What are clinical signs of dehydration?

Tachycardia, dry skin, sunken fontanels, circulatory failure, and prolonged capillary filling time Signup and view all the answers

What is the recommended amount of unsweetened flavored drink mix for every 60-90mL of ORS like Pedialyte?

5mL Signup and view all the answers

What is the recommended fluid content for small popsicles given to older children instead of oral fluids?

40-50mL Signup and view all the answers

Why may some children refuse oral fluids initially?

Due to fear of emesis or decreased strength Signup and view all the answers

What is the recommended starting amount of ORS for rehydration in children?

2-5mL every 2-3 minutes Signup and view all the answers

In which cases is parenteral fluid therapy initiated?

For uncontrollable vomiting Signup and view all the answers

How many phases does parenteral rehydration therapy involve?

Three Signup and view all the answers

When is potassium withheld during parenteral rehydration therapy?

Until kidney function is restored and circulation has improved Signup and view all the answers

Why is rapid fluid replacement contraindicated in hypertonic dehydration?

Due to the risk of water intoxication Signup and view all the answers

What is essential for detecting and managing dehydration in children?

Nursing observation and intervention Signup and view all the answers

What are common signs of dehydration in ill children?

Vigorous cry Signup and view all the answers

In which country is ORS available as commercially prepared solutions?

Canada Signup and view all the answers

When is parenteral fluid therapy initiated?

When the child is unable to ingest sufficient amounts of fluid and electrolytes Signup and view all the answers

What is the recommended amount of oral rehydration solution (ORS) for a mildly dehydrated child?

100 mL/kg of ORS Signup and view all the answers

What is a common manifestation of severe depletion of extracellular fluid (ECF) volume?

Tachycardia Signup and view all the answers

What is impaired by decreased blood flow through the kidneys in cases of dehydration?

Urinary excretion Signup and view all the answers

What is the primary focus of therapeutic management for pediatric dehydration?

Restoring blood volume Signup and view all the answers

What are laboratory data useful for in determining dehydration in children?

Assessing acid-base balance Signup and view all the answers

What is a late sign of shock in infants and young children?

Hypotension Signup and view all the answers

What is the initial recommended rate for oral rehydration solution (ORS) for a child with moderate dehydration?

30 mL/kg/hour Signup and view all the answers

What is a common feature of severe depletion of extracellular fluid (ECF) volume?

Hypovolemia Signup and view all the answers

What is the primary mechanism for maintaining blood volume in response to fluid losses?

Movement of interstitial fluid into the vascular compartment Signup and view all the answers

What is the primary goal of medical management for pediatric dehydration?

Treating the underlying cause Signup and view all the answers

What is a common sign of severe depletion of extracellular fluid (ECF) volume?

Decreased skin turgor Signup and view all the answers

What is the recommended rate for oral rehydration solution (ORS) for a child with severe dehydration?

60 mL/kg/hour Signup and view all the answers

Study Notes

Pediatric Dehydration Management and Oral Rehydration Therapy

Oral rehydration solutions (ORS) like Pedialyte may need flavor enhancement with 5mL of unsweetened flavored drink mix for every 60-90mL of ORS.
Older children may be given small popsicles instead of oral fluids, containing 40-50mL of fluid and small amounts of sucrose.
Some children may refuse oral fluids initially due to fear of emesis or decreased strength, and rehydration can begin with 2-5mL of ORS every 2-3 minutes, gradually increasing.
Oral rehydration therapy (ORT) is effective for mild to moderate dehydration in children, is cost-effective, and has fewer complications than intravenous therapy.
Parenteral fluid therapy is initiated for severe dehydration, uncontrollable vomiting, or inability to drink, using isotonic solutions such as 0.9% sodium chloride or lactated Ringer’s solution.
Parenteral rehydration therapy involves three phases: initial therapy to expand volume quickly, subsequent therapy to replace deficits and meet maintenance requirements, and the final phase to allow the patient to return to normal and begin oral feedings.
Potassium is withheld until kidney function is restored and circulation has improved during parenteral rehydration therapy.
Rapid fluid replacement is contraindicated in hypertonic dehydration due to the risk of water intoxication and central pontine myelinolysis.
Nursing observation and intervention are essential for detecting and managing dehydration, with assessment starting with the general appearance and proceeding to more specific observations.
Ill children usually have dry mucous membranes and lips, loss of appetite, diminished activity level, and a less vigorous cry.
ORS is available in Canada as commercially prepared solutions and is successful in treating the majority of infants and children with dehydration.
Parenteral fluid therapy is initiated when the child is unable to ingest sufficient amounts of fluid and electrolytes, and involves three phases of therapy.

Pediatric Dehydration: Assessment and Management

Compensatory mechanisms maintain fluid equilibrium by adjusting to losses, with interstitial fluid moving into the vascular compartment to maintain blood volume and vasoconstriction of peripheral arterioles helping to maintain pumping pressure.
When fluid losses exceed the body's ability to sustain blood volume and pressure, circulation is compromised, resulting in tissue hypoxia and accumulation of acid metabolites, leading to metabolic acidosis.
Renal compensation is impaired by decreased blood flow through the kidneys, leading to little urine formation, and increased serum osmolality stimulates ADH to conserve fluid and initiates the renin-angiotensin mechanisms in the kidneys, leading to further vasoconstriction.
Shock, a common manifestation of severe depletion of extracellular fluid (ECF) volume, is preceded by tachycardia and signs of poor perfusion and tissue oxygenation.
Low blood pressure may be a late sign of shock in infants and young children, signaling the onset of cardiovascular collapse.
Clinical signs such as abnormal capillary refill, skin turgor, and respiratory pattern are useful in predicting dehydration in children.
Laboratory data are useful only when results are significantly abnormal, with urine specific gravity and blood urea nitrogen measurements being unreliable for determining dehydration in children.
Shock, tachycardia, and very low blood pressure are common features of severe depletion of ECF volume.
Therapeutic management involves determining the degree and type of dehydration, initial plasma sodium concentrations, serum bicarbonate concentration, and any associated electrolyte and acid-base imbalances.
Medical management is directed at correcting the fluid imbalance and treating the underlying cause, with oral fluid administration attempted when the child is alert and not in danger, and IV intervention required for severe dehydration.
Oral rehydration management involves replacement of fluid loss over 4 to 6 hours, provision for maintenance fluid requirements, and adjusting amounts and rates based on body weight and severity of dehydration.
A mildly dehydrated child may be given 50 mL/kg of oral rehydration solution (ORS), and a child with moderate dehydration may be given 100 mL/kg of ORS, with amounts and rates increased if rehydration is incomplete or if excess losses continue.

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Description

Test your knowledge of pediatric dehydration management and oral rehydration therapy with this quiz. Explore topics such as oral rehydration solutions, oral rehydration therapy, parenteral fluid therapy, compensatory mechanisms, clinical signs of dehydration, and therapeutic management. Perfect for healthcare professionals and students.