Question

Case Study:
Yasmin is a 12 month old female who was brought to the Emergency Department by her aunt. Yasmin’s aunt anxiously reports that the child has been having diarrhea for the past two days and “is not her usual self”. She adds that the child is fussy, lethargic, not feeding well and when she attempted to give Yasmin acetaminophen
she spit it out. Yasmin’s aunt reports that her parents are out of town, but that she does have the phone number of the hotel in which they are staying.
Assessment:
Weight: 11 kg Vital Signs Heart Rate: 115
Blood pressure: 85/50
Respiratory rate: 30 deep and rapid breathing Oxygen saturations: 95% on room air Temperature: 39.0 Degrees Celsius
General Appearance: Appears stated age. Height and weight proportional
Cardiovascular: Sinus tachycardia Respiratory: Clear breath sounds GI: Hypoactive bowel sounds
Gastrointestinal and Urinary: Has not voided in 8 hours, and is refusing fluids
Integumentary: Warm and dry to touch. Dry lips. Eyes appear sunken. No tears. Poor skin turgor
Neurological: Awake, but lethargic and irritable. Pupils equal, round and reactive to light, weak movements present in all four limbs

1.Differentiate between mild, moderate and severe dehydration in the pediatric patient. (3 marks)
2. Outline four priority nursing actions while caring for Yasmin. (4 marks)
3. Explain how diarrhea causes electrolyte imbalances and dehydration. (4 marks)
4. Describe 3 common methods of treatment for dehydration and diarrhea in young children. (3 marks)
5. Describe what actions should be taken to administer an antipyretic to Yasmin considering she is spitting up the medication. (2 marks)
6. Identify 3 assessment findings that indicate improvement in the dehydrated child. (3 marks)

Answer 1

1.Dehydration

Mild	Moderate	Severe
There is no hemodynamic changes Weight loss is less than 5% The symptoms are Dry skin ,dry mucosa Thirsty Child passes less or minimal urine Skin is moist Vitals are generally within limits Skin tents is normal No fever No hospitalization required Home remedies are enough	There is mild hemodynamic changes Weight loss is less than 10% There is dry skin with no urine output ,anterior fontanelles is sunken Eyes sunken Sticky oral cavity Heart rate increases Fatigue Skin tents slowly Mild fever Hone remedy with medical help	There is severe hemodynamic changes Weight loss is more than 15% There are Zero urine output Thready pulse Changes in mental status Electrolyte imbalance Decreased blood pressure Tears are absent Limbs are cold Capillary refills are very slow Fontanelles are more sunken Skin tents for a very longer time Drowsiness Abdominal pain Fever Needs to be hospitalized

2.The priority nursing actions are

• Fluid replacement prevent fluid loss and its complications .This can correct the blood pressure, increase urine output, maintain skin turgor.
• Administer analgesics to reduce fever .Tapid sponging or cold spine can be helpful
• Encouraging oral intake
• Monitoring for vitals ,electrolyte imbalance

3.Diarrhea refers to the increased number of bowel movements which is often watery. When it happens it generally excretes the nutrients and minerals from the body.The sodium, potassium,chloride, magnesium, etc., are lost from the body .When these electrolytes are lost there is an imbalance in the acid base secretion stimulating the major organs like kidney, heart and lungs to compensate the loss.If thus slowen or doesn't happen properly it leads to complications of diarrhea.

4.The common methods of treatment for diarrhea in children are

• Increasing the fluid intake orally in form of drinks, juice, soups,etc.,
• Providing a diet with bananas, rice ,apple sauce, toast or BRAT diet is highly effective
• Medication to stop diarrhea, intravenous fluid therapy