Explain the various types of dehydration and the causes of each
Hypotonic (hyponatremic)
- primarily a loss of sodium
- heat stroke
- burns
- trauma
- ketouria
- cystic fibrosis
- diuretics
Hypertonic (hypernatremic)
- loss of water
- diarrhea
- water deprivation
- excessive sweating
- heat stroke
Isotonic
- equal loss of water and sodium
- excessive sweating not drinking
- vomiting
- diarrhea
- bleeding
Dehydration, is thus a term that has loosely been used to mean loss of water, regardless of whether it is as water and solutes (mainly sodium) or as free water. Hypotonic dehydration refers to solute loss, and thus loss of intravascular volume, but in the presence of exaggerated intravascular volume depletion for a given amount of total body water gain. Neurological complications can occur in hypotonic and hypertonic states. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon rapid rehydration.[6]
Describe the manifestations of dehydration
Mild to moderate
- Dry, sticky mouth
- Sleepiness or tiredness — children are likely to be less active than usual
- Thirst
- Decreased urine output
- No wet diapers for three hours for infants
- Few or no tears when crying
- Dry skin
- Headache
- Constipation
- Dizziness or lightheadedness
Severe
-listless
-weak rapid pulse
-Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
Very dry mouth, skin and mucous membranes
Little or no urination — any urine that is produced will be darker than normal
Sunken eyes
Shriveled and dry skin that lacks elasticity and doesn’t “bounce back” when pinched into a fold
In infants, sunken fontanels — the soft spots on the top of a baby’s head
Low blood pressure
Rapid heartbeat
Rapid breathing
No tears when crying
Fever
In the most serious cases, delirium or unconsciousness
List predisposing factors to fluid and electrolyte problems in young children and elderly patients
Children
- vulnerable because of their relatively small body weight and high turnover of water and electrolyte
- high metabolic rate
- immature kidneys
Elderly
- bodys ability to conserve water is reduced
- thirst sense becomes less acute
- less able to respond to changes in temperature
- decrease renal function
- medication
Describe various causes and manifestations of gastroenteritis including E.coli
- viruses, bacteria, parasites
- fecal to oral
- E-coli comes from undercooked ground beef
- found in unpasteurized diary and fruit
Manifestation
- Watery diarrhea with cramping
- Vomiting may be present
- Bloody diarrhea after several days
- Pallor
- Edema
- Oliguria or anuria
- Petechiae
Some complications
- Chronic renal failure
- Seizures
- Coma
- Congestive heart failure
Interpret diagnostic tests related to gastroenteritis and dehydration
Stool culture – to determine bacteria causing diarrhea
Stool O&P – determine presence of OVA and parasites
Stool viral panel/culture – determine presence of rotavirus or other
Stool for occult blood – to determine if blood in stool to determine inflammation or other ulcertation present
Electrolyte panel to indicate dehydration
ABD radiograph – constipation, fecal infection or obstruction
CBC
URINE
HEMATOCRIT – falsely elevated because of dehydration
POTASSIUM – falsely elevated
Describe the nursing assessment and management of a child with gastroenteritis
Auscultate for hyperactive bowel sounds indication of diarrhea
- assessment of dehydration caused by diarrhea
- tenting, dry mouth, dry mucous
- intake and output
Identify the potential learning needs of parents whose children have gastroenteritis
- Ask her what she wants to know
- signs and symptoms of dehydration
- risk factors for gastroenteritis (uncooked meat)
- infection spread (good hand washing)
