Care of the Mother and Child at Risk and with Problem (Acute and Chronic)

CU 7: PEDIA LEC
PROBLEMS IN NUTRITION AND ELIMINATION
o to maintain electrical equilibrium.

DEHYDRATION  DEHYDRATION is classified into three categories

on the basis of osmolality and depends primarily on
 DEHYDRATION is a common body fluid
the serum sodium concentration:
disturbance in infants and children and occurs
1. ISOTONIC DEHYDRATION – is a primary
whenever the total output of fluid exceeds the total
form of dehydration in which;
intake, regardless of the cause.
o Electrolyte and water deficits are
present in approximately balanced
 DEHYDRATION may result from a number of
proportions.
diseases that cause;
o Water and sodium are lost in
o Insensible Fluid Losses through the Skin and
approximately equal amounts.
Respiratory Tract
o through Increased Renal Excretion
2. HYPOTONIC DEHYDRATION - occurs
o through the GI Tract
when the electrolyte deficit exceeds the water
deficit;
 Although DEHYDRATION can result from; o Leaving the serum hypotonic.
o impaired oral intake, it is often a result of o Because ICF is more concentrated
abnormal losses, such as those that occur in than ECF in hypotonic dehydration,
vomiting or diarrhea, when oral intake only water moves from the ECF to the ICF
partially compensates for the abnormal losses. to establish OSMOTIC
EQUILIBRIUM.
 Other significant causes of dehydration include o This movement further increases the
diabetic ketoacidosis and burns. ECF volume loss, and shock is a
frequent finding.
 Recognizing that the distribution of water between o Because there is a greater proportional
the ECF and ICF spaces depends on active loss of ECF in hypotonic dehydration,
transport of potassium into and sodium out of the physical signs tend to be more
cells by energy-requiring processes. severe with smaller fluid losses than
with isotonic or hypertonic dehydration.
 SODIUM is the chief solute in ECF and is the o Serum Sodium Concentration is
primary determinant of ECF volume. LESS THAN 130 MEQ/L.

 SODIUM is considered a unique electrolyte in that 3. HYPERTONIC DEHYDRATION - results

water balance determines SODIUM from water loss in excess of electrolyte loss
CONCENTRATION; when water is lost and sodium o Usually caused by a proportionately
concentration becomes elevated compensatory larger loss of water or a larger intake
mechanisms in the kidney stop ADH secretion so of electrolytes.
water is retained. o This type of dehydration is the most
dangerous and requires more specific
 The THIRST MECHANISM (not fully functional in
fluid therapy.
infants) is also stimulated so water is replaced, thus o Plasma Sodium Concentration is
increasing the total body water content and
GREATER THAN 150 MEQ/L.
returning sodium to a normal level.

 POTASSIUM is primarily found inside the cell

(intracellular) but small amounts are also found in The DEGREE OF DEHYDRATION has been described as a
extracellular fluid. percentage of body weight dehydrated:

 SODIUM DEPLETION in Diarrhea occurs in two  MILD

ways: out of the body in stool into the ICF o Older Children: LESS THAN 3%
compartment; o Infants: LESS THAN 5%
o to replace potassium
 Care of the Mother and Child at Risk and with Problem (Acute and Chronic)
CU 7: PEDIA LEC
PROBLEMS IN NUTRITION AND ELIMINATION
 MODERATE Oral Rehydration Solution with ZINC added has been
o Older Children: 3% to 6% effective in diarrhea treatment.
o Infants: 5% to 10%
PREBIOTICS (oral supplements that stimulate growth of
probiotic bacteria to positively alter intestinal flora) have also
 SEVERE
been found to be effective in decreasing the number of
o Older Children: MORE THAN 6%
diarrheal stools in children with acute gastrointestinal
o Infants: MORE THAN 10%
disease.

ISOTONIC INTRAVENOUS FLUID is given accompanied

WEIGHT is the most important determinant of the percent by oral rehydration.
of total body fluid loss in infants and younger children.
A MILDLY DEHYDRATED CHILD may be given 50 ml/kg
However, often the pre-illness weight is UNKNOWN. of oral rehydration solution (ORS), and a child with
MODERATE DEHYDRATION may be given 100 ml/kg of
OTHER PREDICTORS OF FLUID LOSS include;
ORS.
 Changing level of consciousness (irritability to
A child with fluid losses from diarrhea may be given 10
lethargy)
ml/kg for each stool.
 Altered response to stimuli
 Decreased skin elasticity and turgor Amounts and rates are determined from BODY WEIGHT
 Prolonged capillary refill (>2 sec) and the SEVERITY OF DEHYDRATION and are
 Increased heart rate INCREASED if rehydration is incomplete or if excess losses
 Sunken eyes and fontanels continue until the child is well hydrated and the basic
problem is under control.
EARLIEST DETECTABLE SIGN is usually;
ABDOMINAL COLIC
 Tachycardia
 Dry skin and mucous membranes COLIC is a condition generally described as ABDOMINAL
 Sunken fontanels PAIN or CRAMPING that is manifested by loud crying and
 Signs of circulatory failure (coolness and mottling of drawing the legs up to the abdomen.
extremities)
Other definitions include variables such as DURATION OF
 Loss of skin elasticity
CRY greater than 3 hours a day occurring more than 3
 Prolonged capillary filling time
days a week and for more than 3 weeks and PARENTAL
DIAGNOSIS OF DEHYDRATION is best accomplished by DISSATISFACTION WITH THE CHILD’S BEHAVIOR.
clinical observations.
COLIC is more common IN INFANTS YOUNGER THAN
3 MONTHS than in older infants, and infants with
 Elevated blood urea nitrogen (BUN) (over 17
DIFFICULT TEMPERAMENTS are more likely to be
mg/dL)
colicky.
 Low serum bicarbonate (16–17 mEq/L or mmol/L)
Despite the obvious behavioral indications of PAIN, the infant
Useful to identify DEHYDRATION from moderate and
with colic gains weight and usually thrives.
severe DIARRHEA
There is no evidence of a residual effect of colic on older
ORAL REHYDRATION is the treatment of choice to treat
children.
mild and moderate dehydration in children.
Colic is SELF-LIMITING and in most cases resolves as
LACTOSE FREE milk, breast milk, or half-strength milk are
infants mature, generally around 12 to 16 weeks of age.
allowed to be given in addition to oral rehydration therapy
solution. POTENTIAL CAUSES FOR COLIC are;
Oral rehydration may be accompanied by ONDANSETRON  Too rapid feeding
to decrease vomiting in the child and its resultant continued
 Overeating
dehydration.
 Swallowing excessive air
 Care of the Mother and Child at Risk and with Problem (Acute and Chronic)
CU 7: PEDIA LEC
PROBLEMS IN NUTRITION AND ELIMINATION
 Improper feeding technique (especially in positioning ACUTE GASTROENTERITIS/ DIARRHEA
and burping)
 Emotional stress or tension between the parent and GASTROENTERITIS
child.
 Inflammation of the stomach and intestines that
Although all of these may occur, there is NO EVIDENCE that may be accompanied by VOMITING and
one factor is consistently present. DIARRHEA.

Colic is MULTIFACTORIAL and that NO SINGLE DIARRHEA

TREATMENT for every colicky infant will be effective in
 A SYMPTOM that results from disorders involving
alleviating the symptoms.
o Digestive
MANAGEMENT OF COLIC should begin with an o Absorptive
investigation of possible ORGANIC CAUSES o Secretory functions
(intussusception, cow’s milk allergy, or other GI problems).  DIARRHEA is caused by abnormal intestinal
water and electrolyte transport.
ONE IMPORTANT NURSING INTERVENTION (before  GASTROENTERITIS can affect any part of the GI
or after an organic cause has been eliminated) is; tract.
 It may be an ACUTE PROBLEM, caused by viral,
 Reassuring both parents that they are not doing
bacterial, or parasitic infections, or a chronic
anything wrong
problem.
 That the infant is not experiencing any physical or
 ROTAVIRUS is a leading cause of severe
emotional harm.
gastroenteritis in children less than 5 years of age
The INITIAL STEP IN MANAGING COLIC is; worldwide.
 Infants and small children with gastroenteritis or
 To take a thorough, detailed history of the usual daily diarrhea can quickly become DEHYDRATED and
events. are at RISK FOR HYPOVOLEMIC SHOCK if
fluid and electrolyte losses are not replaced.
AREAS THAT SHOULD BE STRESSED include;  DIARRHEA in children is related to many different
causes and the specific etiology is NOT always
1. The infant’s diet
identified.
2. The diet of the breastfeeding mother
3. The time of day when crying occurs  The COMMON MECHANISM is;
4. The relationship of crying to feeding time o Decrease in the absorptive capacity of the
5. The presence of specific family members during bowel through inflammation
crying and habits of family members, such as o Decrease in surface area for absorption
smoking o Alteration of parasympathetic innervation
6. Activity of the mother or usual caregiver before,
DIARRHEA may be mild, moderate, or severe.
during, and after crying
7. Characteristics of the cry (duration, intensity);
 In MILD DIARRHEA
8. Measures used to relieve crying and their
o Stools are slightly increased in number and
effectiveness
have a more liquid consistency.
9. The infant’s stooling, voiding, and sleeping patterns.
 In MODERATE DIARRHEA
Of special emphasis is a careful assessment of the o The child has several loose or watery stools.
FEEDING PROCESS via DEMONSTRATION BY THE
PARENT. Other symptoms include irritability, anorexia, nausea, and
vomiting. Moderate diarrhea is usually self-limiting, resolving
COLIC DISAPPEARS SPONTANEOUSLY, usually by 3 to without treatment within 1 or 2 days. In severe diarrhea,
4 months of age, although guarantees should never be given, watery stools are continuous. The child exhibits symptoms of
since it may continue for much longer. fluid and electrolyte imbalance, has cramping, and is
extremely irritable and difficult to console.
Other support persons and extended family members may
be enlisted to help the parents during this difficult time.
Care of the Mother and Child at Risk and with Problem (Acute and Chronic)
CU 7: PEDIA LEC
PROBLEMS IN NUTRITION AND ELIMINATION