Dehydration and Fluids
Why are oral rehydration solutions (ORS) preferred over drinks like juice or soda in children with vomiting or diarrhea?
ORS contain the correct balance of electrolytes and glucose to promote optimal absorption of fluids, while juice/soda can worsen diarrhea due to high sugar content.
A child has green (bilious) vomiting. What is the MOST concerning cause?
Bowel obstruction
Infant spits up but gains weight. Most likely condition?
Normal reflux/spitting up
Constipation leading to urinary symptoms occurs because?
Stool compresses bladder → incomplete emptying
A toddler with vomiting and diarrhea is alert and drinking fluids. Which order should the nurse question?
A. Offer oral rehydration solution
B. Monitor intake and output
C. Administer IV fluid bolus
D. Assess mucous membranes
C. Administer IV fluid bolus
Rationale:
Child is stable → oral rehydration is appropriate
IV fluids = unnecessary escalation
A child has tachycardia, delayed cap refill, and decreased urine output. What level of dehydration is MOST likely?
Perfusion changes + ↓ urine = worsening dehydration
What findings BEST indicates improvement in diarrhea?
Increased urine output / moist mucous membranes
Infant with projectile vomiting but still hungry. Diagnosis?
Pyloric stenosis
Vomiting child becomes lethargic with no tears. What is developing?
Dehydration
A child with dehydration has the following findings. Which indicates the child is worsening?
A. HR 140 → 120
B. Cap refill 3 sec → 5 sec
C. Increased thirst
D. Moist mucous membranes
B. Cap refill 3 sec → 5 sec
Rationale:
Perfusion worsening = shock progression
A lethargic child with poor perfusion is prescribed oral rehydration. What is the nurse’s BEST action?
Question the order and prepare for IV fluids
Which vomiting finding requires immediate follow-up?
Blood/coffee grounds/very green (bilious)
RLQ abdominal pain after starting near umbilicus. Priority?
Appendicitis → prepare for surgery
Appendicitis pain suddenly decreases. What is happening?
Rupture (emergency)
A child with suspected appendicitis reports sudden relief of abdominal pain.
Question: What is the nurse’s PRIORITY action?
A. Document improvement
B. Notify provider immediately
C. Administer pain medication
D. Encourage ambulation
Notify provider immediately
Rationale:
Pain relief = possible rupture → emergency
A child has hypertonic dehydration. What fluid strategy is MOST appropriate?
Replace with hypotonic fluids (more water than sodium)
What is the correct sequence for managing diarrhea?
Assess → rehydrate → maintain fluids → reintroduce diet
A child is newly diagnosed with celiac disease. Which meal selection by the parent indicates a need for further teaching?
A. Grilled chicken with rice and green beans
B. Scrambled eggs with fruit
C. Turkey sandwich on wheat bread
D. Baked potato with cheese
Turkey sandwich on wheat bread
GI bleed + tachycardia + pallor = priority concern?
Hypovolemic shock
A nurse is caring for a infant with pyloric stenosis. Which finding requires immediate intervention?
A. Projectile vomiting after feeds
B. Hungry after vomiting
C. Decreased urine output
D. Visible peristaltic waves
C. Decreased urine output
Rationale:
Dehydration = most dangerous complication
A child receiving IV fluids develops edema and bounding pulses. What complication is occurring?
Fluid overload
Coffee-ground emesis indicates what?
Upper GI bleeding
The nurse is teaching a parent of a child with celiac disease. Which statement indicates correct understanding?
A. “My child can have small amounts of gluten occasionally.”
B. “We should focus on a lifelong gluten-free diet.”
C. “Symptoms will resolve once medication is started.”
D. “Gluten only needs to be avoided during flare-ups.”
B. “We should focus on a lifelong gluten-free diet.”
Severe constipation + distention = likely complication?
Fecal impaction or bowel obstruction
A child with diarrhea has the following orders. Which should the nurse implement FIRST?
A. Administer anti-diarrheal medication
B. Obtain stool sample
C. Initiate oral rehydration
D. Provide low-fiber diet
C. Initiate oral rehydration
Rationale:
Priority = prevent dehydration (ABCs → circulation)
Everything else is secondary