FLUID BALANCE IN CHILDREN

1. FLUID BALANCE IN CHILDREN Chapter 11 Vanessa Lockyer-Stevens

2. Introduction • This presentation investigates diarrhoea and vomiting, a major cause of the need for hydration therapy. • In conjunction with the book chapter, these slides should enable you to: • Identify the population at risk of diarrhoea and vomiting • Examine the nurse’s role in the assessment, planning, implementation and evaluation of care for a child with severe diarrhoea and vomiting and their family • List support agencies involved in the child’s care following discharge

3. Epidemiology Diarrhoea and vomiting (D&V) in the under 5s is still a leading cause of morbidity and mortality globally. Diarrhoea kills 2.5 million children every year, accounting for approximately 21% of all-cause mortality for children under five years old in developing countries. This equates to ‘one child dying every twelve seconds, or a jumbo jet full of children crashing every 90 minutes’. (Kosek et al 2003).

4. Use the book, or your own sources to answer the following questions within your learning groups: • Q. What is diarrhoea and vomiting? • Q. What are the common causes? • Q. What are the signs and symptoms?

5. Q. Look at the list of issues below. How might each of these affect the treatment you provide to a child with extreme diarrhoea and vomiting, and the advice you give to his family? • Physical well-being • Psychological well-being • Socio-economic circumstances • Cognitive development • Environment: - Disruption of routine - Effects on parents - Institutional factors - Increased nutrition factors

6. Assessing the Child • General impression - Does the child look unwell? • Airway, Breathing, Circulation – are they within normal limits for the child’s age? • Does the child exhibit gaze aversion? • Do they have dry skin, sunken eyes, a positive pinch test? Calculate the severity of dehydration. • Have there been less than 3 wet nappies in 24 hours, or less than 2-3 mls/kg for infant; 1-2 mls for young child 4 or ½ ml/kg for older child? • How many bouts of diarrhoea and vomiting has the child had?

7. Planning • The child needs to be isolated, so where in the ward are they best located? Check room to include oxygen, suction, cot or bed • Get: disposable gloves and linen, weighing equipment, stool specimen bottle, cannulation equipment, intravenous and oral fluids • Identify: nursing documentation, residency arrangements for parents and who to contact in the first instance (medical staff, play specialists, etc)

8. Implementation • Record, report and revaluate neurological state, breathing, pulse, temperature and if required, blood pressure • Weigh child to assess percentage of dehydrationAssist with intravenous cannulation. • Calculate emergency resuscitation fluids (if required) • Calculate replacement fluids • Calculate maintenance fluids over 24 hours • Accurately record & report all intake: fluid and food • Accurately record & report all output: vomit, urine and diarrhoea • Communicate plan and procedures to parents at all times • Send off stool specimen • Pay meticulous attention to child’s skin hygiene particularly buttocks and perineum

9. Evaluation • To track recovery, assess whether the child is: • More responsive to surroundings? • Less irritable, lethargic or distressed? • Displaying vital signs within normal range? • Hungry and thirsty? • Passing more urine? • Having fewer episodes of diarrhoea and vomiting? • Has sodium levels that are returning to normal?

10. Checklist for Discharge • Eating and drinking • No further vomiting • Seen by Dietician • Advice given about reducing the incidence of re-infection and cross infection • Information given about open access. • Information given about who will follow up and where it will take place • Parents happy with the discharge plan

11. After Care – Who Can Help? • Open access • NHS Direct • Heath Visitor • Practice Nurse • Nurse Practitioner