Early signs include dry mucous membranes, decreased urine output, no tears when crying, and irritability.
Before you read
Test yourself first: 4 questions
Question 1 of 4
An older adult is brought in for evaluation. Which set of findings is most consistent with delirium from dehydration?
Answer: A. Delirium from dehydration presents with acute confusion, dry mucous membranes, decreased skin turgor, concentrated urine, and possible hypotension or tachycardia. Gradual painless memory loss with normal vitals points to dementia, not an acute reversible cause.
Question 2 of 4
A nurse palpates a newborn's anterior fontanel. Which finding is EXPECTED and normal?
Answer: B. The anterior fontanel is normally soft, flat, and diamond-shaped, and may pulsate gently; it closes by 12-18 months. A bulging, tense fontanel suggests increased intracranial pressure, and a markedly sunken fontanel suggests dehydration. A flat, soft fontanel is the reassuring finding.
Question 3 of 4
Which presentation should make the nurse suspect delirium rather than dementia in an older adult?
Answer: B. Delirium has an acute, abrupt onset over hours to days with a fluctuating course and impaired attention, often from an underlying cause such as infection, dehydration, or medication. Dementia develops gradually over months to years with stable attention early on.
Question 4 of 4
What is the compression-to-ventilation ratio for two-rescuer CPR in a child or infant?
Answer: B. For two-rescuer pediatric CPR (child or infant), the ratio is 15 compressions to 2 breaths. For a lone rescuer it is 30 to 2.
Keep the streak going with more questions like these, each with a full rationale.
What is pediatric dehydration?
Infants and young children dehydrate faster than adults because they have a higher body-water percentage, higher metabolic rate, and greater body-surface-area-to-weight ratio. Severity is classified as mild, moderate, or severe based on weight loss and clinical signs; weight is the most accurate indicator.
Key points to remember
- Early signs include dry mucous membranes, decreased urine output, no tears when crying, and irritability.
- A sunken anterior fontanelle in infants and sunken eyes indicate significant fluid loss.
- Tachycardia is an early compensatory sign; hypotension is a late and ominous sign in children.
- Prolonged capillary refill (over 2-3 seconds), poor skin turgor, and cool mottled extremities suggest moderate-to-severe dehydration.
- Weight loss quantifies severity: mild about 3-5%, moderate about 6-9%, severe 10% or more.
- Decreased level of consciousness and minimal or absent urine output mark severe dehydration.
Signs & symptoms
- ↓ urine, no tears, dry mucosa
- Sunken fontanel + eyes
- Poor skin turgor, ↑ cap refill
Nursing priorities
- Assess hydration status: weigh the child, check fontanelle, mucous membranes, skin turgor, capillary refill, and urine output.
- For mild-to-moderate dehydration, give oral rehydration solution in small frequent amounts.
- For severe dehydration or shock, establish IV access and give isotonic fluid boluses (normal saline or lactated Ringer's) as ordered.
- Monitor strict intake and output, daily weights, and vital signs frequently.
- Identify and treat the underlying cause and correct electrolyte imbalances as ordered.
Labs & values
Patient teaching
- Offer oral rehydration solution rather than plain water, juice, or soda during diarrhea and vomiting.
- Continue breastfeeding or formula; give small frequent sips to avoid triggering more vomiting.
- Watch for and report fewer wet diapers, no tears, dry mouth, sunken eyes, or unusual sleepiness.
- Seek care promptly for ongoing vomiting, bloody stools, or signs of worsening dehydration.
Red flags: report now
- Lethargy, no urine output for many hours, sunken fontanelle, or absent tears signal severe dehydration.
- Hypotension, weak pulses, mottled or cold extremities, and altered consciousness indicate impending hypovolemic shock.
- Continued vomiting that prevents oral intake requires escalation to IV rehydration.
- Never delay IV fluid resuscitation in a child showing signs of shock.
References
Clinical references for this topic
