A nurse is assessing a child for dehydration.
Which of the following should the nurse evaluate during the physical examination?

Choice A rationale:

Normal saline (0.9% NaCl).

Rationale: Normal saline is the most appropriate choice for a client with dehydration and hyponatremia.

It provides a balanced solution with sodium and chloride, which can help correct hyponatremia and rehydrate the client.

It is an isotonic solution and is commonly used for fluid resuscitation.

Choice B rationale:

Half normal saline (0.45% NaCl).

Rationale: Half normal saline is also an isotonic solution, but it contains less sodium than normal saline.

In a case of hyponatremia, it's better to use a solution with a higher sodium concentration, making choice A (normal saline) more appropriate.

Choice C rationale:

Lactated Ringer’s.

Rationale: Lactated Ringer's is another isotonic solution, but it may not be the best choice for a client with hyponatremia.

It contains lactate, which can be metabolized to bicarbonate, potentially worsening the client's hyponatremia.

Therefore, it's not the most appropriate option in this case.

Choice D rationale:

D5W (5% dextrose in water).

Rationale: D5W is a hypotonic solution and should not be used for rehydration in a client with hyponatremia.

It can exacerbate the electrolyte imbalance and is not suitable for addressing dehydration.

Choice A rationale:

Vital signs are essential in assessing dehydration.

An elevated heart rate may indicate compensatory mechanisms due to decreased intravascular volume.

Low blood pressure may suggest severe dehydration, and abnormal temperature may indicate an underlying infection.

These parameters provide crucial information about the child's circulatory status, helping to assess the severity of dehydration.

Choice B rationale:

Physical examination findings, such as skin turgor and mucous membrane moisture, are valuable indicators of dehydration.

Poor skin turgor, where the skin doesn't return to its normal position promptly when pinched, indicates decreased tissue turgor due to fluid loss.

Dry mucous membranes, including the mouth, suggest dehydration and help evaluate the extent of fluid deficit.

These signs offer direct visual clues about the child's hydration status.

Choice C rationale:

Laboratory tests play a significant role in diagnosing dehydration.

A complete blood count (CBC) helps identify elevated hematocrit levels, indicating hemoconcentration due to fluid loss.

Electrolyte levels, specifically sodium and potassium, provide insights into the child's electrolyte balance, which can be disrupted in dehydration.

Urine specific gravity measures the kidney's ability to concentrate urine; a high specific gravity suggests concentrated urine due to reduced fluid intake.

These tests aid in confirming the diagnosis and assessing the severity of dehydration.

Choice D rationale:

Assessing the child's history is fundamental in understanding the underlying cause of dehydration.

Recent fluid intake and urine output patterns help determine the balance between intake and output.

Symptoms such as diarrhea, vomiting, and fever indicate potential causes of fluid loss.

Additionally, evaluating the child's overall health and any recent illnesses provides context for the dehydration, guiding appropriate treatment.