A client who has been diagnosed with mild hyponatremia and has experienced gastric fluid loss from vomiting is about to receive Half Normal Saline (0.45% NaCl).
This intravenous fluid contains Sodium 77 mEq/L and Chloride 77 mEq/L.
It is contraindicated in cases of hypovolemia, hyponatremia, increased intracranial pressure, liver disease, trauma, and burns.
What should the client say to demonstrate understanding of the treatment plan?

“Severe dehydration, which is ≥10% loss of body weight.”.

Choice A rationale:

Mild dehydration is typically classified as a 3-5% loss of body weight.

The signs and symptoms described in the scenario, such as dry mucous membranes, decreased urine output, and decreased skin turgor, are indicative of more severe dehydration than a 3-5% loss.

Choice B rationale:

Moderate dehydration is generally considered to be a 6-9% loss of body weight.

However, the signs and symptoms presented in the scenario suggest a more severe state of dehydration.

Choice C rationale:

Severe dehydration is classified as a loss of ≥10% of body weight.

The signs and symptoms observed by the nurse, including dry mucous membranes, decreased urine output, and decreased skin turgor, are consistent with severe dehydration, making choice C The correct classification.

Choice D rationale:

No dehydration is defined as less than a 3% loss of body weight.

The clinical manifestations observed in the child, as described in the scenario, clearly indicate dehydration.

In this case, the child's signs and symptoms align with the classification of severe dehydration, which is characterized by a loss of ≥10% of body weight.

These symptoms include dry mucous membranes, decreased urine output, and decreased skin turgor.

It's crucial to recognize the severity of dehydration accurately to initiate the appropriate treatment and prevent complications.

The correct answer is B. Shakiness.

Choice A: Increased capillary refill Capillary refill time (CRT) is a simple and quick test requiring minimal equipment or time to perform. Prolonged CRT is a ‘red flag’ feature, identifying children with increased risk of significant morbidity or mortality. A normal CRT should be between 2-3 seconds when applied centrally, such as to the sternum or the forehead. Therefore, increased capillary refill is not typically associated with hypoglycemia.

Choice B: Shakiness Shakiness, or tremors, are rhythmic shaking movements that most often happen in the hands, but can also occur in the arms, legs, head, vocal cords, and torso. Tremors can occur while a child is resting or active. Shakiness is a common symptom of hypoglycemia.

Choice C: Thirst While it’s true that excessive thirst can be a sign of diabetes, it’s a tricky one when the patient is a child. Young children often drink plenty of fluids when they are perfectly healthy. However, thirst is typically associated with hyperglycemia, not hypoglycemia.

Choice D: Decreased appetite Loss of appetite (anorexia) is a common symptom in children. Acute illness in childhood is often associated with transient loss of appetite. However, decreased appetite is not typically a direct symptom of hypoglycemia.