Therapeutic management of the child with acute diarrhea and dehydration usually begins with what intervention?

Choice A reason: Mechanical ventilation does not necessarily increase the fluid requirements of a child. Mechanical ventilation is a method of providing artificial breathing support to a child who has respiratory failure or insufficiency. Mechanical ventilation may affect the fluid balance of a child by altering the insensible losses, the renal function, or the hemodynamics. However, the net effect may vary depending on the type, mode, and settings of the ventilator, as well as the underlying condition of the child. Therefore, the fluid requirements of a child on mechanical ventilation should be individualized and monitored closely¹.

Choice B reason: Increased intracranial pressure (ICP) does not increase the fluid requirements of a child. Increased ICP is a condition in which the pressure inside the skull is higher than normal, due to various causes such as head injury, brain tumor, infection, or hydrocephalus. Increased ICP may affect the fluid balance of a child by impairing the cerebral blood flow, the cerebrospinal fluid drainage, or the hypothalamic-pituitary axis. However, the net effect may vary depending on the severity, duration, and cause of the increased ICP, as well as the presence of other complications such as cerebral edema or diabetes insipidus. Therefore, the fluid requirements of a child with increased ICP should be individualized and monitored closely².

Choice C reason: Congestive heart failure does not increase the fluid requirements of a child. Congestive heart failure is a condition in which the heart is unable to pump enough blood to meet the body's needs, due to various causes such as congenital heart defects, cardiomyopathy, or infection. Congestive heart failure may affect the fluid balance of a child by causing fluid retention, edema, or pulmonary congestion. However, the net effect may vary depending on the type, severity, and stage of the heart failure, as well as the presence of other complications such as renal failure or liver failure. Therefore, the fluid requirements of a child with congestive heart failure should be individualized and monitored closely³.

Choice D reason: Fever increases the fluid requirements of a child. Fever is a condition in which the body temperature is higher than normal, due to various causes such as infection, inflammation, or immunization. Fever increases the fluid requirements of a child by increasing the metabolic rate, the insensible losses, and the urine output. The amount of fluid loss due to fever depends on the degree and duration of the fever, as well as the ambient temperature and humidity. A general rule of thumb is that for every degree Celsius increase in body temperature, the fluid requirements increase by 10%⁴. Therefore, the fluid requirements of a child with fever should be adjusted and monitored closely.

Choice A reason: Suctioning the mouth and nasopharyngeal passages is the most important priority for airway care after a cleft palate repair. This is because the infant may have blood, mucus, or secretions in the mouth or nose that can obstruct the airway and cause breathing difficulties. Suctioning can help clear the airway and prevent aspiration, infection, or hypoxia.

Choice B reason: Cleaning the suture line with normal saline is an important part of wound care after a cleft palate repair, but it is not the most important priority for airway care. Cleaning the suture line can help prevent infection, promote healing, and reduce scarring. However, it should be done gently and carefully, as not to disturb the sutures or cause bleeding.

Choice C reason: Elevating the head of the bed 30 degrees is a helpful measure to facilitate breathing and drainage after a cleft palate repair, but it is not the most important priority for airway care. Elevating the head of the bed can help reduce swelling, congestion, and pressure on the surgical site. However, it should be done with caution, as not to cause neck flexion or extension that may compromise the airway.

Choice D reason: Giving IV morphine for pain is a necessary intervention to provide comfort and analgesia after a cleft palate repair, but it is not the most important priority for airway care. Giving IV morphine can help relieve the pain and distress that the infant may experience after the surgery. However, it should be given with close monitoring, as it may cause respiratory depression, sedation, or hypotension.