Dehydration: Signs and Symptoms and Diagnosis (Nursing)

00:01 So, now that we've talked about some causes of dehydration, I want you to be able to recognize some signs and symptoms of severe dehydration in particular, but really any dehydration.

00:14 In infants and children, sometimes those signs and symptoms can be a little bit harder to pick up on.

00:20 So you might see an infant or small child really increase their breathing.

00:25 They might be breathing much more rapidly.

00:27 They might have an increased heart rate, which if they're running around, you're not going to know they had an increased heart rate.

00:32 But if they're hospitalized, and you notice that their heart rate is getting higher and higher, dehydration can be a cause for that heart rate increasing.

00:41 They might be restless or irritable.

00:46 We don't really think about those as signs of dehydration.

00:50 But if they're not feeling good, maybe they're a little headachy or a little woozy, which is how we would respond to severe dehydration.

01:00 They can't tell you that. They're pediatric patients.

01:04 So they're gonna get irritable, they're gonna get cranky, maybe a little restless, they might become lethargic or weak.

01:12 If you notice this in pediatric patients, you have some really severe dehydration and you're about to get into trouble.

01:19 So any kind of lethargy or weakness would be a very, very, that's a sign you don't want to miss.

01:28 So another sign of dehydration is poor skin turgor.

01:31 And if you haven't heard that term before, when you're checking skin turgor you're going to pinch skin.

01:37 And it should pop right back into the place that you've pinched it from.

01:41 But if you pinch that skin and it stays tented or elevated or in the position that you pinched it to, that means that the patient is really dehydrated.

01:50 So they're are some other signs and symptoms of severe dehydration.

01:55 So if an infant is crying and they don't have any tears, that means they're dehydrated.

02:02 They might have sunken eyes, if they're an infant who has an open fontanelle still, that fontanelle might be sunken, meaning if you put your fingers on the top of their head, you're actually going to feel a little depression in that area there where the fontanelle is.

02:18 They may also have tacky mucous membranes, you might hear that term.

02:24 And all that means is is that their spit is getting really thick.

02:28 So if you take your finger and you roll it around the infant's mouth, and you come out with a ball of spit, and it just it feels sticky, that means that they are dehydrated.

02:39 And you'll hear that referred to as tacky mucous membranes.

02:42 Infants might be thirsty.

02:44 They're not going to tell you they're thirsty, because they can't do that yet.

02:48 but they might be irritable, or reaching for a bottle, or trying to drink more than they normally would.

02:57 They might also have decreased urinary output.

03:00 So if you notice that an infant, or a child that still in diapers hasn't had a wet diaper in six or eight hours, then that is also a sign of severe dehydration.

03:13 Or if you notice that the diaper just has a very little amount of fluid in it and that it's dark, it's kind of nasty looking, then that is also a sign of severe dehydration.

03:27 So, I want you to take this moment to think about all of these signs and symptoms of dehydration and don't look at your notes. Maybe pause the video and see if you can remember those signs and symptoms of dehydration.

03:44 What would you be looking for in this pediatric patient? So did you get things like sunken fontanelle, sunken eyes, a dry mouth, tacky mucous membranes? Did you remember to assess the skin turgor? Did you perhaps say that the pulses wouldn't be as strong that can also be a sign and symptom of dehydration? Did you talk about the fact that infants that are dehydrated might have a delayed cap refill? And what do we mean by that? When you press your finger into the skin of an infant, and we usually choose to do that on the soul of a foot or the palm of a hand, we should really see the color pop back into that skin in less than two seconds, two to three seconds is considered normal.

04:41 If it takes four or five seconds for that color to return back to the skin, then you are probably having signs of dehydration.

04:51 Did you say that maybe there would be decreased urine output.

04:56 So if you got some of these signs and symptoms of dehydration, then great, we have been paying attention.

05:03 So it turns out that there are some early signs of dehydration and some late signs.

05:09 Earlier signs of dehydration will include dry mouth, maybe the lips are cracked a little bit, maybe there's a little bit of decreased urine output.

05:19 And then as the dehydration gets worse and worse, you're going to notice things like the increased heart rate.

05:26 You're going to see those sunken eyes.

05:28 If you have an infant, you're going to have that fontanelle where you can really feel that depression.

05:33 You might notice some weaker pulses, you might notice that patients breathing a little bit more rapidly.

05:41 And then late and severe signs of dehydration are going to be those signs like low blood pressure.

05:49 This really indicates shock.

05:51 Pediatric patients that have low blood pressure are really getting into trouble.

05:57 This is a very, very late sign of volume loss and dehydration.

06:02 If they have cold extremities, if you feel their hands and feet and they are just icy cold, that is a late and very severe sign of dehydration.

06:12 And as always, if you have decreased mental status, if the infant or child is not responding to you or they are lethargic, that is a very, very bad sign.

06:24 And that is a sign that this patient needs to be attended to immediately.

06:28 They are getting into trouble.

06:31 So when we're talking about urine output in dehydrated patients, this can be a way to think about you know one of the assessments that you can do.

06:40 We talked a little bit in a previous presentation about the fact that if there's a lot of stuff in the urine, your urine is going to be darker it means it's concentrated.

06:51 And if you're dehydrated, your urine is going to be a little more concentrated.

06:55 If you're well hydrated, your urine is going to be less concentrated.

06:59 So if you're well hydrated, and you have that happy face, your urine is going to be this nice light color, and if you are dehydrated, you're going to start noticing these darker and darker colors because you just don't have the fluid in your system that is going to be coming out into the urine.

07:17 So if you get up to that number eight, and you feel like that urine looks a little bit more like a soda, you know you're getting into trouble.

07:26 So one of the ways that we really track dehydration and volume loss in the hospital is weight loss.

07:35 That is a way that we can determine, how much of that total body water has been lost from the child? And as a nurse, that is why it is so important to be able to get an accurate weight on your patient.

07:50 That is going to determine how the fluids are replaced, that is going to determine that level of dehydration.

07:56 So again, that accurate weight is so important.

08:02 When you're thinking about dehydration as well, you can use your symptoms to kind of predict how much of a fluid deficit you have? It's not quite as good as using wait to predict, but you can predict that fluid deficit with some of the symptoms.

08:18 So, if you have a capillary refill greater than two seconds.

08:22 If you have a patient that is crying, but doesn't have tears, or again has the really sticky spit.

08:30 If you have dry mucous membranes, or if they are just very ill appearing if they are toxic appearing so they're lethargic or their limbs are cool, or cold, or modelled, then those are all signs of dehydration.

08:47 So if you have a couple of these symptoms, 2 out of 4 of these will predict that you have at least a 5% fluid deficit.

08:57 So, what kind of feeds into this mild, moderate, and severe dehydration? I do want to mention that any illness, if it is allowed to kind of run unchecked can cause severe dehydration.

09:13 But some illnesses are more prone to causing severe dehydration, and some are usually going to cause mild dehydration.

09:21 But just know that this is just a way to kind of think about dehydration, and that any of these illnesses can cause anywhere from a mild to severe.

09:34 But generally, if you have some mild diarrhea, you're dehydrated, usually about 5%.

09:41 Patients are able to kind of continue to take in some fluids.

09:45 And that dehydration might stay fairly mild.

09:48 If it is a gastroenteritis that maybe lasts only a day or two.

09:52 If you have a patient that has DKA, they are losing a lot of fluid because DKA is notable for having just a huge amount of losses through the urine.

10:04 And so those patients usually come in and moderate dehydration, at least a seven to 10%.

10:11 Whereas, if you have a burn patient, or a patient that's in septic shock, then you usually that is going to be more of a severe dehydration, and they're going to need a lot more fluid.

10:23 But again, these are all relative and any of these things, if you even have a gastroenteritis, where the child is not able to get fluids back in, that can still progress to a severe dehydration.

10:39 So, the first signs of mild or moderate dehydration, they might not be evident.

10:47 We talked about earlier that sometimes infants when they're getting dehydrated, they just, they get a little bit irritable, or maybe they're breathing a little bit faster.

10:54 So you might not even notice dehydration and still talk until it starts getting a little bit worse.

11:01 And it's past that 5% range.

11:05 So the goal of your assessment is identifying how dehydrated your patient is? And where do you need to start your treatment? Are they okay for just some oral replacement of fluids? Or are they really severely dehydrated and are they going to need IV fluids? It's all dependent on how bad the dehydration is?