Pediatric Nursing Report: Fluid Management in Pediatric Care

This report delves into the realm of pediatric nursing, specifically addressing the case of an 8-month-old infant, John, admitted with dehydration and diagnosed with diabetes insipidus (DI). The report begins with a detailed description of the clinical condition, including the pathophysiology of DI, a rare condition characterized by the body's inability to regulate fluid balance due to insufficient antidiuretic hormone (ADH) or kidney response to ADH. It explores the rationale behind the fluid management plan, emphasizing the importance of desmopressin administration and the use of hypo-osmolar intravenous fluids to address hypernatremia. Furthermore, the report outlines crucial nursing management strategies, such as maintaining electrolyte balance, monitoring serum sodium levels, and providing clear instructions to parents regarding medication and dietary restrictions. It highlights the significance of post-hospitalization follow-up and the benefits of maintaining electronic health records for comprehensive patient care. References to relevant research and studies are included to support the information provided.

Running head: PEDIATRIC NURSING
Pediatric Nursing
Name of the student
University name
Author’s note

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Table of Contents
Brief description of the clinical condition of the patient focussing on pathophysiology...........2
Rationale for the fluid management plan...................................................................................3
Nursing management strategies important to patient care.........................................................4
References..................................................................................................................................5

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Brief description of the clinical condition of the patient focussing on pathophysiology
The current assignment focuses on the areas of pediatric nursing and the respective
care and support services rendered in this area. In this respect, John was an 8 months old
child who was admitted to the hospital on account of dehydration. On preliminary
investigation it was found that the child had inborn diabetes inspidus, which had become
more severe in the long run. The boy was rushed to the hospital by his parents on account of
certain symptoms such as the presence of a slight fever from a few days. Additionally, the
child had depicted excessive need to urinate along with less energy and a constant lethargy.
Diabetes Inspidus (DI) is a rare disease with a presence of 1 in 25 people and has
debilitating effects (Bultas et al. 2014). It is also known as water diabetes and results in
recurrent loss of fluid from the body. The disease is supposed to be caused by either less or
an absolute lack of anti-diuretic hormone (ADH), which leads to an inability in concentrating
the urine. As commented by de Cassia Sparapani et al. (2015), the blood serum is often
raised to a concentration greater than 295milliOsmol/kg which can result in a constant feeling
of dizziness and lethargy. The treatment of the disorder is mainly aimed at reducing the loss
of water from the body and increasing the activity of the anti-dieuretic hormone (ADH)
(Hanta et al. 2015). In most of the cases desmopressin, which is an analog of ADH is
administered in the patients.
However, for understanding the pathophysiological condition of the patient there is a
need to undertake assessment tests and measures. The primary tests should begin with the
assessment of the hydration status of the patient. The blood plasma concentration of the
patient would help in confirming or ruling out the presence of hypernatria in the patient
(excessive presence of sodium in the blood). Additionally, the patient history should also be
considered for the presence of recurrent urinary tract infections. The loss of water and

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excessive salt deposition promote further growth of the opportunistic pathogens such as
B.coli, which cause urinary tract infections (UTI) in children and adult.
The diabetes inspidus could be further divided into three main types such as – central,
nephrogenic and primary polydypsia. It is necessary that the clinical conditions associated
with each is understood first in order to design an effective treatment and care plan. The two
main types of Di are mainly central and nephreogenic. In central DI, the vasopressin
synthesis is impaired. In nephrrogenic response the renal tubule response to vasopressin is
also impaired. The child here was seen to be suffering from a central dibetes inspidus.
Rationale for the fluid management plan
It is necessary to design an effective fluid management plan for the effective care of
the patient. In this respect, the age of the child is a governing factor in deciding the dosage of
the medicine. The symptomatic expression of the disease is different in the infants compared
to the elder children (Al Nofal and Lteif 2015). In this respect, John depicted recurrent
episodes of fever, vomiting along with excessive crying and irritability. Since, John is an
infant who is less than two years old; therefore before the administration of an alternate
medication his condition should be discussed with an endocrinologist. In this respect,
desmopressin administration is one of the most plausible methods of controlling the fluid
balance in the children. It acts on the distal tubules and the collecting ducts of the kidney by
increasing water absorptions. It is provided as an intranasal solution to the children by
dissolving 100 micrograms in one ml. However, for the treatment of the condition of children
below two years of age dose is usually 2-5 micrograms per ml. The hydration assessment
depicted that John had hypernatria and therefore he was put under hypo-osmolar intravenous
fluid. This would help in restoring the concentration of water in the blood serum of the
patient a restore the normal well being in the patient by removing the feeling of dizziness.

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Nursing management strategies important to patient care
It is important to design effective nursing management strategies for the utmost care
of the patient. As commented by Hill et al. ( 2017), the post administration follow up is
crucial for maintaining the health of the patient in the long run. However, lack of time and
knowledge often deter the parents from taking their child to the nearby hospitals.
Additionally, the idea that administration of home-made electrolyte solution is sufficient for
management of the fluid imbalance in the child is wrong. This is because only after a proper
blood examination the condition of hypernatria can be confirmed within the child. Depending
upon the osmolarity of the blood the child should be put under further electrolyte
administration. As commented by Jakubik et al. (2017), the lack of expert supervision can
further deteriorate the condition of the patient.
The nursing priority which should be undertaken for managing the condition of John
over here is maintaining a healthy electrolyte balance. Therefore, the nursing professional
attending to the care concern of John need to develop a plan of action for maintaining the
electrolyte balance in accordance with expert opinions of the nephrologists and
endocrinologist. The administration of sterile water with dextrose would be undertaken for
maintaining the electrolyte balance in the child. The serum sodium of the child needs to be
monitored against 24 hours urinary volume specific gravity. A clear instruction should be
given to the parents to avoid the administration of foods and liquids to the child that promotes
dieresis. The parents should be given clear indications regarding the management of the
medications of the child. In this respect, a blood test will be conducted by the healthcare
professionals for accessing the condition of hypernatria in John on a quarterly basis.

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Additionally, post-hospitalization follow up for the patient very 6-12 months can help in
managing the long term condition and health of the patient.
The nursing professionals could personally follow up after the clinical condition of
the patient by paying home visits to the patients after discharge from the hospital.
Additionally, record keeping can also help in keeping a track of the clinical conditions of the
patients (Djermane et al. 2016). The data could be referred to in times of need for designing
of an effective support care plan for the patient. Additionally, maintaining an electronic
health based data can also help in getting helpful referrals for the condition management of
the child.

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References
Al Nofal, A. and Lteif, A., 2015. Thiazide diuretics in the management of young children
with central diabetes insipidus. The Journal of pediatrics, 167(3), pp.658-661.
Bultas, M.W., Hassler, M., Ercole, P.M. and Rea, G., 2014. Effectiveness of high-fidelity
simulation for pediatric staff nurse education. Pediatric Nursing, 40(1), p.27.
de Cássia Sparapani, V., Jacob, E. and Nascimento, L.C., 2015. What is it like to be a child
with type 1 diabetes mellitus?. Pediatric nursing, 41(1), p.17.
Djermane, A., Elmaleh, M., Simon, D., Poidvin, A., Carel, J.C. and Léger, J., 2016. Central
diabetes insipidus in infancy with or without hypothalamic adipsic hypernatremia syndrome:
early identification and outcome. The Journal of Clinical Endocrinology &
Metabolism, 101(2), pp.635-643.
Djermane, A., Elmaleh, M., Simon, D., Poidvin, A., Carel, J.C. and Léger, J., 2016. Central
diabetes insipidus in infancy with or without hypothalamic adipsic hypernatremia syndrome:
early identification and outcome. The Journal of Clinical Endocrinology &
Metabolism, 101(2), pp.635-643.
Hanta, D., Törer, B., Temiz, F., Kılıçdağ, H., Gökçe, M. and Erdoğan, Ö., 2015. Idiopathic
central diabetes insipidus presenting in a very low birth weight infant successfully managed
with lyophilized sublingual desmopressin. J Pediatr, 57, pp.90-93.
Hill, C., Knafl, K.A. and Santacroce, S.J., 2017. Family-Centered Care From the Perspective
of Parents of Children Cared for in a Pediatric Intensive Care Unit: An Integrative
Review. Journal of pediatric nursing, pp. 55-85.

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Jakubik, L.D., Eliades, A.B. and Weese, M.M., 2016. Part 1: An overview of mentoring
practices and mentoring benefits. Pediatric nursing, 42(1), p.37.