Lesson Objective for Nursing Care Plan (NCP) for Dehydration & Fever

Let’s compare dehydration and fever in the human body to a garden. Dehydration is like a garden not getting enough water, causing the plants to wilt. This happens when your body lacks sufficient fluids. 

Fever, on the other hand, is like the sun heating the garden too much. Normally, your body temperature is stable, but with a fever, it rises, similar to an overheated garden. Both are signals that your body, like a garden, needs care to restore balance.

Upon completion of this nursing care plan for dehydration and fever, nursing students will be able to:

• Identify Signs and Symptoms:
  • Recognize and differentiate clinical manifestations of dehydration and fever in pediatric patients.
• Implement Fluid Management Strategies:
  • Apply evidence-based interventions for fluid resuscitation and management to restore and maintain hydration in children with dehydration and fever.
• Assess Vital Signs and Fluid Balance:
  • Demonstrate proficiency in monitoring vital signs, assessing fluid balance, and recognizing early signs of complications related to dehydration and fever.
• Educate Caregivers on Home Management:
  • Provide comprehensive education to caregivers on recognizing signs of dehydration and fever, administering prescribed medications, and implementing appropriate home care measures for pediatric patients.

Pathophysiology for Dehydration & Fever

A fever is a rise in body temperature above what is considered a normal range. Most physicians consider a fever to be a temperature over 100° when taken orally, 99° when taken under the arm, and over 100.4° when taken rectally. The purpose of a fever is to help the body fight off infection. Fevers can be mild and benign, but they can also alert to more serious diseases.

Not all fevers need treatment. It is recommended that, unless the child is visibly uncomfortable or in pain, fevers under 102° should not be treated. Dehydration is an excessive loss of fluid from the body and is another common issue among children. Most children get enough water from eating and drinking, but the fluid loss in a child can be dangerous, leading to brain damage or even death.

• Dehydration:
  • Involves an inadequate balance between fluid intake and loss, leading to a reduction in the body’s water content.
  • Common causes include vomiting, diarrhea, decreased oral intake, and increased fluid loss due to fever and sweating.
• Fever (Pyrexia):
  • Elevated body temperature results from the body’s response to infectious or non-infectious stimuli.
  • Infections, inflammatory conditions, or disruptions in the body’s thermoregulatory mechanisms can contribute to fever.
• Fluid and Electrolyte Imbalance:
  • Dehydration disrupts the balance of electrolytes, such as sodium and potassium, essential for cellular function.
  • Fever increases metabolic demand, potentially exacerbating fluid and electrolyte imbalances.
• Vascular Changes:
  • Dehydration can lead to reduced blood volume, causing decreased perfusion to vital organs.
  • Fever induces vasodilation, altering blood flow and contributing to increased fluid loss through perspiration.
• Inflammatory Response:
  • Fever is often a component of the body’s inflammatory response to infection, involving the release of pyrogens and activation of the hypothalamus.
  • Dehydration may intensify the inflammatory response, impacting immune function and exacerbating the overall pathophysiological effects.

Etiology for Dehydration & Fever

The body’s temperature is controlled by the hypothalamus in the brain. When the body temperature rises, it is because the hypothalamus is resetting the temperature in response to some illness or infection. Higher temperature makes it more difficult for germs that cause infection to live. This is a normal defense system of the body and is not a disease in itself, but usually a symptom of some illness or infection. Alternatively, infants who are over-bundled or in a very warm environment may develop a fever because the hypothalamus is not yet able to fully regulate temperature.

Dehydration occurs more often in infants and toddlers as they lose fluid much faster than older children and adults, and may occur from having an illness that causes vomiting, diarrhea, or fever. As the body temperature rises, the tissues use more water. If the child does not take in enough fluid when running a fever or with vomiting and diarrhea, they can dehydrate more quickly. Children who have other diseases such as diabetes may experience excessive urination that results in dehydration. In older children, sweating after play may contribute to fluid loss, but is not usually the only factor.

• Infectious Causes:
  • Bacterial, viral, or parasitic infections can trigger fever and contribute to dehydration through mechanisms such as increased metabolic demand, vomiting, and diarrhea.
• Gastrointestinal Disorders:
  • Conditions like gastroenteritis, which involve inflammation of the gastrointestinal tract, can lead to both fever and dehydration due to vomiting and diarrhea.
• Respiratory Infections:
  • Infections affecting the respiratory system, such as pneumonia or bronchiolitis, can cause fever and may lead to dehydration if accompanied by increased respiratory effort and fluid loss.
• Inadequate Fluid Intake:
  • Insufficient fluid intake, often compounded by reduced appetite during illness, can contribute to dehydration in pediatric patients experiencing fever.

Desired Outcome for Dehydration & Fever

• Hydration Restoration:
  • Ensure the successful restoration of hydration, manifested by improved urine output, normal skin turgor, and moist mucous membranes.
• Fever Resolution:
  • Aim for the resolution of fever, with body temperature returning to within the normal range. Ensure that the child’s overall well-being and comfort are prioritized.
• Clinical Stability:
  • Attain and maintain clinical stability, evidenced by normal vital signs, improved behavior, and a return to age-appropriate activity levels.
• Prevention of Complications:
  • Prevent dehydration-related complications and minimize the risk of fever-related complications by early intervention and effective management.

Fever & Dehydration Nursing Care Plan

Nursing Assessment for Nursing Care Plan (NCP) for Dehydration & Fever

• Vital Signs:
  • Monitor and record vital signs, including temperature, heart rate, respiratory rate, and blood pressure, to assess the severity of fever and the impact on cardiovascular stability.
• Fluid Status:
  • Evaluate fluid balance by assessing urine output, mucous membrane moisture, skin turgor, and fontanelle status in infants. Note any signs of dehydration, such as decreased urine output or sunken fontanelles.
• Clinical Signs:
  • Observe for clinical manifestations of dehydration, including dry mucous membranes, sunken eyes, lethargy, poor skin turgor, and delayed capillary refill time.
• Behavioral Assessment:
  • Assess the child’s behavior, responsiveness, and level of alertness. Note any signs of irritability, lethargy, or changes in normal activity patterns.
• Fluid Intake and Output:
  • Document oral fluid intake, tolerance of feeds, and any instances of vomiting or diarrhea. Monitor for signs of fluid retention or overload, such as edema or sudden weight gain.

Nursing Interventions and Rationales for Nursing Care Plan (NCP) for Dehydration & Fever

• Obtain history from parent or caregiver to determine the cause
  • The cause and time of onset of symptoms or recent exposure to other sick individuals to help to determine the appropriate course of action.
• Monitor intake and output
  •   Determine fluid balance; monitor for and measure vomiting or diarrhea; note the amount and color of urine (darker with dehydration)
• Remove excess clothing or blankets, educate parents/caregivers for fever
  •  Infants are especially sensitive to over-bundling as they are unable to regulate temperature. Often when infants are ill, parents will bundle them up but don’t realize they are making things worse.
• Encourage oral fluid intake; administer IV fluids if necessary
  •  Oral fluid intake may be in the form of breastfeeding or bottle feeding in infants. Offer snacks and liquids frequently and monitor the patient’s response, especially with vomiting and diarrhea. Children may be more responsive to frozen juice bars, ice pops, or flavored gelatin. IV fluid replacement may be required if the patient is resistant to or cannot tolerate oral intake.
• Apply cool compresses to the patient’s forehead, hands, and feet or place in a tepid bath
  •  Do not apply ice packs to the skin, but cool moist cloths and tepid baths  help reduce fever through evaporative cooling; monitor for shivering which may indicate cooling too quickly
• Administer medications as required
  • Anti-nausea medications may be given to children experiencing vomiting
  • Antipyretic medications (acetaminophen) are often given to reduce fever
  • Antibiotics may be given if fever is related to infection
• Provide education and counseling for patients, parents, and caregivers
•  Help families understand treatment methods and ways to treat patients at home Provide demonstrations as necessary for accurate thermometer use and guidance regarding intake and output.

Evaluation for Nursing Care Plan (NCP) for Dehydration & Fever

• Fluid Balance:
  • Assess the restoration of fluid balance by monitoring urine output, mucous membrane moisture, and skin turgor. Evaluate whether the child has achieved and maintained adequate hydration status.
• Resolution of Fever:
  • Monitor the trend of body temperature, ensuring that fever resolves or is effectively managed with prescribed interventions. Evaluate the effectiveness of antipyretic medications and cooling measures.
• Clinical Improvement:
  • Evaluate overall clinical improvement by assessing vital signs, behavioral indicators, and signs of dehydration. Look for resolution of specific symptoms and a return to normal activity levels.
• Parent/Caregiver Education:
  • Assess the understanding and implementation of caregiver education on fluid management, fever management, and signs of complications. Ensure caregivers can confidently manage the child’s care at home.

• References
• https://www.emedicinehealth.com/dehydration_in_children/article_em.htm#how_is_dehydration_in_children_diagnosed
• https://www.healthline.com/health/parenting/signs-of-dehydration-in-toddlers#treatment
• https://kidshealth.org/en/parents/fever.html
• http://www.stanfordchildrens.org/en/topic/default?id=fever-in-children-90-P02512