Care Plan- Dehydration- Nursing

A 5 year old girl Jenny has presented to the Emergency Department with her mother, she is suffering from a variety of symptoms including wheezing and vomiting, a dry mouth, and a temperature of 39. 7 degrees Celsius. Vomiting is when the person is excreting all food from there stomach via the mouth using forces from the oesophagus and stomach (Hockenberry & Wilson, 2007). The rationale for choosing this symptom is that vomiting is a clear sign that the body is trying to get rid of a pathogen, with a large amount of vomiting the body is losing valuable nutrition and electrolytes, and will fail to function properly (Britt, 2007). If left untreated vomiting can cause children to lose a lot of fluids and become dehydrated (Van Rensburg, 2009). Dry mouth is known as Xerostomia it is a common problem, and is usually caused by systematic disease and decreased salivary flow, Dry mouth can be a sign of Dehydration (Turner & Ship, 2007). The rational for choosing dry mouth is important as it represents fluid depletion in the body, without this fluid the cells cannot function properly; it needs to be treated, to ensure fluid levels are raised. A temperature of 39. 7 is the body’s internal area rising, due to the body trying to fight of an infection. The rational for choosing this symptom is that the temperature needs to be back in normal ranges for the body to carry out normal functions, a temperature of 39. 7 puts the body in shock and can cause things such as fainting, low blood pressure and even seizures (Hockenberry & Wilson, 2008). The Pathophysiology of Vomiting is induced by the stomach muscles pushing bolos of food from the stomach to the oesophagus. When the stomach becomes full with gastric material, the muscles of the abdomen and the diaphragm contract (Hockenberry & Wilson, 2008). The oesophageal sphincter then opens and all the contents are removed from the mouth. An area in the brain called the postrema which is found in the fourth ventricle is thought to stimulate chemoreceptors which induce vomiting (Van Rensburg, 2009). The Vagus cranial nerve becomes active when the pharynx is disturbed, this causes a gag reflex; this can then lead to the stomach wanting to remove all of its contents, or can occur after a vomiting episode. The Sympathetic nervous system is also used when vomiting occurs as the body naturally begins to sweat and heart rate will rise (McCance, Huether, Brashers, & Rote, 2010). Salivary glands will work overtime to produce more saliva to help protect the enamel on teeth. Retching can occur when a person is vomiting. When the intrathoracic muscles contract rapidly without notice, the food is trying to escape is pushed up, if the glottis is not completely closed this will push the air through and cause a disturbing sound which is known as retching(McCance, Huether, Brashers, & Rote, 2010). This sound alone can trigger vomiting as it helps the body to build up enough pressure to be able to remove all the contents of the stomach in one go. The pathophysiolgy of Dry mouth occurs when the submandibular and sublingual salivary glands stop producing enough salvia within the mouth, a variety of medications can cause this too occur, along with Sjoren's Syndrome and old age (Turner & Ship, 2007). When a dry mouth occurs the mucosa is stimulated and this signals the salivary responses in the medulla. The efferent nerve releases acetylcholine in the salivary gland terminals which trigger the release and flow of saliva (Turner & Ship, 2007). If left untreated dry mouth can cause a lot of problems with tooth decay as the teeth have no protection from food and debris (Strube, 1994). The pathophisolgy of a high temperature or fever in a child is a problem in itself, it shows that the body is under a lot of pressure to fight of a pathogen (Cohee, Crocetti, Serwin, Sabath & Kapoor, 2010), the body can have various amounts of temperatures changes throughout a day, this is controlled by the thermoregulatory centre which is located in the anterior hypothalamus within the body. The thermostat is set at a normal temperature usually of 37. (Crisp and Taylor, 2007), when this is risen the body will naturally try and get it back down to the normal temperature, usually by sweating or shivering (Crisp & Taylor, 2009). The brain stem and thermoregulatory mechanisms adjust to the change in heat production, this can occur during a fever. A Fever begins when a pyrogen, which is a substance that causes a fever, when the hypothalamus notices a change in the core body temperature vasoconstriction will occur which reduces heat loss throughout the skin and will cause the person to feel cold (McCance, Huether, Brashers, & Rote, 2010). Shivering will then occurs and the movement produces energy, this is why when a child has a fever they often feel hot and cold flushes (Crisp & Taylor, 2009). Vomiting will have a major psychological effect on the client because they cannot socialise with friends or leave the house for long periods of time. They tend not to eat or drink as they think they will be sick, this can lead to malnutrition and anorexia (Davis, Lake-Bakaar, & Grahame-Smith, 2003). Vomiting can cause tooth decay in the client, due to the production of stomach acid in the mouth. This can cause people to lose self confidence in their appearance (McCance, Huether, Brashers, & Rote, 2010). When you vomit the sympathetic nervous system is activated and you begin to sweat, this can also be embarrassing side effect. Dry Mouth causes many psychological effects for an individual because with a dry mouth you find it hard to talk as the tongue does not move easily (Turner & Ship, 2007). The individual would not eat out very often as they find it hard to chew and swallow food; this causes them to take longer when eating. Dry mouth is usually associated with cracked and dry lips this can cause the client to become embarrassed about their looks (Turner & Ship, 2007). Dry mouth can cause bad breath as there isn’t any saliva to remove food and debris from the teeth and tongue (Turner & Ship, 2007); this prevents the individual from socialising which can cause a loss in social skills. Bad breathe can also make the person feel embarrassed and lose intimacy with their partner; this can then cause relationship problems and breakdown. Having a fever can cause many physiological problems for a person; they do not have any energy to do normal everyday activities, such as socialising, sport, even to get out of bed (Hockenberry & Wilson, 2007). The individual often will have hot and cold flushes this causes then to become uncomfortable when being out in public (Hockenberry & Wilson, 2008). When you have a fever the individual is often sweating, and becomes very pale, this can also lead to embarrassment when in public (Strube, 1994). Vomiting can also have environment effects on the individual, as they cannot attend work due to being ill, this causes the individual to lose money, if the individual has children they need to be cared for, and there can then be extra costs that occur from extra babysitting or day-care duties. Vomiting can cause a person to become distressed as they can’t leave the house or look after their children (Davis, Lake-Bakaar, & Grahame-Smith, 2003). Dry mouth can have environmental effects on an individual as they become embarrassed about the smell of their breath, this can prevent the person from working, which will cause lose of income. Bad breathe can cause relationship problems as the partner is embarrassed to be intimate towards there partner. Fever can have environmental effects on an individual as they needs regular care to check temperature and record change, this care may need to be provided by a family member or friend, this can then lead to loss of income for that person. If the person is needed to be taken to the doctor, then that is also an extra expense. The house needs to be kept_ cool with fans or air conditioning; this can cause other family members to become cold.