A 15-month-old child is brought to the OPD with diarrhoea. He has sunken eyes; the skin pinch goes back slowly and he drinks eagerly. As per the Integrated Management of Neonatal and Childhood Illnesses (IMNCI), this child is classified as

1. A

   Severe dehydration

2. B

   Some dehydration

3. C

   No dehydration

4. D

   Severe persistent diarrhoea

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

• The IMNCI guidelines classify dehydration based on a set of clinical signs.
• A child is classified with 'Some dehydration' if they exhibit two or more of the following: restlessness/irritability, sunken eyes, drinking eagerly/thirst, and a skin pinch that goes back slowly.
• This child presents with three of these signs: sunken eyes, drinking eagerly, and a slow-returning skin pinch.
• Therefore, the correct classification is 'Some dehydration', which requires treatment with Plan B (Oral Rehydration Therapy).

Why Other Options Were Wrong

• Option A: This option is incorrect because 'Severe dehydration' requires more extreme signs, such as lethargy, inability to drink, or a skin pinch that returns very slowly (more than 2 seconds). The child's eagerness to drink rules this out.
• Option C: This option is incorrect because the child shows clear and multiple signs of dehydration (sunken eyes, slow skin turgor, thirst).
• Option D: This is a classification based on the duration of diarrhoea (14 days or more) plus the presence of dehydration. The question does not state the duration of the illness, so this classification cannot be made.

Related Visual

• Visual 1: Chart - A flowchart or table illustrating the IMNCI assessment pathway for diarrhoea, showing how to check for signs and classify dehydration.
• Visual 2: Image - A photograph demonstrating the correct technique for performing a skin pinch test on a child's abdomen to assess skin turgor.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain IMNCI classification of dehydration in children as background academic context rather than a clinical decision trigger.
• Correctly classifying dehydration is a critical nursing skill as it directly determines the treatment plan (Plan A, B, or C) and prevents the condition from worsening.
• Nurses are responsible for administering Oral Rehydration Solution (ORS) as per Plan B, monitoring the child's response, and educating caregivers on preparing ORS and recognizing danger signs.
• What if? If the child was described as 'lethargic' and 'unable to drink', the classification would change to 'Severe Dehydration', requiring urgent referral and intravenous fluid therapy (Plan C).

How to Approach the Question

• First, identify the core clinical question: It's about classifying dehydration using IMNCI guidelines.
• Next, list the specific signs provided in the patient scenario: 1) sunken eyes, 2) skin pinch goes back slowly, 3) drinks eagerly.
• Recall or look up the IMNCI classification criteria for dehydration (No, Some, Severe).
• Count how many signs the child has that fit into each category. The 'Some Dehydration' category requires two or more specific signs.
• Match the child's presentation (3 signs) to the correct classification ('Some Dehydration').
• Eliminate other options based on the criteria. 'Severe' requires more serious signs, 'No' requires absence of signs, and 'Persistent' relates to duration, which is not given.

Concept Tested & Keywords

• Concept Tested: IMNCI classification of dehydration in children.
• Stem keywords: 15-month-old, diarrhoea, sunken eyes, skin pinch goes back slowly, drinks eagerly, IMNCI
• Lead-in keywords: classified as
• Clinical cues: The combination of sunken eyes, slow skin turgor, and eager drinking are classic signs used for dehydration assessment.

Question ID

QL5X7cgjFEyQDibN39a0xn

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