In a child with diarrhoea has thirst present and tears absent, degree of dehydration is?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

According to WHO/IMNCI guidelines, a child who is thirsty and drinks eagerly but has absent tears has 'Some Dehydration.'.
The 'Some Dehydration' category is clinically equivalent to moderate dehydration.
The presence of at least two signs from the 'Some Dehydration' column, such as being thirsty and having absent tears, confirms this level of dehydration.
This condition requires treatment with Oral Rehydration Solution (ORS) as per Treatment Plan B.

Option A: Mild dehydration is characterized by less severe symptoms. A child with mild dehydration would typically still have tears present and would drink normally, not eagerly or with intense thirst.
Option C: While tears are also absent in severe dehydration, the key differentiator is the child's ability to drink and their mental status. A child with severe dehydration is typically lethargic, unconscious, or too weak to drink or drinks poorly.
Option D: This option implies the child is not dehydrated. However, the presence of thirst and absent tears are clear clinical indicators of fluid loss and dehydration.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical assessment of dehydration in children based on WHO/IMNCI guidelines as background academic context rather than a clinical decision trigger.
Accurate assessment of dehydration is a critical nursing skill that determines the appropriate fluid management plan (WHO Plan A, B, or C).
Moderate dehydration is managed with supervised administration of Oral Rehydration Solution (ORS) under Plan B. Misclassifying it as severe could lead to unnecessary IV insertion, while misclassifying it as mild could lead to worsening dehydration.
Nurses must educate caregivers on recognizing signs of worsening dehydration (e.g., decreased activity, inability to drink, reduced urination) and seeking immediate care.

How to Approach the Question

First, identify the key clinical signs presented in the question stem: 'thirst present' and 'tears absent'.
Recall the standard classification system for pediatric dehydration, which is typically the WHO/IMNCI scale (No Dehydration, Some Dehydration, Severe Dehydration).
Mentally (or by drawing a quick table) map the given signs to the categories. 'Thirst/drinks eagerly' falls under 'Some Dehydration'. 'Tears absent' falls under both 'Some' and 'Severe'.
To have 'Some Dehydration', at least two signs from that category are needed. The combination of thirst and absent tears meets this criterion.
Recognize that 'Some Dehydration' is clinically referred to as 'Moderate Dehydration'.
Eliminate 'Severe' because a key sign, lethargy or inability to drink, is not present. The child is thirsty, indicating they are conscious and able to drink.

Concept Tested & Keywords

Concept Tested: Clinical assessment of dehydration in children based on WHO/IMNCI guidelines.
Stem keywords: child, diarrhoea, thirst present, tears absent, degree of dehydration
Lead-in keywords: is
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 311-313

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 574-576