Sunken eyes, hollow cheeks, subnormal temperature, decreased urine output, washerman's hands are the features… - HP CHO -9 October 2022

HP CHO -9 October 2022

Medical Surgical Nursing

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Appeared in: HP CHO -9 October 2022

Explanation

The combination of symptoms presented—sunken eyes, hollow cheeks, decreased urine output, subnormal temperature, and washerman's hands—are classic indicators of significant fluid and electrolyte loss from the body.
Sunken eyes and hollow cheeks are due to the loss of fluid from facial and retro-orbital tissues.
Washerman's hands signify severe loss of skin elasticity (turgor), a hallmark of dehydration.
Decreased urine output (oliguria) is the kidney's response to conserve body water.
A subnormal temperature can indicate progression to hypovolemic shock, a life-threatening complication of severe dehydration.

Option A: Measles is a viral illness whose primary features are a high fever, cough, coryza, conjunctivitis (the '3 Cs'), and a characteristic maculopapular rash. The signs listed in the question are not typical of measles.
Option B: Polio is a viral infection that affects the nervous system. Its hallmark sign is asymmetric flaccid paralysis, not the signs of fluid loss described.
Option D: Over hydration is a state of fluid volume excess, which is the opposite of dehydration. Its signs include swelling (edema), a strong, bounding pulse, and potentially shortness of breath from fluid in the lungs.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of dehydration as background academic context rather than a clinical decision trigger.
Recognizing the signs of dehydration is a critical nursing skill, especially in pediatric and geriatric populations who are most vulnerable. Prompt assessment and intervention can prevent progression to hypovolemic shock and death.
Nurses use a systematic approach to assess hydration status, including checking skin turgor, mucous membranes, capillary refill time, vital signs, and monitoring urine output.
What if the patient had a high fever instead of a subnormal temperature? A high fever can be a cause of dehydration (due to increased insensible water loss) and may accompany the underlying infection (like gastroenteritis). However, the presence of a subnormal temperature is a more ominous sign, suggesting the body's compensatory mechanisms are failing and the patient is progressing towards shock.

How to Approach the Question

First, analyze the list of clinical signs provided in the question stem: sunken eyes, hollow cheeks, subnormal temperature, decreased urine output, and washerman's hands.
Recognize that all these signs point towards a common underlying pathophysiology: a significant loss of body fluid.
Evaluate each option in the context of fluid balance. 'Dehydration' is the medical term for significant body fluid loss.
Consider the other options. 'Measles' and 'Polio' are specific infectious diseases with different hallmark signs (rash and paralysis, respectively).
'Over hydration' represents the opposite physiological state (fluid excess) and would present with contrary signs like swelling.
Conclude that the cluster of symptoms is the classic presentation of dehydration.

Concept Tested & Keywords

Concept Tested: Clinical signs of dehydration
Stem keywords: sunken eyes, hollow cheeks, subnormal temperature, decreased urine output, washerman's hands
Lead-in keywords: are the features of

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 310-312, 311-313, 91-93