A 3-month-old is admitted with sunken fontanels and a 3-day history of diarrhea and fever. The infant will receive nothing by mouth, only IV fluids. Which of the following interventions is the highest priority for prevention of circulatory overload in the first hour of IV hydration?
Explanation
• IV fluids given to infants and small children are calculated according to weight. It is essential to maintain the prescribed rate of flow to prevent circulatory overload while administering IV fluids.
• Dehydration of any cause may be a life-threatening situation in infants. Initial therapy is directed toward restoring extracellular fluid volume.
• Rectal temperature is often elevated, both pulse and respirations are weak and rapid, skin is pale and cool, and the infant may appear apprehensive and lethargic.
Incorrect options:
• Dehydrated infants have depressed fontanels, sunken eyes, and poor skin turgor. Urine output is expected to be scanty and concentrated at first and will not provide enough information to indicate hydration status in the first hours of rehydration. Assessments such as depressed fontanels and urine output are used for monitoring hydration status, but monitoring the IV flow rate is the best way to prevent circulatory overload in an infant in the first hour or two of IV fluid hydration.
• Adequate urine output is an indicator of adequate hydration, but it is not an indicator of fluid overload. Additional assessments would be needed to determine if fluid overload were present in an infant including lung sounds. These assessments are not the priority when beginning IV hydration.