The document discusses therapeutic diets and dehydration assessment for children. It provides dietary recommendations for conditions like nephrotic syndrome and protein energy malnutrition. It also outlines the World Health Organization's classification of dehydration as no dehydration, some dehydration, or severe dehydration based on clinical signs. Treatment plans involving oral rehydration solution or intravenous fluids are suggested depending on the level of dehydration.

1. THERAPEUTIC
DIET AND
DEHYRATION
ASSESSMENT
BY
NEMESHA CHELVANAYAGA M.SC(N)
ASSOCIATE PROFESSOR
KARPAGA VINAYAGA COLLEGE OF NURSING,PUDUKKOTTAI

2. THERAPEUTIC DIET :
Therapeutic diet is the suggested for children with
different diseases.
Nephrotic syndrome:
Nephrotic syndrome is a condition that causes the kidneys
to leak large amounts of protein into the urine
Nephrotic syndrome:
the recommended dietary intake and sample diet for
nephrotic syndrome.

3. Sample diet for children with Nephrotic syndrome:
Time Menu Quality Recommended Range
6 am Milk 100mL Fluid requirement 30 mL/kg body weight for
infants.
8am Biscuit
Idiyappam
Milk
2
2
100mL
The fluid based on the
volume of fluid
excreted plus an
allowance of
500mL/day given to
compensate for
insensible water loss.
20mL/Kg body weight for older
children.
10 mL/kg body weight for adult
11 am Apple 1 Energy and protein 100kcal /kg or more for children
daily protein intake of up to
2g/kg/day
1pm Rice 100g

4. Protein energy Malnutrition :
children with protein –energy malnutrition intake rates
should approach 175kcal/kg of energy and 4g/kg of protein.
A daily multivitamin should also added.
Children should consume foods containing proteins such as
meet, fish, poultry, eggs soyabeans, and legumes. Milk and
milk products are also rich in protein.

5. However, children suffering from kwashiorkor may be lactose
–intolerant and may need lactase enzyme supplements to
digest milk, yogurt, and cheese.

6. Time Food items Quality 6Recommended
6am Milk 100mL 175 kcal/kg of energy and 4g/kg of protein for children.
8am Pongal
Sambar
200g
Half Cup
11 am Dates
Groundnut
Peas
25g
25g
25g
A daily multivitamin should also be added
1pm Rice
Daal
Beans
Curd
100g
50mL
Half cup
50mL
4pm Bengal gram sundal Half cup Childern should consume foods containing proteins
such as meat, fish, poultry, eggs ,soybeans ,and
legumes
8pm Idly 2
9pm Milk 150ml

7. DEHYDRATION ASSESSMENT:
Dehydration:
Dehydration is a common body fluid disturbance in the
children and occurs whenever the total output of fluid exceeds
the total intake, regardless of the same.
Types
clinical assessment of dehydration is always approximate and
the child should be frequently re evaluation for continuing
improvement during correction of dehydration.

8. BASED ON WHO CLASSIFICATION:
The degree of dehydration can be roughly “no visible”
dehydration “some” dehydration, or “severe dehydration.
“No visible” Dehydration:
the child has no signs of dehydration or not enough signs to
be classified as “some dehydration”. However, many children
with “no visible dehydration” have still lost more fluid than
normal. They often are thirsty an d pass little urine.

9. “SOME “ DEHYDRATION:
child will have two or more of the following signs:
very thirsty and drinks eagerly
restless and irritable
sunken eyes
Moderate degree of decreased skin turgor. when pinched, the
skin takes longer than usual but less than 2 seconds to return
to normal.

11. “Severe” Dehydration:
child will have two or more of the following signs :
Not able to drink very poorly
Lethargic or unconscious
Eyes very sunken
severe decrease in skin turgor. When pinched, the skin takes
2 seconds or more to return to normal
shock with delayed capillary filling time.

12. Assessment Criteria NO Dehydration
(No signs of Dehydration)
Some Dehydration
2 or more of the following signs
present)
Severe Dehydration (2 or more
of the following signs present)
Observe
General condition Well alert Restless and irritable Lethargic or unconscious
Thirst Drinks normally, not thirsty Very thirsty and drinks eagerly Eyes very sunken
Eyes Normal Sunken eyes Eyes very sunken
Feel
Skin pinch (turgor) Goes back quickly Moderate degree of decreased skin
turgor. when pinched. The skin takes
longer than usual, but less than 2
seconds ,to return to normal
Severe decrease in skin turgor,
when pinched the skin takes 2
seconds or more to return to
normal shock with delayed
capillary filling time.
Decide No dehydration (if
The child exhibits two or
more of the above mentioned
signs)
Some dehydration (if the child
exhibits two or more of the above
mentioned signs)
Severe dehydration (if the
child exhibits two or more of
the above mentioned signs)
Treat Plan A Plan B Plan C

13. Preparation and administration of oral rehydration solution
oral rehydration therapy : is a type of fluid replacement used to
prevent and treat dehydration, especially due to diarrhea and
vomiting. It involves administration of fluids with modest
amounts of sugar and salts either orally or via nasogastric
feeding.
Oral rehydration solution: is a liquid preparation developed by
the WHO that contains 3.5g sodium chloride, 2.9 g potassium
chloride, and 1.5 glucose dissolved in each liter of drinking
water which can replace the fluid loss that had actually occurred
in the individuals.

14. S.No Nursing Action Rationale
1 Gather all necessary equipment near the child’s
bedside.
Minimizes procedure time
2 Perform hand hygiene Prevent cross infection
3 Assess the degree of dehydration of child by
using WHO scale
4 Decide if the child exhibits two or more signs
as mentioned in the scale, classify the severity
of dehydration as no dehydration /some
dehydration /severe dehydration
Classifying dehydration helps in planning further
management accordingly
5 Treat based on the severity of dehydration treat
the child
No dehydration : plan A – Child can be treated
safely at home instruct the mother to give home
based fluids such as rice water, soup, water and
oral rehydration salt (ORS).Breastfed babies
should be given breast milk and ORS. Given as
much as child wants of al the fluids

15. Age (years ) ORS BASIC AMOUNT (mL) ORS after each loose stool passed (mL)
<2 500 or more 50 100
2-10 1000or more 100-200
>10 2000 or more 100-200
Instruct the mother to the health
facility if the child gets worse passes
more watery stools, vomits,repeatedly
becomes very thirsty, eats or drinks
poorly, or is not better in 2 days
Keeps the child rehydrated and aids in appropriate home
management thereby reducing risk of complication and
hospitalization .

16. SOME DEHYDRATION: Plan –B child to be treated in the
health facility. Give ORS over the first 4 hours as shown in
the following table
Ensure early identification for the need of
hospitalization and prompt treatment to prevent
worsening of the condition.
Weight <6kg 6 to <10 kg 10 to <12kg 12-19 kg
Age* up to 4
months
4-12 month 12 months to 2 years 2-5 years
Amount of
ORS (mL)
200-400 400-700 700-900 900-1400
Use the child’s age only when you do not the weight. The approximate amount of ORS required (mL) can also be
calculated by multiplying the child’s weight (kg) by 75
If the child vomits , wait 10 minutes and start again. Continue with other fluids that the child will accept. Instruct
mother to continue breastfeeding if child is breastfed. Observe stools passed and record quantity.
Reassess the state of dehydration after 4 hours .if clinical state has improved with no dehydration, go to plan A. if there are still
signs of some dehydration, repeat plan B. If condition is worsening ,go to plan c

17. s
Severe dehydration plan C –treat severe dehydration quickly. Start IV fluids immediately. Give 100mL/Kg
Ringer’s lactase solution or if not available, normal saline or cholera
Age First Give 30mL/kg in Then 70 mL /kg in
Infants(< 12 months ) 1 hour* 5 hours
Children (2-5) 30 minutes 2.5 hours
Repeat once if radial pulse is still very wear or not detectable
Reassess the child every 1-2 hours. If hydration status is not improving give the IV fluid more rapidly than as
as stated in the table above
Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration. Then choose the appropriate plan (A ,B ,or C)
to continue treatment.
Do not stop the IV fluids until the child has been observed to retain the ORS for at least 1 hour and there is improvement in
the clinical condition.
Continue ORS on treatment plan B and continue to observe child until child has no signs of dehydration, and then move to
plan A

18. Purpose:
1. To correct dehydration
2.To reduce severe complication of diarrheal disease regardless of
causative agent.
Indications:
1. To treat most forms of dehydration and hypovolemia
2. Diarrhea
3. Considerable amount of insensible water loss through excessive
body temperature and sweating.
4. Inadequate fluid intake or refusal to drink fluid
5.Mild blood loss

19. Contraindication:
1.protracted vomiting despite, small frequent feedings.
2.Worsening diarrhea and an inability to keep up with losses
3.stupor or coma
4. Over 9% dehydrated
5. signs of shock
Recommended amount of fluid to be administered:
Infant: one liter over a 24 hour period
Children : one liter over an 8 to 24 hour period according to age

20. PREPARTION OF ENVIRONMENT:
* calm and quite environment
* Good lightening
*parents preferably near the child

21. PREPARATION OF EQUIPMENT:
Articles(A clean tray containing) Purpose
ORS sachets To prepare the solution
One liter of boiled cooled water Boiled water prevents the transmission of microorganisms
Ounce glass Measures accurate amount of fluid to be administered
Cup with lid To store the prepared solution
Medicine cup /dropper/ paladai/spoon Allows appropriate selection of feeding methods
Mackintosh and towel Prevent spoiling of dress and linen
Kidney tray Collects waste and vomitus of the child
Scissors To cut open the sachet easily

22. Preparation of child and parents:
* Explain the need and procedure to the child and parents.
* Instruct the parents to follow the steps of preparation
which helps in home management.

23. S.NO Nursing Action Rational
1 gather all necessary supplies to the child’s bedside Time management
2
Check the record