Nursing Care Plan for Dehydration & Fever
Pathophysiology
A fever is a rise in body temperature above what is considered a normal range. Most physicians consider a fever to be a temperature over 100° when taken orally, 99° when taken under the arm and over 100.4° when taken rectally. The purpose of a fever is to help the body fight off infection. Fevers can be mild and benign, but they can also alert to more serious diseases. Not all fevers need treatment. It is recommended that, unless the child is visibly uncomfortable or in pain, fevers under 102° should not be treated. Dehydration is an excessive loss of fluid from the body and is another common issue among children. Most children get enough water from eating and drinking, but the fluid loss in a child can be dangerous, leading to brain damage or even death.
Etiology
The body’s temperature is controlled by the hypothalamus in the brain. When the body temperature rises, it is because the hypothalamus is resetting the temperature in response to some illness or infection. Higher temperature makes it more difficult for germs that cause infection to live. This is a normal defense system of the body and is not a disease in itself, but usually a symptom of some illness or infection. Alternatively, infants who are over bundled or in a very warm environment may develop a fever because the hypothalamus is not yet able to fully regulate temperature. Dehydration occurs more often in infants and toddlers as they lose fluid much faster than older children and adults, and may occur from having an illness that causes vomiting or diarrhea or from fever. As the body temperature rises, the tissues use more water. If the child does not take in enough fluid when running a fever or with vomiting and diarrhea, they can dehydrate more quickly. Children who have other diseases such as diabetes may experience excessive urination that results in dehydration. In older children, sweating after play may contribute to fluid loss, but is not usually the only factor.
Desired Outcome
The patient will maintain optimal fluid balance; the patient will exhibit vital signs within normal range; the patient will be free from infection
Fever & Dehydration Nursing Care Plan
Subjective Data:
Fever
- The fussiness of infant or toddler or irritability
- Lethargy
- Changes in sleep habits
- Decreased appetite
- Headache
- Body aches
Dehydration
- Report of dry diapers or no urine output for 4-6 hours
- Report of vomiting more than 24 hours
- Lethargy
- Irritability, fussiness (maybe inconsolable)
- Abdominal pain
Objective Data:
Fever
- Feel hot to touch
- Elevated temperature
- Tachypnea
Dehydration
- Fever
- Sunken eyes
- Dry mouth or no tears when crying
- Vomiting
- Sunken soft spot on head (infants)
- Tachycardia
- Tachypnea
- Decreased urine output
Nursing Interventions and Rationales
- Assess vitals
- Assess skin for signs of dehydration
- Obtain history from parent or caregiver to determine the cause
- Monitor intake and output
- Remove excess clothing or blankets, educate parents/caregivers
- Encourage oral fluid intake; administer IV fluids if necessary
- Apply cool compresses to patient’s forehead, hands and feet or place in a tepid bath
- Administer medications as required
- Anti-nausea medications may be given to children experiencing vomiting
- Antipyretic medications (acetaminophen) are often given to reduce fever
- Antibiotics may be given if fever is related to infection
- Provide education and counseling for patients, parents, and caregivers
References
- https://www.emedicinehealth.com/dehydration_in_children/article_em.htm#how_is_dehydration_in_children_diagnosed
- https://www.healthline.com/health/parenting/signs-of-dehydration-in-toddlers#treatment
- https://kidshealth.org/en/parents/fever.html
- http://www.stanfordchildrens.org/en/topic/default?id=fever-in-children-90-P02512
Jon Haws, BS, BSN, RN, Alumnus CCRN 
Miriam Wahrman MSN/Ed, RNC-MNN 
Nichole Weaver MSN/Ed, RN, CCRN 