Fontanel depression
Fontanel depression: Excerpt from Nursing: Interpreting Signs and Symptoms
Depression of the anterior fontanel below the surrounding bony ridges of the skull is a sign of dehydration. A common disorder of infancy and early childhood, dehydration can result from insufficient fluid intake, but typically reflects excessive fluid loss from severe vomiting or diarrhea. It may also reflect insensible water loss, pyloric stenosis, or tracheoesophageal fistula. It's best to assess the fontanel when the infant is in an upright position and isn't crying.
Action stat!
If you detect a markedly depressed fontanel, take the infant's vital signs, weigh him, and check for signs of shock—tachycardia, tachypnea, and cool, clammy skin. If these signs are present, insert an I.V. catheter and administer fluids. Have size-appropriate emergency equipment on hand. Anticipate oxygen administration. Monitor urine output by weighing wet diapers.
History and physical examination
Obtain a thorough patient history from a parent or caretaker, focusing on recent fever, vomiting, diarrhea, and behavioral changes. Monitor the infant's fluid intake and urine output over the past 24 hours, including the number of wet diapers during that time. Ask about the child's preillness weight, and compare it with his current weight; weight loss in an infant reflects water loss. Then perform a complete physical examination.
Medical causes
Dehydration.With mild dehydration (5% weight loss), the anterior fontanel appears slightly depressed. The infant has pale, dry skin and mucous membranes; decreased urine output; a normal or slightly elevated pulse rate; and, possibly, irritability.
Moderate dehydration (10% weight loss) causes slightly more pronounced fontanel depression, along with gray skin with poor turgor, dry mucous membranes, decreased tears, and decreased urine output. The infant has normal or decreased blood pressure, an increased pulse rate and, possibly, lethargy.
Severe dehydration (15% or greater weight loss) may result in a markedly sunken fontanel, along with extremely poor skin turgor, parched mucous membranes, marked oliguria or anuria, lethargy, and signs of shock, such as a rapid, thready pulse; very low blood pressure; and obtundation.
Nursing considerations
▪ Monitor the infant's vital signs and level of consciousness.
▪ Monitor intake and output and watch for signs of worsening dehydration.
▪ Obtain serum electrolyte values to check for an increased or decreased sodium, chloride, or potassium level.
▪ If the infant has mild dehydration, provide small amounts of clear fluids frequently or provide an oral rehydration solution.
▪ If the infant can't ingest sufficient fluid, begin I.V. parenteral nutrition.
▪ If the patient has moderate to severe dehydration, provide rapid restoration of extracellular fluid volume to treat or prevent shock.
▪ Continue to administer I.V. solution with sodium bicarbonate added to combat acidosis. As renal function improves, administer I.V. potassium replacements.
▪ When the infant's fluid status stabilizes, begin to replace depleted fat and protein stores through diet.
▪ Obtain urinalysis for specific gravity and, possibly, blood tests to determine blood urea nitrogen and serum creatinine levels, osmolality, and acid-base status.
Patient teaching
▪ Explain all procedures and treatments to the infant's parents.
▪ Provide emotional support.
▪ Explain ways to prevent dehydration.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES (Differential Diagnosis in Primary Care)
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