BASIC NURSING TUTORIAL USING PROJECT BASED LEARNING

(PBL) SEVEN JUMP METHOD

FULFILLMENT OF FLUID AND ELECTROLYTE NEEDS

Subject : Basic Human Needs Practicum

Facilatator: Sofia Februanti, S. Kep., Ners., M. Kep.

By :
Group 1 – 1A D4 of Nursing
Names Of Members Attached 1

POLTEKKES KEMENKES TASIKMALAYA

Jln. Babakan Siliwangi No.35, Tlp. (0265)340186 Fax (0265)338939

Website: https://poltekkestasikmalaya.ac.id/
E-mail: [email protected]
Tasikmalaya Jawa Barat 46115

2024/2025
OUR MEMBERS
1. Azmi Ramdani (P20620524005)
2. Fira Tsania Fauziah (Board Note taker) (P20620524010)
3. Gania Yuntafa Amalia (P20620524012)
4. Mohamad Dzaki Al Fawwaz (Leader) (P20620524017)
5. Najwa Nujliza Maulana (P20620524021)
6. Naysila Yulistiana Putri (P20620524022)
7. Nazwa Zahrotun Nisa (P20620524023)
8. Neng Nisa Nur Wahidah (P20620524024)
9. Rafli Maulana Iskandar (P20620524025)
10. Reva Ayu Nur Ilma (P20620524027)
11. Rifqi Muhamad Fauzi (P20620524029)
12. Ryan Nova Ramdhani (P20620524031)
13. Sinta Ketriyana (P20620524034)
14. Sri Widiyanti (P20620524035)
15. Syamsul Arif (P20620524037)
16. Voka My Zona (P20620524039)
17. Wulan Rahmadiani Oktavia (Book Note (P20620524040)
taker)
18. Zakiyyah Azhar Nurmaulida (P20620524041)
 FOREWORD

Praise be to God Almighty, because for His blessings and grace, we can complete
this paper entitled "Fulfillment of Fluid and Electrolyte Needs in Children". This
paper was prepared as one of the assignments in pediatric health subjects, with the
aim of providing a deeper understanding of the importance of fluids and
electrolytes for children's growth and development.

The need for fluids and electrolytes is a crucial aspect in maintaining children's
health. Given that children have different needs compared to adults, a proper
understanding of meeting these needs is essential to prevent dehydration and
electrolyte balance disorders that can have a serious impact on their health.

In this paper, we will discuss various aspects of meeting fluid and electrolyte
needs, including factors that affect these needs, good sources of fluids and
electrolytes, and ways to ensure children are getting enough. We hope that this
paper can provide useful insights for readers, especially parents, educators,
and health workers.

Tasikmalaya, 10 Desember 2024

 TABLE OF CONTENTS

FOREWORD..............................................................................................................4
TABLE OF CONTENTS...............................................................................................5
BAB I SCENARIO.......................................................................................................6
BAB II DISCUSSION AND LITERATURE STUDY.........................................................7
1.1. Step 1 (Identifying difficult words and deciphering them)...................7
1.2. Step 2 (Identifying questions and problems)........................................8
1.3. Step 3 Analyze the problem by answering the questions in step 2......8
1.4. Step 4 Systematically formulate the various explanations obtained in
step 3. It can be in the form of a scheme...........................................10
1.5. Step 5 (Learning Objective).................................................................10
1.6. Step 6 (Self Discussion).......................................................................11
1.7. Step 7 Report the results of the discussion and synthesis of the
information that has been carried out......................................................11
BAB III CONCLUSION..............................................................................................17
BAB IV ADVICE.......................................................................................................19
LITERATURE...........................................................................................................20
 BAB I
CASE SCENARIO

An. K male, 3 years old, brought by his mother to the emergency room of Suka-
suka Hospital. The mother complained that her child often defecated 8x for the
past 3 days with a watery consistency, accompanied by fever and the child was
fussy because he felt pain in his stomach. Assessment results: the child is
lethargic, nausea, and vomiting, anemic conjunctiva, sunken eyes, turgor > 3
seconds, vesicular breath sounds, there is abdominal distension. Anthropometric
examination results obtained current weight 13 kg while according to his mother
the initial weight before illness was 15 kg, TB 68.5 cm. TTV examination: BP
90/70 mmHg, pulse 110x/min, breathing frequency 40x/min. Laboratory
examination results showed An. K had hypoglycemia, hyponatremia, and
dehydration. An. K received parenteral therapy with KAEN 3B intravenous fluid
with microdrip drip factor.
 BAB II
DISCUSSION AND LITERATURE STUDY

1.1. Step 1: Identifying difficult words and deciphering them

1. Hypoglycemia
Hypoglycemia is a condition when the blood sugar level is below normal.
2. Hyponatremia
Hyponatremia is a medical condition when the sodium level in the blood
is below the normal limit.
3. Anemic conjunctiva
Anemic conjunctiva is a condition when the conjunctiva of the eye looks
pale or unhealthy.
4. Lethargic
Lethargy is a condition when the body feels very tired and does not get
better after resting.
5. Nausea
Nausea is nausea, which is a feeling of discomfort at the back of the throat
or stomach that can lead to vomiting.
6. Vomiting
Vomiting is the process of expelling stomach contents through the mouth
by force or vomiting.
7. Abdominal tension
Abdominal distension is the condition of an enlarged abdomen that is
often accompanied by a feeling of bloating due to trapped gas or digestive
contents.
8. Vesicular breathing
Vesicular breathing is a smooth, soft sound that you can hear when
inhaling and exhaling. This sound is also called vesicular lung sound.
9. Skin turgor
Skin turgor refers to the elasticity of the skin, or how well your skin
returns to its original shape.
 10. Diarrhea
Diarrhea is the passage of frequent, soft, and unformed phases.

1.2. Step 2: Identifying questions and problems

1. Why did the child have a bowel movement 8 times in 3 days?

2. Why does the child have a fever?
3. Why does the child feel pain in his stomach that causes him to be fussy
because of his stomach ache?
4. Why did the child experience lethargy?
5. Why does the child experience vomiting, nausea?
6. Why does the child experience skin turgor >3 seconds?
7. Why does the child experience abdominal distension?
8. Why does a child lose weight when they have diarrhea and is that normal?
9. What can cause hypoglycemia, hyponatremia, and dehydration?
10. What is the function of KAEN 3B infusion fluid and?

1.3. Step 3: Analyze the problem by answering the questions in step 2

1. Infectious gastroenteritis, namely inflammation of the stomach and

intestines caused by infection or poison
a. Consumption of unbalanced or contaminated food which can cause
digestive disorders.
b. Lack of hygiene, such as not washing hands before eating, can cause
the spread of bacteria.
2. Fever in children is caused by infection, because the child experiences
diarrhea for three days with loose and frequent stools. This infection is
caused by bacteria and parasites. This infection causes the body to
respond with inflammation, which ultimately causes fever.
3. Stomach pain in 3 year old boys can be caused by various things, ranging
from constipation, too much gas, infection, food allergies, as well as
inflammation of the digestive organs due to infection.
4. Lethargy can be caused by physical and psychological disorders, for
example excessive activity, stress, depression, injury, lack of exercise,
poor sleep patterns, use of narcotics and alcohol, and certain illnesses or
medical procedures. Lethargy in children who experience diarrhea can
occur due to dehydration because the body releases a lot of fluids and
electrolytes.
5. Nausea and vomiting are symptoms of digestive system disorders. The
main cause is a viral infection.
6. Pinch/skin turgor slow return can be caused by lack of fluids in the body.
This can also be a sign that someone is experiencing diarrhea with severe
dehydration. Diarrhea with severe dehydration is characterized by
lethargy, sunken eyes, very slow return of turgor >3 seconds, and fluid
loss >10% of body weight.
7. Abdominal distension in this child is most likely caused by a combination
of fluid accumulation due to dehydration, increased gas production due to
gastrointestinal infections, and impaired bowel movements due to
prolonged diarrhea. Appropriate medical treatment is needed to treat this
condition and prevent further complications.
8. Diarrhea can cause weight loss due to nutrients not being absorbed
completely by the body. If a child experiences diarrhea, the child will
experience a rapid lack of fluids in the body which can result in weight
loss. The weight loss was considered abnormal, because the weight
dropped by 2 kg in 3 days. (Wulan)
9. Hypoglycemia can be caused by poor diet, genetic factors, and nutritional
deficiencies which can cause diarrhea (neng nisa)
10. KA-EN 3B fluid is used to provide and replace water and electrolytes in
conditions of dehydration, illness and need for care, and is used before
and after surgery where fluids cannot be received orally.
1.4. Step 4: Systematically formulate the various explanations obtained in
step 3. It can be in the form of a scheme

1.5. Step 5: Learning Objective

1. Based on the case, what disorder is An. K? (Sri)

2. What is the intervention technique given based on the case in An. K's
case? (Najwa)
3. What is the pathogenesis and pathophysiology of the gastrointestinal tract
in children? (Voka)
4. What is the relationship between hypoglycemia, hyponatremia, and
gastrointestinal disorders? (Fira)
1.6. Step 6: Self Discussion

We conducted independent learning discussions in groups at the library of the

Poltekkes Kemenkes Tasikmalaya. With learning resources that we get from
websites, e-journals, e-books. And the results of the discussion in step 6 will
be explained in step 7.

1.7. Step 7: Report the results of the discussion and synthesis of the
information that has been carried out

1. After we weighed and matched it with the data we got from the SDKI
book, we formulated that An. K had 5 nursing diagnoses, namely:
1) D.0019 Nutritional Deficit
2) D.0020 Diarrhea
3) D.0021 Gastrointestinal Motility Dysfunction
4) D.0023 Hypovolemia
5) D.0027 Blood Glucose Level Instability
2. Interventions that can be carried out by being associated with diagnoses
according to the SDKI, then the interventions obtained from the SIKI
book, namely:
1) D. 0019 Nutritional Deficit
a. Main Interventions
- Nutrition management
- Nutrition counselling
b. Supporting interventions
- Weight promotion
- Hypoglycemia management
- Nutrition monitoring
- Feeding (enteral, parenteral)
2) D.0020 Diarrhea
a. Main Intervantions
- Diarrhea management
- Fluid monitoring
 b. Supportive Interventions
- Medication administration (oral, intravenous, intradermal)
- Fluid and electrolyte management
3) D.0021 Gastrointestinal Motility Dysfunction
1) Main Interventions
- Nutrition management
- Infection control
2) Supportive Interventions
- Medication administration (oral, intravenous)
- Enteral feeding
4) D.0023 Hypovolemia
1) Main Interventions
- Hypovolemic shock management
2) Supportive Interventions
- Electrolyte management
- Intravenous insertion
- Ngt hose insertion
5) D.0027 Blood Glucose Level Instability
1) Main Interventions
- Hypoglycemia management
2) Supportive Interventions
- Dietary education
- Physical exercise education
- Medication administration (oral, intravenous, subcutaneous)
3. Pathogenesis and pathophysiology in digestive tract disorders including
diarrhea there are several types, namely:
a. Pathogenesis in the child's digestive tract:
- Osmotic disorders
The body's inability to absorb incoming food or substances can
cause osmotic pressure in the intestinal cavity can cause
 osmotic pressure in the intestinal cavity to increase, resulting in
a shift of water and electrolytes into the intestinal cavity
increase, resulting in a shift of water and electrolytes into the
intestinal cavity. The large amount of contents in the intestinal
cavity can stimulate the intestines to expel it, resulting in
diarrhea.
- Impaired secretion
Certain irritants of the intestinal wall (e.g. by toxins) increases
excretion of water and electrolytes in the intestinal lumen,
causing diarrhea due to increased intestinal contents.
- Impaired intestinal motility Hyperperistalsis reduces the ability
of the intestine to absorb food, causing diarrhea. Conversely,
intestinal peristalsis may cause bacterial overgrowth, leading to
diarrhea.
b. Pathophysiology in the pediatric gastrointestinal tract :
i. Pathophysiology of emerging pediatric gastrointestinal
infections: Nausea, vomiting, fever, loss of appetite, muscle
pain, weakness, Flatulence, weight loss, diarrhea. There are
four pathophysiologies of diarrhea, namely: (Harahap,
2015)
a) Osmotic diarrhea is a material that cannot be absorbed,
the osmotic pressure of the intestinal lumen increases.
osmotic pressure of the intestinal lumen increases,
drawing water and electrolytes from the plasma into the
into the intestinal lumen, causing diarrhea. Osmotic
diarrhea includes the body's inability to take in food,
rapid rapid gastric emptying, lactase enzyme deficiency
and osmotic effects.
b) Secretory diarrhea where toxins are released during this
diarrhea. Toxins are bacteria (cholera toxin), the effects
of bile salts and intestinal hormones such as gastric
 hormones, bile, and intestinal hormones such as gastrin
vasoactive intestinal vasoactive polupeptide (VIP) that
interferes with electrolyte transport (abdominal muscles
or secretions). Toxins that stimulate cAMP and cGMP
constitute the ATP chain that can stimulate the secretion
of fluids and electrolytes. Secretory diarrhea can be
divided into active diarrhea and passive diarrhea.
- Active is the interruption of flow (absorption) from
the intestinal lumen into the plasma or the
acceleration of water fluid from the intestinal lumen
into the plasma or the acceleration of water fluid
from the plasma into the lumen.
- Passive is the hydrostatic pressure in the tissues due
to the expansion of water from the tissue into the
intestinal lumen. For example: increased mesenterial
venous pressure, obstruction of the lymphatic system,
intestinal ischemia, inflammatory processes intestine,
inflammatory processes.
c) Exudative diarrhea is inflammation of the small
intestine. inflammation and exudation can be due to
bacterial, nonbacterial infection (gluten sensitive
enteropathy, IBD), or radiation. Examples: ulcerative
colitis, Crohn's disease, amebiasis, shigellosis,
champylobacter, yersinia.
ii. Water and electrolyte loss as well as acid-base disturbances
that can leading to dehydration, metabolic acidosis and
hypokalemia.
iii. Circulatory disorders can be in the form of hypovolemic or
pre-arrest as a result of diarrhea with or without vomiting,
tissue perfusion is reduced, resulting in hypoxia and
metabolic acidosis worsening, cerebral circulatory disorders
 can occur in the form of decreased consciousness
(soporokomatosa) and if not treated quickly can result in
death.
Nutritional disorders that occur due to excessive fluid
discharge due to diarrhea and vomiting, sometimes parents
stop feeding the child for fear of increased food for fear of
increased vomiting and diarrhea in the child or if food is
still given in diluted form.
Hypoglycemia will be more common in children who have
previously suffered from malnutrition or infants with
weight gain failure. As a result of hypoglycemia, brain
edema can occur which can lead to seizures and coma.
result in seizures and coma.
4. The relationship between the three conditions as a whole, the
relationship between hypoglycemia, Hyponatremia, and
gastrointestinal disorders can be understood as follows:
a. Hipoglikemia
Examples of gastrointestinal disorders are diarrhea, in People with
this diarrhea can cause hypoglycemia. Hypoglycemia occurs in 2 –
3% of children suffer from diarrhea. This happens because of
storage or Glycogen supply in the liver is disturbed and there is a
disruption of glucose absorption (although rare). Symptoms of
hypoglycemia will appear if glucose levels blood decreased by up
to 40% in infants and 50% in children. (Noerasid et al., 1988).
Sugar is very important as a source of energy for the brain,
muscles, as well as cells in the digestive tract. That's why when
people have hypoglycemia, cells in the brain and gastrointestinal
tract experience a lack of sugar and energy, so that symptoms of
nausea appear.
The initial symptoms of low blood sugar are caused by the release
of the hormone epinephrine or known as adrenaline. When blood
 sugar drops, this condition triggers a response fight-or-flight (the
body's response mechanism when facing stress). As a result, it
occurs adrenaline rush. The body creates a surge of adrenaline to
move glucose in the bloodstream quickly. However, the surge of
adrenaline causing side effects, one of which is nausea.
b. Hiponatremia
Severe and prolonged diarrhea and vomiting can cause significant
loss of sodium from the body. When the body loses a lot Fluids and
electrolytes, including sodium, these can cause hyponatremia.
Hyponatremia is often caused by fluid retention in the body, which
can occurs due to conditions such as heart failure, kidney disease,
or cirrhosis. Retention This fluid can cause sodium in the blood to
become diluted. Fluid retention can affect intestinal motility and
cause symptoms such as bloating and abdominal discomfort. In this
condition, the body produces antidiuretic hormones (ADH) in
excessive amounts, which leads to water retention and a decrease
in sodium levels in the blood. Excessive water retention may affect
the function of the gastrointestinal tract and cause gastrointestinal
symptoms such as nausea and vomit.
c. The Relationship between the Three Conditions
Overall, the relationship between hypoglycemia, hyponatremia,
and Gastrointestinal disorders can be understood as follows:
- Vomiting and diarrhea: Both can lead to loss of nutrients
and electrolytes, including sodium and glucose.
- Fluctuations in blood sugar levels: Digestive disorders such
as gastroparesis can worsens blood sugar control, increases
the risk of hypoglycemia.
- Fluid retention: In the case of hyponatremia, water
retention due to increased ADH can disrupts electrolyte
balance and worsens digestive problems.
 BAB III
CONCLUSION

PBL (Program Based Learning) is an educational method that focuses

learning on students, where students decide for themselves what they need to
learn and what literature sources they need. One method is seven jumps in the
form of small discussions, usually consisting of ten people, where there are
those who serve as chairman, secretary and scribe and are accompanied by a
tutor. Each has a task and role in the discussion. Seven jumps are done in 7
steps, namely:
Step 1: Clarify unfamiliar terms
Step 2: Define the problems Step 3: Brainstorm
Step 4: Mind mapping
Step 5: Defining LO (Learning Objects)
Step 6: Information gathering
Step 7: Solving unsolved problem in step 5 The seven jumps method has
advantages and disadvantages.

By using the PBL seven jump method, we were able to troubleshoot the given
tutorial case with the following results:
1. Child K has experienced diarrhea with the prioritized diagnosis being
Hypovolemia, which is a lack of fluid volume.
2. Interventions that can be given to child K are fluid resuscitation and
monitoring body weight.
BAB IV
ADVICE
LITERATURE