Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter can eat any kind of fruit." "There are many types of flour besides wheat." "There is gluten hidden in unexpected foods." "My daughter is eating more vegetables."

"My daughter can eat any kind of fruit." Explanation: While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? hernia esophageal atresia (EA) cleft palate pyloric stenosis

esophageal atresia (EA) Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

A toddler requires an enema. After explaining the procedure to the parent and preparing the supplies, what action will the nurse take? Place the toddler on the right side. Place the toddler on the abdomen. Place the toddler on the left side. Place the toddler on the back.

Place the toddler on the abdomen. Explanation: The best position for administering an enema to an infant or toddler is on the abdomen with the knees bent (knee-chest position). For a child or adolescent, the nurse places the child on the left side with the right leg flexed toward the chest. To provide atraumatic care, the parents need to be educated on the procedure and its purpose. A child-life specialist can also be involved for diversionary activities. The nurse should also ascertain, before administering the enema, if the toddler is potty trained or is in diapers.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Soft and flat fontanels (fontanelles) Pale and slightly dry mucosa Tenting of skin Blood pressure of 80/42 mm Hg

Tenting of skin Explanation: Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

The nurse is assessing a toddler and palpates a sausage-shaped mass in the upper mid abdomen. When taking the toddler's history, what question would the nurse ask the parent first? "How is your toddler's appetite?" "Has your toddler been around anyone who has been sick?" "Can you describe any pain your toddler is having?" "Has your toddler been having different colored stools?"

"Has your toddler been having different colored stools?" Explanation: A sausage-shaped mass in the upper mid abdomen is a classic sign of intussusception. Intussusception occurs when the proximal segment of the bowel "telescopes" into a more distal segment of the bowel, thus the sausage-shaped mass. Another classic sign of intussusception is stools that appear like currant jelly. These are stools which are bloody and mixed with mucus. This should be the question the nurse asks first. Next, the nurse should ask about the pain. The pain with intussusception has a sudden onset and is intermittent and crampy. The appetite of the child generally is poor due to abdominal pressure and pain. Intussusception is not a contagious or infectious disease.

The nurse is taking a health history of an 11-year-old child with recurrent abdominal pain. Which response will lead the nurse to suspect irritable bowel syndrome? "I always feel better after I have a bowel movement." "I have pain in my mouth and abdomen, all the way to my anus." "I have stomach cramps after eating bread and pasta." "My stools are loose with mucus and have blood on them."

"I always feel better after I have a bowel movement." Explanation: In cases of irritable bowel syndrome, the pain may be relieved by defecation. Abdominal pain associated with the eating of gluten-rich food such as pasta and bread may be indicative of celiac disease. Bloody stools and abdominal pain that starts in the mouth and abdomen, going all the way to the anus, are not symptoms of irritable bowel syndrome but of Crohn's disease.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have to be careful because I am prone to not absorbing nutrients." "I have a lot of diarrhea every day because of how my small intestine is damaged." "It's unusual for someone my age to get Crohn disease."

"I have to be careful because I am prone to not absorbing nutrients." Explanation: Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease affecting the intestine(s) in a continuous pattern.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will watch for diaper rash." "I will add the nystatin to her bottle four times per day." "I will use a cotton tipped applicator to apply the medication to her mouth." "I will make sure to clean all of her toys before I give them to her."

"I will add the nystatin to her bottle four times per day." Explanation: Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will weigh her every morning at the same time." "I will monitor her IV line to help maintain her fluid volume." "I will teach her mother to give her small drinks frequently."

"I will make sure there is plenty of orange juice available. It's her favorite juice." Explanation: Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction? "I will find out how much of the liquid my child drank." "I will use syrup of ipecac to get it out of my child's system." "I will watch my child's breathing status and keep my child calm." "I will call the Poison Control Center now."

"I will use syrup of ipecac to get it out of my child's system." Explanation: The CDC no longer recommends that the syrup of ipecac be used in the home for treatment of poisoning and, furthermore, recommends that it be disposed of safely. All the other statements are accurate. Depending on the amount of detergent ingested, the parent is instructed to first terminate any exposure and then possibly transport the child to a health care facility.

The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? "Have you tried using a toothbrush to get it off?" "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it." "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system."

"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Explanation: Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.

The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? "My child only has a bowel movement about four times a week." "My child eats vegetables and fresh fruit, but does not like beans." "My child does not have liquid stool or leak liquid stools that I am aware of." "My child has such large bowl movements that it clogs the toilet."

"My child has such large bowl movements that it clogs the toilet." Explanation: Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? "Try some Anbesol or Kank-A." "Offer him some orange juice." "Offer 'magic mouthwash' followed by a popsicle." "Encourage him to have some soda."

"Offer 'magic mouthwash' followed by a popsicle." Explanation: Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

The nurse is caring for an infant. The infant's mother asks the nurse, "What did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? "Regurgitation is just another term for vomiting. All infants vomit some." "Regurgitation is the backflow of stomach contents up into the esophagus or mouth." "Regurgitation is not normal in infants. She will need more testing to see what is causing this." "Regurgitation is when an infant can't tolerate their formula. You will need to switch."

"Regurgitation is the backflow of stomach contents up into the esophagus or mouth." Explanation: Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? "What foods has your child eaten during the last few days?" "How many times a day does your child urinate?" "Tell me about the types of stools your child has been having." "How long has your child been toilet trained?"

"Tell me about the types of stools your child has been having." Explanation: For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on the number and type of stools per day. Recent eating patterns, determining if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? "The surgery will create an opening to the large intestine." "The surgery will create an opening to the small intestine." "The surgery is performed to create an opening between the esophagus and the neck." "The surgery creates an opening between the stomach and abdominal wall."

"The surgery creates an opening between the stomach and abdominal wall." Explanation: Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? "We will give enemas until clear and then teach you how to do these at home." "The treatment for the disorder will be a surgical procedure." "Your child will receive counseling so the underlying concerns will be addressed." "Your child will be treated with oral iron preparations to correct the anemia."

"The treatment for the disorder will be a surgical procedure." Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number. ___________

48 Explanation: Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? 3 to 5 days 7 to 14 days 5 to 7 days 1 to 3 days

7 to 14 days Explanation: The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Barium enema Upper endoscopy Surgery Endoscopic retrograde cholangiopancreatography

Barium enema Explanation: A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? Effortless vomiting Bloody vomiting Projectile vomiting Bilious vomiting

Bilious vomiting Explanation: The contents and character of the vomitus may give clues to the cause of vomiting. Bilious vomiting is never considered normal and suggests an obstruction. Projectile vomiting is associated with pyloric stenosis. The gender and the age of the child are not consistent with pyloric stenosis. Effortless vomiting is often seen in gastroesophageal reflux. Bloody emesis can signify esophageal or gastrointestinal bleeding.

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes. Use a syringe plunger to administer the feeding. Check for gastric residual before starting feeding. Position the client with the head of the bed at a 20° angle.

Check for gastric residual before starting feeding. Explanation: The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and the formula should be allowed to flow with gravity, not plunged unless the tube is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the G-tube open for 5 to 10 minutes after feeding to allow for escape of air.

A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? food poisoning Hirschsprung disease Crohn disease ulcerative colitis

Crohn disease Explanation: Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Hirschsprung disease Ulcerative colitis (UC) Gastroenteritis Short bowel syndrome (SBS)

Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Improving hydration Maintaining skin integrity Promoting comfort Preparing family for home care

Improving hydration Explanation: Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? In this disorder the sphincter that leads into the stomach is relaxed. A thickened, elongated muscle causes an obstruction at the end of the stomach. A partial or complete intestinal obstruction occurs. There are recurrent paroxysmal bouts of abdominal pain.

In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? Lower left Lower right Upper left Upper right

Lower right Explanation: With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant is referred to as the McBurney point, an area of tenderness 1.5 to 2 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis? Irregular breathing Prolonged bleeding Chronic cough Persistent constipation

Persistent constipation Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? Prepare the child for admission to the hospital. Assess the child's usual urinary voiding pattern. Encourage fluid intake. Administer antacids as ordered.

Prepare the child for admission to the hospital. Explanation: The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? Prevention of T-cell rejection of the transplanted liver Maintenance of electrolyte balance Reduction of hypertension Prevention of hypoglycemia

Prevention of hypoglycemia Explanation: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by fingerstick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine and nitroprusside may be needed to reduce hypertension.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Projectile vomiting Frequent urination Explosive diarrhea Severe abdominal pain

Projectile vomiting Explanation: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Feed the child a cracker Administer IV potassium Administer antibiotic therapy Take a stool culture

Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? Hypothermia is common. The adolescent's urine will be dark and infectious. The adolescent will be very irritable and perhaps require sedation. The adolescent will become fatigued easily.

The adolescent will become fatigued easily. Explanation: Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? Vomiting about 2 hours after feeding Chronic diarrhea Refusal to eat Vomiting immediately after feeding

Vomiting immediately after feeding Explanation: With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. applesauce bananas rye bread skim milk wheat bread

applesauce bananas skim milk Explanation: The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? confirm pancreatitis determine esophageal contractility evaluate gastric pH detect Helicobacter pylori

detect Helicobacter pylori Explanation: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

The nurse is caring for a 2-year-old child with a gastrointestinal infection resulting in 4 to 5 liquid stools per day over the past 3 days. Based on this information, which important concern(s) will the nurse address in the child's care? Select all that apply. undernourishment risk: malnutrition diarrhea and loss of electrolytes the risk for skin maceration in the perineum availability of parents to care for the child fluid deficiency risk: dehydration

fluid deficiency risk: dehydration diarrhea and loss of electrolytes the risk for skin maceration in the perineum Explanation: Four to five loose stools per day are considered diarrhea. The child is at risk for fluid and electrolyte deficiency given the length of time and number of stools per day. The risk for skin maceration can occur in the perianal area because of the prolonged skin exposure to liquid stools. The child does not have malnutrition. Malnutrition is defined as a condition that results from a nutrient deficiency or overconsumption. Parental presence to care for the child can be addressed after the immediate needs of the child are addressed.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: gastroesophageal reflux disease. inflammatory bowel disease. Hirschsprung disease. cystic fibrosis.

gastroesophageal reflux disease. Explanation: Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? perianal fissures and skin tags sausage-shaped mass in the upper mid abdomen abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant

hard, moveable "olive-like mass" in the upper right quadrant Explanation: A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? preterm birth history of hypoxia at birth mother age 42 with pregnancy maternal use of acetaminophen in third trimester

mother age 42 with pregnancy Explanation: Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

Which body system is most sensitive to lead ingestion? renal system musculoskeletal system gastrointestinal system nervous system

nervous system Explanation: The system most affected from lead ingestion is the nervous system. The onset of chronic lead poisoning is insidious. Symptoms of irritability, hyperactivity, aggression, impulsiveness, or disinterest in play may be noted. Short attention span, lethargy, learning difficulties, and distractibility are signs of lead poisoning. The other systems are impacted by lead but not to the same degree.

A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect? ulcerative colitis Crohn disease appendicitis pancreatitis

pancreatitis Explanation: The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted. Appendicitis pain and tenderness would be localized to the right lower quadrant. Crohn disease is a chronic bowel disorder causing frequent, recurring diarrhea. Ulcerative colitis is a chronic bowel disease affecting the large intestine and the rectum.

Which congenital condition leads to the infant being hungry, irritable, losing weight, and rapidly becoming dehydrated with the potential of metabolic alkalosis? intussusception colic aganglionic megacolon pyloric stenosis

pyloric stenosis Explanation: This clinical picture includes assessment findings consistent with pyloric stenosis. These infants are very hungry yet once they eat, regurgitate the feeding leading to the infant being irritable, losing weight, and becoming dehydrated. The infant with aganglionic megacolon has a main symptom of constipation. Intussusception is a painful telescoping of the bowel. Colic has similar symptoms but primarily includes bouts of abdominal pain.

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? pyloric stenosis peptic ulcer disease appendicitis gastroesophageal reflux

pyloric stenosis Explanation: With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.