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

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? "You may need adhesive remover to ease pouch removal." "You must be meticulous in caring for the surrounding skin." "Gather all of your supplies before you begin." "Call the doctor immediately if the stoma is not pink/red and moist."

"Call the doctor immediately if the stoma is not pink/red and moist." A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

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 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." "I will use a cotton tipped applicator to apply the medication to her mouth." "I will watch for diaper rash."

"I will add the nystatin to her bottle four times per day." 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 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 call the Poison Control Center now." "I will watch my child's breathing status and keep my child calm." "I will use syrup of ipecac to get it out of my child's system." "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." 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.

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Appendicitis Gastroenteritis Pancreatitis Hirschsprung disease

Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

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? A thickened, elongated muscle causes an obstruction at the end of the stomach. In this disorder the sphincter that leads into the stomach is relaxed. There are recurrent paroxysmal bouts of abdominal pain. A partial or complete intestinal obstruction occurs.

In this disorder the sphincter that leads into the stomach is relaxed. 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 right Upper right Upper left Lower left

Lower right 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 completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern? aspiration nutritional deficiency stomach irritation stunted growth

aspiration The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? esophageal atresia hiatal hernia gastroschisis omphalocele

esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

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? history of hypoxia at birth maternal use of acetaminophen in third trimester preterm birth mother age 42 with pregnancy

mother age 42 with pregnancy 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.

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

Tenting of skin 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.

Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? Semiformed bowel movements Vomiting Flatulence Falling asleep at each feeding

Vomiting Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema. Flatulence and semi-formed stools would be positive signs that motility is active and digestion is occurring. Falling asleep is a sign that the child is full and satisfied.

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 stomach cramps after eating bread and pasta." "My stools are loose with mucus and have blood on them." "I have pain in my mouth and abdomen, all the way to my anus."

"I always feel better after I have a bowel movement." 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.

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

Barium enema 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 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? Promoting comfort Improving hydration Maintaining skin integrity Preparing family for home care

Improving hydration 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.

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? cleft palate esophageal atresia (EA) hernia pyloric stenosis

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

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: painless rectal bleeding. dehydration. respiratory distress. ischemia.

painless rectal bleeding. With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

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? "How long has your child been toilet trained?" "Tell me about the types of stools your child has been having." "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." 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.

Which client most likely has ulcerative colitis rather than Crohn disease? 12-year-old with oral temperature of 101.6° F (38.7° C) 18-year-old male with abdominal pain 16-year-old female with continuous distribution of disease in the colon, distal to proximal 14-year-old female with full-thickness chronic inflammation of the intestinal mucosa

16-year-old female with continuous distribution of disease in the colon, distal to proximal Ulcerative colitis is usually continuous through the colon while the distribution of Crohn disease is segmental. Crohn disease affects the full thickness of the intestine while ulcerative colitis is more superficial. Both conditions share age at onset of 10 to 20 years, with abdominal pain and fever in 40% to 50% of cases.

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 back. Place the toddler on the left side. Place the toddler on the abdomen. Place the toddler on the right side.

Place the toddler on the abdomen. 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 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. wheat bread bananas applesauce skim milk rye bread

bananas applesauce skim milk 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.

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

pyloric stenosis 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.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease? "I have learned to make my own bread with no gluten." "Even though milk and pudding are good for her, we don't give her those foods." "The soup we eat at our house is all made from scratch." "She loves hot dogs, and we always cut hers up into small pieces."

"She loves hot dogs, and we always cut hers up into small pieces." Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hot dogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.

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 creates an opening between the stomach and abdominal wall." "The surgery will create an opening to the small intestine." "The surgery will create an opening to the large 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." 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 mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits."

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.

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." "Encourage him to have some soda." "Offer 'magic mouthwash' followed by a popsicle." "Offer him some orange juice."

"Offer 'magic mouthwash' followed by a popsicle." 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.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "She might lose some weight initially." "We might notice some of the medication in her stool." "We should not stop this medication abruptly." "This drug helps to control the abdominal cramping."

"We should not stop this medication abruptly." Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

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? Encourage fluid intake. Prepare the child for admission to the hospital. Administer antacids as ordered. Assess the child's usual urinary voiding pattern.

Prepare the child for admission to the hospital. 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.

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: projectile stools. severe diarrhea. currant jelly stools. steatorrhea.

steatorrhea. Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant. Medicate the infant with analgesics. Prepare the infant for surgery.

Prepare the infant for surgery. In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

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

detect Helicobacter pylori 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 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 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." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "It's unusual for someone my age to get Crohn disease."

"I have to be careful because I am prone to not absorbing nutrients." 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 a 6-month-old infant who has been nutritionally deprived. The infant appears weak and uninterested in eating. Which nursing interventions are most helpful? Select all that apply. Use a hard, small-holed nipple. Be relaxed when feeding to promote relaxation. Schedule feedings every 2 to 3 hours. Prop the bottle in the crib for accessibility. Limit feedings to approximately 20 minutes.

Schedule feedings every 2 to 3 hours. Limit feedings to approximately 20 minutes. Be relaxed when feeding to promote relaxation. It is most important to provide a calm, relaxing environment when feeding the infant. Feedings should be a time of human interaction; never prop a bottle. Use a soft, large hole (large enough to allow the formula to drip without pressure) nipple. Hard, small-holed nipples cause frustration and expend excess energy to suck. Feedings are scheduled every 2 to 3 hours lasting 20 to 30 minutes because most babies can handle small feedings better than larger ones.

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

hard, moveable "olive-like mass" in the upper right quadrant 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.

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing."

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.

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 the backflow of stomach contents up into the esophagus or mouth." "Regurgitation is when an infant can't tolerate their formula. You will need to switch." "Regurgitation is just another term for vomiting. All infants vomit some." "Regurgitation is not normal in infants. She will need more testing to see what is causing this."

"Regurgitation is the backflow of stomach contents up into the esophagus or mouth." 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.

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? Reduction of hypertension Prevention of T-cell rejection of the transplanted liver Maintenance of electrolyte balance Prevention of hypoglycemia

Prevention of hypoglycemia 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 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 Take a stool culture Administer antibiotic therapy

Take a stool culture 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 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. Hirschsprung disease. cystic fibrosis. inflammatory bowel disease.

gastroesophageal reflux disease. 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.

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? Crohn disease ulcerative colitis pancreatitis appendicitis

pancreatitis 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.