Chapter 45: Nursing Care of a Family when a child has a Gastrointestinal Disorder

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?

Prepare the infant for surgery.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?

inguinal hernia

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:

steatorrhea.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with Kwashiorkor. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of Kwashiorkor?

"It is important to increase the intake of protein for these children."

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?

"Tell me about the types of stools your child has been having."

After teaching nursing students about pyloric stenosis, the instructor determines that the session was successful when the students state which of the following? Select all that apply.

"The infant experiences vomiting immediately after each feeding." "The infant doesn't seem to be ill otherwise."

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg (55 lb). How much fluid does the child need per day?

1,600 ml

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 congenital aganglionic megacolon?

A partial or complete intestinal obstruction occurs.

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what action will the nurse take to promote healing and prevent further skin breakdown?

Apply a barrier/healing cream or paste on the skin.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?

Baked salmon, potato slices, vanilla ice cream, and apple juice

A young child has presented to the pediatric unit with a swollen abdomen, edema, thin patchy hair, and irritability with growth retardation and muscle wasting. The nurse suspects a malnutrition disorder. The nurse identifies this child to most likely have which condition?

Kwashiorkor

A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent?

Do not rub or put pressure on the abdomen.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten

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?

Gastroenteritis

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

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.

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively?

Listening for bowel sounds

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

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?

Only occurs with feeding

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

The incidence of vitamin D deficiency in the United States is less than in many countries. What is the most likely reason for this?

Some foods in the U.S. have been fortified with vitamin D.

A nurse caring for clients in a free women's health clinic counsels women on infant nutrition and formula preparation. Which of the following is an appropriate guideline for the proper use of infant formula?

Use a soy-based formula for infants with lactase deficiency.

A child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply.

Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation.

The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention?

administration of adequate vitamin D

The nurse is caring for an infant born at 34 weeks' gestation who has developed necrotizing enterocolitis (NEC). When meeting the infant's nutritional needs, which type of supplies will be needed?

an intravenous pole and pump for total parenteral nutrition (TPN)

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 skim milk

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

The nurse recognizes that in the disorder referred to as rickets, the child has a lack of vitamin D. Because of the lack of vitamin D, the absorption of which of the following is decreased?

calcium and phosphorus

Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to:

care for a temporary colostomy.

The nurse is providing care to a child with an intussusception. The child has a bowel movement, and the nurse inspects the stool. How will the nurse document the stool's appearance?

currant jelly-like

The nurse admits an infant who is nutritionally deprived. The infant is weak and seems somewhat uninterested in food. In developing the infant's plan of care, how often will the nurse most likely plan to feed this infant?

every 2 or 3 hours

The nurse has admitted a child with a diagnosis of severe gastroenteritis. To help prevent the risk of transmitting infection to other clients, the nurse should:

follow standard precautions.

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.

The parents of a 6-week-old infant come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the past week. The parent says, "Sometimes, it seems like it just bursts out of their mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what is the nurse likely to find?

hard, moveable, olive-shaped mass in the right upper quadrant

Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is:

maintaining NPO status while restoring hydration and electrolyte balance.

A 7-year-old has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which analysis of the blood gases indicates that the illness has progressed to metabolic acidosis?

pH of 7.25, HCO3 of 20 mEq/L (20 mmol/L)

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.

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