EDAPT: Nursing Care - Pediatric Gastrointestinal and Elimination Alterations

The nurse is caring for an 8-year-old pediatric client in a healthcare provider clinic. The child presents with eye swelling, poor appetite, and brown colored urine. Which is the most important assessment question for the nurse to ask?​

"Can you tell me about any recent illnesses?"​

The nurse is completing the assessment of a 3-year-old child in a pediatric primary care office. The parent brought the toddler in for gastroenteritis. Which are important assessment questions for the nurse to ask the parent? Select all that apply.​

"How much has your child been eating and drinking?"​ "Does your child attend daycare or preschool?"​ "Has your child had any vomiting?"​ "Can you describe your child's activity level since being ill?"​ "How many times a day has your child had diarrhea episodes?"​

The nurse is caring for a 6-year-old who was admitted to the pediatric unit for dehydration related to gastroenteritis. The nurse is initiating a peripheral intravenous catheter to administer intravenous fluids. Which is the best statement by the nurse when explaining the procedure to the client?​

"I am going to put a special straw in your hand."​

The health care provider orders a urine culture and sensitivity and prescribes amoxicillin 500 mg oral (PO) twice daily (BID). The nurse has completed education about preventing future urinary tract infections. Which statement by the parent indicates further education is needed?​

"I will give my child two spoonfuls of the antibiotic twice a day."​

The nurse is providing education for the parent of a 2-month-old infant who is newly diagnosed with gastroesophageal reflux. Which statement by the parent indicates additional education is needed?​

"I will lay the baby down on their stomach to sleep to reduce reflux."​

Match the laboratory or diagnostic test with the description. ​

*Abdominal x-ray* - Basic picture of abdomen and pelvis; can be used to identify stones​. *Voiding cystourethrogram (VCUG)* - Provides visualization of bladder outline and urethra; can show reflux of urine into ureters and bladder emptying. *Ultrasound* - Provides visualization of structures of the urinary system. *Urine culture and sensitivity* - Urine test for pathogens and drugs to which they are sensitive​. *Specific gravity* - Urine test to indicate fluid status.

For each finding, indicate if the finding is consistent with the disease process of gastroenteritis, pyloric stenosis, or appendicitis. Each finding may support more than one disease process. ​

*Gastroenteritis:* Caused by viral, bacterial, and parasitic pathogens​ Diarrhea Fever Poor oral (PO) intake​ Sunken anterior fontanel​ *Pyloric Stenosis​:* Poor oral (PO) intake​ Sunken anterior fontanel​ *Appendicitis:* Caused by viral, bacterial, and parasitic pathogens​ Diarrhea Fever Poor oral (PO) intake​

For each finding, indicate if the finding is consistent with the disease process of gastroesophageal reflux, appendicitis, or constipation. Each finding may support more than one disease process. ​

*Gastroesophageal Reflux​:* Abdominal pain Vomiting *Appendicitis:* Abdominal pain Fever Lethargy Vomiting *Constipation:* Abdominal pain

Match the gastrointestinal problem with the correct description.​

*Hirschsprung's disease* - Mechanical obstruction from inadequate motility of intestine. *Pyloric stenosis* - Thickened obstruction between stomach and duodenum​. *Constipation* - Alteration in frequency, consistency, or ease of passing stool​. *Appendicitis* - Inflammation of sac at the end of cecum. *Gastroesophageal reflux* - Relaxation of esophageal sphincter allowing stomach contents into esophagus​.

For each assessment finding, select whether the finding indicates that the client's condition has improved, has not changed, or has declined from admission.​

*Improved:* Child rates pain 2 out of 10 using the FACES pain scale.​ Temperature 98.6F.​ *Declined:* Surgical incision reddened and warm to the touch.​ *No change​:* Child is unable to tolerate clear liquids; intravenous fluids continued.​

The pediatric surgeon has diagnosed the child with appendicitis and has scheduled the child for an emergency appendectomy. For each potential nursing action, indicate whether the action is indicated, nonessential, or contraindicated for the care of the client.​

*Indicated:* Administer intravenous fluids.​ Administer pre-operative antibiotics as prescribed.​ Maintain no oral intake (NPO) status.​ Prepare surgical consent form and witness informed consent.​ *Nonessential:* Begin discharge education. ​ *Contraindicated Increase oral (PO) intake as tolerated.​

For each potential nursing action, indicate whether the action is indicated or not indicated for the care of the client.​

*Indicated:* Provide education about urinary tract infection prevention.​ Request an order for a urine culture.​ *Not Indicated​:* Request order for an intravenous fluid bolus.​

The healthcare provider diagnosed the client with gastroenteritis and dehydration. For each potential nursing action, indicate whether the action is indicated or contraindicated for the care of this client.​

*Indicated:* Request closed top crib for hospital room Request an order to administer a fluid bolus Request an order to insert a peripheral intravenous catheter Weigh diapers to monitor output *Contraindicated:* Request an order for no oral intake (NPO) status

Match the clinical manifestations of dehydration to the severity of dehydration. ​

*Mild* - Increased thirst, slightly dry mucous membranes. *Moderate* - Loss of skin turgor, dry mucous membranes, sunken eyes, and sunken fontanel​. *Severe* - Loss of skin turgor, dry mucous membranes, sunken eyes, sunken fontanel, and rapid thready pulse.

For each finding, indicate if the finding is consistent with a urinary tract infection or enuresis.​

*Urinary Tract Infection​:* Fever Foul-smelling urine​ Frequent urination​ New incidence of daytime incontinence​ *Enuresis:* Nighttime incontinence 2-3 times per week in potty-trained child​

The healthcare provider diagnosed the client with gastroenteritis and dehydration. Review the orders by the healthcare provider. Which 3 orders should the nurse implement first?​

Acetaminophen 100 mg oral (PO)/rectal every 6 hours as needed for fever greater than 101.1º F​ Administer 0.9% sodium chloride 200 ml intravenous (IV) fluid bolus over 30 minutes​ Insert a peripheral intravenous (IV) catheter​

A pediatric client with diarrhea lasting 5 days is classified as having __________ diarrhea, which is most likely due to a __________. Treatment generally includes __________ with the goal of preventing dehydration and resuming a normal diet.​

Acute Virus or bacteria Home care

The nurse is caring for a postoperative 15-year-old client who had an appendectomy with drain placement for a ruptured appendix. Which action should the nurse perform first? ​

Administer pain medication for pain rating of 4/10​.

The healthcare provider orders a urine culture and sensitivity and prescribes amoxicillin 500 mg oral (PO) twice daily (BID). The available concentration is 250 mg/5 mL. How many milliliters will the nurse instruct the parent to administer per dose?​

10 mL​

The nurse is educating the parent of a child about oral rehydration therapy for moderate dehydration. The child weighs 12 kg. The nurse advises that the child should drink 100 mL/kg over 4 hours. What is the minimum number of ounces the child should drink per hour?​

10 ounces​

The nurse is preparing to administer ibuprofen because the child rates their pain 6 out of 10 using the FACES pain scale and the last dose was administered 7 hours ago. Review the pediatric surgeon's orders. The child weighs 44 pounds. The available concentration of ibuprofen is 100 mg/mL. How many milliliters will the nurse administer?​

2 mL​

The nurse is caring for a pediatric infant with gastroenteritis and dehydration on a pediatric acute unit. The nurse administered a fluid bolus. The infant has had no urine output since admission. Which maintenance intravenous fluid is contraindicated at this time?​

20 mEq potassium

The nurse is caring for a group of pediatric clients. Which client is most at risk for dehydration?​

3-month-old infant with diarrhea and a sunken fontanel

The nurse is caring for a pediatric infant with gastroenteritis and dehydration on a pediatric acute unit. The healthcare provider prescribed a fluid bolus of Ringer's lactate 200 mL IV over 30 minutes. The nurse is programming the infusion pump to deliver the fluid bolus. Which pump represents the correct settings? ​

400 mL/hr 200 mL

Which client experiencing constipation is at the most risk for serious complications? ​

A 2-day-old newborn who has never had a bowel movement​.

The nurse is caring for a child who will be having abdominal surgery. Which nursing action(s) does the nurse anticipate performing prior to surgery? Select all that apply.​

Administer prescribed intravenous fluids​. Administer prescribed preoperative antibiotics​. Request services from child life specialist​. Prepare surgical consent and witness informed consent​.

The child is most at risk for developing __________ as evidenced by the abdominal pain, __________.​

An infection Vomiting, fever, and lethargy

The nurse is admitting a 2-month-old infant prior to a surgical intervention for pyloric stenosis. The parent reports the infant has not had a wet diaper since the evening before. The nurse assesses the infant has a sunken anterior fontanelle and is tachycardic. Which is the most important order the nurse should request from the health care provider?​

An order for intravenous fluids​

The nurse is providing education to the parent of a 3-year-old child in a pediatric primary care office. The parent brought the toddler in for gastroenteritis and dehydration. The healthcare provider determined the child could likely be rehydrated at home with oral rehydration therapy. Which are benefits of oral rehydration therapy for the nurse to include in the education? Select all that apply.​

Can be accomplished at home​ Safer than intravenous fluid therapy​ Less costly than intravenous fluid therapy​

The healthcare provider orders a urine culture and sensitivity. Which method should the nurse use to collect the specimen?​

Clean catch urine​

A urine culture and sensitivity requires the collection of sterile urine collected by clean-catch, catheterization, or suprapubic aspiration collection. The nurse is educating a client about how to collect a clean-catch specimen to determine if the client has a urinary tract infection. Place the steps of collecting a clean-catch urine in the order performed. ​

Clean urethral meatus​ Void a few milliliters of urine​ Collect urine in sterile specimen cup​

The nurse is caring for a new admission on a pediatric unit. Review the electronic health record (EHR) before answering each question. Highlight the assessment findings that are concerning to the nurse.​

Diarrhea for the last 3 days Attends daycare Poor skin turgor No tears when crying Sunken anterior fontanel P 170

Which 4 findings should the nurse follow-up with?

Daytime incontinence​ Frequent urination​ Foul-smelling urine​ Temperature

The child is at highest risk for __________ as evidenced by __________.

Dehydration Diarrhea and lack of tears

The nurse is caring for a child with a urinary tract infection. Which teaching points should the nurse include in the education for the child and parent to prevent future infections? Select all that apply.​

Ensure adequate fluid intake​ Encourage frequent voiding​ Ensure females wipe from front to back​ Encourage wearing cotton underwear​ Encourage showers instead of baths​

Which assessment findings indicate the infant is improving? Select all that apply.​

Infant has had no stools for 12 hours Infant is tolerating formula, rice cereal, and baby food Infant had three wet diapers overnight Peripheral intravenous catheter was removed

The parent of a 3-year-old calls the nurse advice line. The parent reports the toddler has had diarrhea for the past two days, has had no vomiting, has a dry mouth, and sunken looking eyes. Which is the best recommendation by the nurse?​

Initiate oral rehydration therapy​

The nurse is caring for a child who just returned to the pediatric unit after having an abdominal surgery. Which nursing action(s) does the nurse anticipate performing? Select all that apply.​

Monitor vital signs per post-operative protocol​. Assess for return of bowel sounds. Assess surgical wound and/or dressing​. Advance oral intake as tolerated. Administer pain medication as prescribed​.

The nurse is caring for a 10-year-old pediatric client with enuresis. The client completes a functional bladder capacity test with results of 360 milliliters. The result is __________ for the client's age. The result indicates the bladder can __________ retain a night's urine.​

Normal Sufficiently

The nurse is caring for a 6-month-old pediatric client in a healthcare clinic. Which assessment findings are consistent with the clinical manifestations of urinary dysfunction? Select all that apply.​

Parent reports increased number of diaper changes​ Temperature is 100.5º F Parent reports infant is sleeping more than usual​ Parent reports infant has decreased interest in eating​ Anterior fontanel​ is sunken

The nurse is caring for a pediatric client who presented to the pediatric unit with abdominal pain which causes the child to double over in pain. The child has intermittent periods of relief from the abdominal pain. The pediatric surgeon has scheduled the child for surgery. Which assessment finding should the nurse report to the pediatric surgeon immediately?​

Passage of normal brown stool

The nurse is caring for a 6-year-old child who is 4 hours post-operative from a ruptured appendectomy. Ibuprofen was administered 2 hours ago and the child rates pain as 1 out of 10. The child's intake includes water, crackers, a cup of gelatin, and a bottle of juice. Review the health care provider's orders. Which action should the nurse take next?​

Saline lock the intravenous line​.

Which are the top 4 assessment findings that require follow up by the nurse? Select four responses.​

Temperature Lethargy Abdominal pain Vomiting

The highest priority to resolve is the potential __________ to avoid the outcomes of __________ that could result from not resolving the problem. ​

Urinary tract infection Permanent renal scars

Which 3 orders from the pediatric surgeon should the nurse implement right away? Select 3 responses.​

Vital signs per surgical post-op protocol​ 0.9% sodium chloride intravenous (IV) at 100 ml/hour​ Nasogastric tube to intermittent wall suction​

The nurse is caring for an infant with repeated urinary tract infections, suggesting there may be a functional or structural abnormality. Which test does the nurse anticipate the healthcare provider will order? ​

Voiding cystourethrogram (VCUG)​

The nurse is caring for a pediatric client with acute poststreptococcal glomerulonephritis. Weight on admission was 55 kg. Blood pressure was 140/80. Which assessment finding is the best indication of improvement?​

Weight 52 kg​