Pediatric Test 2 GI Case Study & Success

The nurse is caring for a newborn with an anorectal malformation and has had a colostomy placed. The nurse knows that more education is needed when the infant's parent states which of the following?

The colostomy contains stool from the large intestine; an ileostomy contains the very irritating stool from the small intestine.

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a fever of 101.8°F (38.8°C). The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is most appropriate for this patient

Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals?

Cheese, banana slices, rice cakes, and whole milk do not contain gluten.

GI Case Study 3: What is this child's medical diagnosis?

R/O Appendicitis

GI Case Study 2: What interventions does the nurse implement postoperatively?

Assess VS Maintain Accurate I&O- may or may not have foley catheter

GI Case Study 4: Which of the following recommendations should the office nurse anticipate she will need to implement?

Administration of Ducosate, Laculose or Miralax

The nurse is caring for a 3-month-old male who is being evaluated for possible Hirschsprung disease. His parents call the nurse and state that his diaper contains a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which of the following should be the nurse's next action?

All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.

The nurse is conducting an in-service lecture on NEC to a group of colleagues. The nurse knows that she needs to provide more education when one of the participants states which of the following?

Although much more common in preterm and low-birth-weight infants, NEC is also seen in term infants as well.

Which of the following manifestations suggests that an infant is developing NEC?

Bloody diarrhea can indicate that the infant has NEC.

The nurse is working in the pediatric clinic and is seeing many children with diarrhea. Which of the following children can most likely be discharged without further evaluation?

It is common for children to have a relapse of diarrhea after resuming a regular diet

The nurse is caring for a 3-month-old infant who has SBS and has been receiving TPN. The parents ask if their child will ever be able to eat. Select the nurse's best response.

It is important to begin feedings as soon as the bowel is healed so that it receives stimulation and does not atrophy.

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response.

Offering small amounts of clear liquids is usually well tolerated. The amount can be halved if the child vomits as long as the child does not appear to be dehydrated. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.

GI Case Study 2: What interventions does the nurse implement preoperatively

Place NPO Initiate IV Assess for abdominal distention Prepare parents for possible colostomy

The nurse in the pediatric clinic is providing instructions to the parents of a 2-year- old child who has just been diagnosed with acute hepatitis. Which of the following would be an appropriate activity for the nurse to recommend?

Playing with puzzles is a developmen- tally appropriate activity for a 3-year- old on bedrest.

GI Case Study 1: What is this infant's medical diagnosis?

Pyloric Stenosis

GI Case Study 3: Which of the following clinical manifestations should lead the nurse to suspect that Maria's appendix has ruptured?

Sudden relief from pain

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response.

The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.

The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal atresia and is scheduled for surgery. Which of the following should the nurse expect to do in the preoperative period?

Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are ad- ministered to prevent pneumonia be- cause aspiration of secretions is likely.

The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, the nurse would expect to find which of the following?

Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero.

GI Case Study 2: What are the priority nursing diagnoses?

PC: Fluid Volume Deficit Alteration in Elimination r/t inability to pass meconium

The nurse is caring for a 6-year-old in the early stages of acute hepatitis. Which of the following manifestations should the nurse expect to find

The early stages of acute hepatitis are referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise.

The nurse is in the room while a mother of a newborn is feeding her infant for the first time. The baby immediately begins coughing and choking. The nurse notes that the baby is extremely cyanotic. Which of the following should be the nurse's immediate action?

The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained.

The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response.

The infant is displaying signs of intus- susception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.

The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response.

The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus

The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child?

The right side-lying position promotes comfort and allows the peritoneal cavity to drain.

The mother of a newborn asks the nurse why she has to nurse so frequently. The nurse replies using which of the following principles?

The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small frequent feedings.

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period.

The supine position is preferred because there is decreased risk of the infant rubbing the suture line.

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response.

There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

GI Case Study 3: Maria has an appendectomy. The nurse anticipates that she will return from surgery with an NG tube. The NG which will be placed on low intermittent decompression until:

Bowel motility returns

GI Case Study 1: What interventions does the nurse implement in the preoperative period?

NPO Initiate IV - Replace Fluid

The nurse is caring for an 18-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care?

Pain medication should be adminis- tered regularly to avoid crying, which places stress on the suture line.

The nurse is reviewing the discharge instructions of a child diagnosed with encopresis. Which of the following instructions should the nurse question?

Positive reinforcement is encouraged. The use of negative reinforcement is discouraged, however, as it may cause the child to attempt to be controlling by holding on to the stool.

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?"

Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

The nurse is caring for an infant with biliary atresia who is scheduled for a Kasai procedure. Which of the following is an accurate description of this surgery?

The Kasai procedure is a palliative pro- cedure in which a bile duct is attached to a loop of bowel to assist with bile drainage.

The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states:

The child should wait 6 weeks before returning to any strenuous activity.

GI Case Study 1: What interventions does the nurse implement in the postoperative period?

Assess Vital Signs Check op Site Initiate feedings slowly - Start with glucose water or Pedialyte

The nurse is caring for an infant who has been diagnosed with SBS. The parents of the infant ask how the disease will affect their child. Select the nurse's best response.

Because the intestine is used for ab- sorption, children with SBS usually need alternative forms of nutrition such as hyperalimentation.

The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. The nurse is sending the child home. Which of the following is likely to be included in the discharge teaching?

Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.

The nurse is administering Prilosec to a 3-month-old with GER. The child's parents ask the nurse how the medication works. Select the nurse's best response.

This accurate description gives the parents information that is clear and concise.

GI Case Study 5

Tommy is an 18 month-old who is brought to see the PNP by his anxious mother, who reports that Tommy has just swallowed a penny. Tommy has no evidence of dysphagia, respiratory distress or discomfort. A plain abdominal x-ray shows the penny in the stomach.

An expectant mother asks the nurse if her new baby will likely have an umbilical hernia. The nurse bases the response on which of the following?

Umbilical hernias occur more often in premature infants

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of is the enema. Select the nurse's most appropriate response.

In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

The nurse is about to receive a 4-year-old from the recovery room after an appendectomy for a non-ruptured appendix. The parents have not seen the child since the surgery and ask what to expect. Select the nurse's best response.

In the immediate postoperative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.

The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response

Increasing fluid consumption helps to decrease the hardness of the stool

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis?

Infants with pyloric stenosis are always hungry and often appear malnourished.

The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing NEC. Which of the following would the nurse expect to be included in the plan of care?

Intravenous antibiotics are adminis- tered to prevent or treat sepsis.

The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which of the following is the optimal way to manage pain?

Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is noted to be restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115.The parents state that the child has not urinated in 12 hours. After estab- lishing a saline lock, the nurse reviews the physician's orders. Which of the following orders should the nurse question?

Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified.

The nurse is caring for an infant with pyloric stenosis. The parents ask if any future children will likely have pyloric stenosis. Select the nurse's best response.

Pyloric stenosis can run in families, and it is more common in males.

The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response

The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

A 2-month-old male is brought to the pediatric clinic. The infant has had vomiting and diarrhea for 24 hours. The infant's anterior fontanel is sunken. The child is irrita- ble, and the nurse notes that the infant does not produce tears when he cries. Which of the following tasks will help confirm the diagnosis of dehydration?

The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration.

The nurse is caring for a 4-week-old infant with biliary atresia. Which of the following manifestations would the nurse expect to see?

The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the ab- sence of bile pigments. The urine is tea- colored due to the excretion of bile salts.

The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action?

The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.

The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but that the infant's urine contains meconium. The nurse can make which of the following assumptions?

The presence of stool in the urine in- dicates that the anorectal malformation is high.

The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which of the following could be a causative factor? Select all that apply.

1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation.

Which of the following children may need extra fluids to prevent dehydration? Select all that apply.

1. The lights in phototherapy increase insensible fluid loss, requiring the nurse to monitor fluid status closely. 2. The infant with pyloric stenosis is likely to be dehydrated due to persistent vomiting. 3. A 2-year-old with pneumonia may have increased insensible fluid loss due to tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid overload can result in increased respiratory distress. 5. The child with a burn experiences ex- tensive extracellular fluid loss and is at great risk for dehydration. The younger child is at greater risk due to greater proportionate body surface area.

GI Case Study 1: How much weight has this child lost and what degree of dehydration is he exhibiting.

4800 gms - 4300 gms = 500 gms ÷ 4.8 Kgs = 104 gms/mls per Kg Severe Dehydration

GI Case Study 2

A 1 day-old infant in the special care nursery is noted to have abdominal distention and has not passed any meconium. The baby is refusing to nipple and has vomited what little formula the nurses were able to get her to nipple. The physician noted upon his physical exam that the infant's internal anal sphincter is tight.

The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care

In addition to giving fluids intra- venously and keeping the infant NPO, an NGT is placed to decompress the stomach.

GI Case Study 3: Several diagnostic tests are ordered. Appropriate interventions in the preoperative period include which of the following?

D. Ensure that the diagnostic tests are administered as soon as possible to prevent delay in treatment

A 4-month-old female is brought to the emergency department with severe dehydra- tion. Her heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous>? line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which of the following would the nurse expect to do immediately?

Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.

GI Case Study 5: Which of the following recommendations should the PNP make to the child's mother?

Examine all stools for verification that the penny has passed. Give the mother instructions on how to make the home safe for small children

GI Case Study 1: What are the priority nursing diagnoses?

Fluid Volume Deficit Acid-Base Imbalance

GI Case Study 2: What is this infant's medical diagnosis?

Hirschsprungs

The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which of the following should be included in the plan of care?

If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency.

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. Which of the following does the nurse understand about this infant's condition?

In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumu- lation of bowel contents and abdominal distention.

The parents of a 6-year-old being evaluated for appendicitis tell the nurse the physician diagnosed their child as having a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response.

A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant.

The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup?

A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis

A 7-year-old is being seen in the pediatric clinic. The child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which of the following pharmacological measures is most appropriate?

A stool softener is the drug of choice because it will lead to easier evacuation.

GI Case Study 1

A 3 month-old infant is brought to the E.R. by his parents. The parents report that the infant started vomiting after every feeding about a week ago. The parents state that their pediatrician told them that the infant had the flu and to give him pedialyte. The father stated that "he vomits so hard it shoots across the room." The infant has been on Carnation Good Start with Fe since birth. Mother reports that he usually takes 4-5 ounces every 4-6 hours. According to the mother after the baby vomits he cries "just like he does when he is hungry." "We go ahead and feed him again and he will take another 2-3 ounces and then vomit again within a half-hour." "His vomit looks just like his formula." The infant's parents also report that they think he has lost some weight, his soft spot is sunken and he isn't wetting as many diapers.

The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say which of the following?

A change in stool form is important to report because it could indicate stenosis of the rectum.

The nurse is caring for a 6-year-old with hepatitis. The child is hungry and wants to eat dinner. Which of the following foods should be offered?

A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention.

GI Case Study 4

Allison is a 2 1/2 year-old who has not passed any stool in the past 5 days. The last stool she passed was a firm stool that appeared to cause great discomfort during defecation. Allison has tried to defecate, but it appears she has had a hard time dispelling the stool. There has been no change in Allison's diet, and she is growing well. There is no other history of other symptoms, medical problems or prior constipation. Her parents have been trying to toilet train her for the last 2 weeks and they are concerned, so they brought her to the PNP for advice.

The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response.

The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems

A nurse working in an emergency room of a large pediatric hospital receives a transfer call from a reporting nurse at a local community hospital. The nurse will soon receive a 4-month-old who has been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse?

Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.

The nurse is caring for a 2-month-old infant diagnosed with GER. Which of the following should the nurse include in the plan of care to decrease the incidence of symptoms of GER?

Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down

GI Case Study 3

Maria is a 10 year-old girl brought to the E.R. by her grandmother because of generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 38.C ax. Bowel sounds are present in all 4 quadrants.

The nurse in the pediatric clinic receives a call from the parent of a 5-year-old and states that the child has been having diarrhea for 24 hours. The parent explains that the child vomited twice 2 hours ago and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response.

Pedialyte is the first choice, as recom- mended by the American Academy of Pediatrics. Offering the child appropri- ate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated

The nurse is caring for a 4-month-old with GER. The infant is due to receive Reglan (metoclopramide). Based on the medication's mechanism of action, when should this medication be administered?

Reglan increases gastric emptying and should be administered 30 minutes before a feeding.

The nurse is teaching feeding techniques to new parents. The nurse emphasizes the importance of slowly warming the formula and testing the temperature prior to feed- ing the infant. The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response

Swallowing is a reflex in infants younger than 6 weeks.

The nurse is caring for a 6-week-old infant with cerebral palsy and GER. After two hospital admissions for aspiration, the child is scheduled for a Nissen fundoplication. The nurse knows that this procedure involves which of the following?

The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal sphincter or cardiac sphincter.

The nurse is giving discharge instructions to the parents of a 1-month-old infant with tracheoesophageal atresia. The infant is being discharged with a GT. The nurse knows that the parents understand the discharge teaching when the mother states:

The area around the GT should be cleaned with soap and water to prevent an infection.

GI Case Study 1: Assessment

Weight 4.3 kg - Weight a month ago was 4.8 kg Vital Signs: Temp: 37.5 C ax HR: 100 RRR s Murmur RR: 16 BP: 74/P Skin: Pale pink, cool and dry. Skin Turgor: Loose, some mottling noted when infant cries Capillary Refill: > 2 secs Anterior Fontanel: Sunken L.O.C.: Listless, requires a fair amount of stimulation to evoke a response Lab Values: Serum Electrolytes: Na+ 130, K+ 3.0, Cl- 92, CO2 31 Arterial Blood Gases: pH 7.50, pO2 50, pCO2 50, HCO3 45 meq/L Urine Specific Gravity: 1.30 Blood Urea Nitrogen 15 mg/dl