PEDS - Gastrointestinal System

A nurse is discussing the causes of chronic diarrhea with a client. Which of the following conditions is caused by malabsorption? A. Celiac disease B. Ulcerative colitis C. Hirschprung's disease D. Crohn's disease

A. Celiac disease Celiac disease causes chronic diarrhea due to malabsorption. Other malabsorption conditions include short-bowel syndrome, lactose-intolerance, and congenital enzyme deficiency. UC & Crohn's disease cause chronic diarrhea because they are inflammatory bowel diseases. Hirschprung's disease causes chronic diarrhea because of motility disorders.

True/False Crohn's disease is inflammation in any part of the GI tract, from mouth to anus.

True.

Daily fluid requirement formula for a child weighing 15 kg.

1,000 + ([weight over 10 kg] x 50 mL/kg) This formula is for children weighing 11 to 20 kg. A child weighing 15 kg, would be the following formula & calculation: 1,000 mL + (5 x 50 mL/kg) = 1,250 mL/day (52.1 mL/hr)

Daily fluid requirement formula for a child weighing 24 kg.

1,500 mL + ([weight over 20 kg] x 20 mL/kg) This formula is for children weighing over 20 kg. A child weighing 24 kg, would be the following formula & calculation: 1,500 mL + (4 x 20 mL/kg) = 1,580 mL/day (65.8 mL/hr)

A nurse is caring for a child who has a possible intussusception. The parents of the child ask the nurse how the diagnosis is determined. Which of the following responses should the nurse make? A. "An abdominal ultrasound will confirm the pocket in the intestine." B. "Genotyping will be done to identify this condition." C. "A biopsy will be done on a small amount of tissue from the colon." D. "An upper GI series should identify the area involved."

A. "An abdominal ultrasound will confirm the pocket in the intestine." Intussusception is the invasion of a part of the intestine into another, creating a pocket. The presence of an intussusception is confirmed by an abdominal X-ray, ultrasound, or CT-scan.

A young child is diagnosed with Crohn's disease. Which manifestations differ from that of Ulcerative Colitis? SATA. A. Anal lesions B. Diarrhea C. Weight loss D. Fistulas E. Strictures F. Rashes

A. Anal lesions D. Fistulas E. Strictures The rest of the symptoms are shared by both UC and Crohn's disease.

Which type of dehydration is more like to lead to seizures? A. Hypertonic B. Isotonic C. Hypotonic

A. Hypertonic More water loss. Electrolytes aren't being lost. Patient will become hyper-irritable, have increased muscle tone, and will be hyperreflexic.

Which GI disorder is associated with steatorrhea & exceedingly foul-smelling stools? A. Meckel's diverticulum B. Celiac disease C. Crohn's disease D. Gastroschisis

B. Celiac disease

Which GI condition is associated with white or tan stools? A. Ulcerative colitis B. Hirschprung's disease C. Biliary atresia D. Intussusception

C. Biliary atresia

Which GI disorder requires surgery, and may result in a temporary ostomy? A. Intussusception B. Meckel's diverticulum C. Hirschprung's disease D. Hypertrophic pyloric stenosis

C. Hirschprung's disease The surgery is two stages & they may have a temporary ostomy.

Which clinical manifestations will the registered nurse (RN) assess for in the newborn with a diagnosis of hirschsprung disease? Select all that apply. A. the presence of frequent yellowish green diarrhea stools. B. the frequent expelling of flatulence by the newborn. C. the absence of a meconium stool since birth. D. the absence of a bowel movement by 2nd day of life. E. the stool appears thin and ribbon-like in appearance.

C. the absence of a meconium stool since birth. D. the absence of a bowel movement by 2nd day of life. E. the stool appears thin and ribbon-like in appearance. Hirschsprung disease is a congenital anomaly that affects the large intestine. This disease can affect the entire colon, but is usually confined to the distal colon. The presentation of this disease occurs within the first 48 hours of the newborn's life. In a healthy newborn, a meconium stool is passed within the first 24 hours of life. For the newborn with hirschsprung disease, there will be an absence of a bowel movement by the 2nd day or the stool will be thin ribbon-like in appearance.

A nurse is assessing an infant who has gastroesophageal reflux. The nurse should anticipate which of the following manifestations? SATA. A. Regurgitation B. Diarrhea C. Irritability D. Poor weight gain E. Respiratory issues

A. Regurgitation C. Irritability D. Poor weight gain E. Respiratory issues

Which GI disorder is associated with red, currant jelly-like stools (stools mixed with blood & mucus)? A. Intussusception B. Hirschprung's disease C. Crohn's disease D. Biliary atresia

A. Intussusception

At the six week check up, a mother reports that her infant is projectile vomiting after feedings. Which other findings would the nurse expect to discover upon assessment? Select all that apply. A. A happy and content infant. B. Abdominal distention. C. Sunken fontanelles. D. Watery stool in diaper. E. Current weight less that birth weight.

B. Abdominal distention. C. Sunken fontanelles. E. Current weight less that birth weight. The pylorus is the opening that connects the stomach to the small intestine. Pyloric stenosis is a condition found in infants where the pyloric sphincter muscles are enlarged and the opening is blocked. When food cannot pass through to the intestine for digestion, vomiting occurs. The vomiting is often forceful or "projectile" after feedings, yet the infant still presents as hungry after vomiting. Eventually, the infant will begin showing signs of dehydration, lethargy, failure to gain weight or weight loss. Olive shaped mass= pyloric stenosis. Vomiting leads to dehydration, failure to gain weight or weight loss.

Which type of dehydration is more severe with less of a volume loss? A. Hypertonic B. Hypotonic C. Isotonic

B. Hypotonic Loss of more electrolytes. Loss of extracellular fluid that leads to shock.

A nurse is assessing an adolescent who has appendicitis. Which of the following manifestations should the nurse expect? A. Upper right quadrant pain B. Rigid abdomen C. Hyperactive bowel sounds D. Bradycardia

B. Rigid abdomen Right lower quadrant abdominal pain, not RUQ, is an expected manifestation. Other expected manifestations: decreased or absent bowel sounds, and tachycardia.

A nurse is providing dietary teaching to a patient who has ulcerative colitis. Which of the following food selections by the patient indicate an understanding of the teaching? A. Raw vegetable salad with low-fat dressing. B. Roast chicken & white rice. C. Fresh fruit salad & milk. D. Peanut butter on whole wheat bread.

B. Roast chicken & white rice. Patients with UC are restricted to a low-fiber diet, which omits whole grains & raw fruits & vegetables.

A nurse is caring for an infant following the surgical repair of a cleft lip & palate. Which of the following actions should the nurse take? A. Keep the infant's mouth open by using a tongue blade for 4 hr following surgery. B. Suction the infant gently with a bulb syringe PRN. C. Place the infant in a prone position. D. Clean the infant's incision with chlorhexidine.

B. Suction the infant gently with a bulb syringe PRN. Gently suction the infant's mouth with a bulb syringe to maintain a patent airway. Avoid placing objects in the infant's mouth during the post-op period to avoid trauma to the incision. Position the infant upright to facilitate drainage of secretions. Placing the infant in a prone position could lead to aspiration. Clean the operative incision with sterile saline or sterile water after each feeding & as needed.

Which GI condition is associated with stool that is bright red or dark red with mucus. A. Crohn's disease B. Celiac disease C. Meckel's diverticulum D. Hepatitis

C. Meckel's diverticulum

With a diagnosis of hirschsprung disease in a 2 day old newborn, what treatment plan will the registered nurse (RN) expect the healthcare provider to implement? A. administer a saline enema slowly over 20 minutes, monitoring for stool. B. maintain nothing by mouth for the newborn until the first passage of stool. C. prepare the newborn for a colon resection and temporary colostomy. D. prepare the newborn rectal biopsy to determine the cause of the disease.

C. prepare the newborn for a colon resection and temporary colostomy. Hirschsprung disease is a congenital anomaly that affects the large intestine. This disease can affect the entire colon, but is usually confined to the distal colon. The decreased or inability to pass stool will cause the infant to develop a bowel obstruction. This obstruction can progress into a bowel perforation. The priority treatment for an infant diagnosed with hirschsprung disease is surgical intervention to perform a colon resection. It helps to remember that this is a congenital anomaly that results in missing nerve cells. There is nothing that will correct the issue. The issue must be removed.

What explanation will the registered nurse (RN) provide to the mother of a child diagnosed with intussusception? A. "A parasite has entered the colon causing tissue damage and limiting the movement of stool through the colon." B. "Part of the colon has died which has resulted in stool being trapped in the colon." C. "There is a problem with the colon that prevents the muscles from contracting to move the stool through the colon." D. "One portion of the colon telescopes into another portion of the colon, causing a blockage."

D. "One portion of the colon telescopes into another portion of the colon, causing a blockage." Intussusception is defined as a telescoping of one portion of the colon into another portion of the colon. This telescoping of the colon results in colon obstruction and decreased blood flow. Unless corrected this can result in ischemia and colon perforation, leading to peritonitis. This condition presents from infancy to 6 years of age. Most cases are idiopathic.

A nurse is assessing a newborn who has a congenital diaphragmatic hernia. Which of the following findings should the nurse expect? A. Distended abdomen B. Increased BP C. Generalized petechiae D. Barrel-shaped chest

D. Barrel-shaped chest The nurse should expect a newborn who has a congenital diaphragmatic hernia to exhibit a barrel-shaped chest as the abdominal organs have shifted into the chest cavity. The newborn should exhibit a scaphoid, not distended, abdomen since abdominal contents have shifted into the chest cavity. Expected findings are decreased BP, cyanosis, and respiratory distress.

A Nissan Fundoplication is a surgical intervention for which GI disorder? A. Crohn's disease B. Omphalacele C. Diaphragmatic hernia D. Gastroesophageal reflux

D. Gastroesophageal reflux A Nissan Fundoplication wraps the gastric fundus behind the esophagus and keeps pressure on the sphincter when the stomach is full, thereby preventing reflux.

Which GI disorder is associated with ribbonlike, foul-smelling stools? A. Celiac disease B. Biliary atresia C. Hepatitis D. Hirschprung's disease

D. Hirschprung's disease

What is the most dangerous complication of ulcerative colitis? A. Perianal lesions B. Growth delay C. Rectal bleeding D. Toxic megacolon

D. Toxic megacolon

Daily fluid requirement formula for a child weighing 8 kg.

weight x 100 mL/kg This formula is for children weighing 0 to 10 kg. A child weighing 8 kg, would be the following formula & calculation: 8 x 100 mL/kg = 800 mL/day (33.3 mL/hr)

Infant presents to the ER with a recent diagnosis of pyloric stenosis. The infant continues to demonstrate projectile vomiting and signs of severe dehydration. Which intervention should the nurse give the highest priority after the assessment? A. Fluid and electrolyte replacement. B. Obtaining a family history. C. Calling the doctor for immediate surgery. D. Placing an NG tube for feeding assistance.

A. Fluid and electrolyte replacement. Pyloric stenosis is a condition where the muscles in the pylorus are enlarged causing a narrowing or blockage and food cannot pass into the small intestine. Projectile vomiting is a symptom, and if it is severe, it can lead to dehydration. Dehydration is a life threatening health condition if it is left untreated. Severe dehydration leads to altered mental status, elevated heart rate and low blood pressure. Fluid and electrolyte replacement is the highest priority in nursing care of infants because their body composition is primarily water. Excessive vomiting can deplete the body of fluid and electrolytes needed to function properly. These must be prevented and corrected before surgery is performed for the safety of the infant.

The clinic nurse is reviewing feeding regimens with the mother of an infant recently diagnosed with pyloric stenosis. While waiting for an appointment with the surgeon, the mother is instructed to remember which of the following steps to minimize vomiting after feedings? Select all that apply. A. Keep the infant upright for at least 30 minutes after feeding. B. Rock the baby to sleep after feeding. C. Thicken the formula with cereal and use a nipple with a large hole. D. Feed the infant slowly and take breaks often. E. Give the infant larger feedings more frequently.

A. Keep the infant upright for at least 30 minutes after feeding. C. Thicken the formula with cereal and use a nipple with a large hole. D. Feed the infant slowly and take breaks often. Infants with pyloric stenosis are at a much higher risk of fluid volume deficit. These infants can quickly develop dehydration if not closely monitored for signs and symptoms. It is also important to take steps to prevent vomiting and improve the amount of nutrients received during feedings. Parents must be educated to feed the infant in an upright position and maintain this position for at least 30 minutes after a meal. Parents can also thicken the formula with cereal in order to provide more nutrients from the feedings. If the infant is still bottle-fed, the parent may have to get a nipple with a larger hole for the thickened formula to pass through. Parents may also choose to give smaller, more frequent feedings to improve nutrition.

While discussing post op care for a child before cleft lip surgery, a mother states her child uses thumbsucking to fall asleep each night. What is the nurse's best response to the mother? A. "It would be best to try to wean your child from that behavior now." B. "After surgery, your child will be restrained to prevent thumb and finger sucking." C. "After surgery, it will be too painful, so your child won't have a desire for thumb sucking." D. "After surgery, a special pacifier will be given in order to comfort your child."

B. "After surgery, your child will be restrained to prevent thumb and finger sucking." Cleft lip and cleft palate are congenital malformation where the lip and soft palate in the mouth do not close. Surgery is required for closure of these openings. Educating parents about the surgery and post operative care is extremely important. Parents should be taught that the child should not suck on any object, nor should any object be placed in the child's mouth. Sucking can damage the sutures, and objects, including fingers, can increase the risk of infection. This is one reason that the child will be restrained at the elbows immediately after surgery. Parents who are educated in advance will have less anxiety and will help with compliance.

A nurse is caring for a 4-week-old infant who is 2 weeks post-op following surgical correction of biliary atresia. Which of the following findings is an indication that the surgery was successful? A. The infant has lost 2.2. kg since the surgery. B. The infant has a total bilirubin level of 0.3 mg/dL. C. The infant has an AST level of 120 units/L. D. The infant's stools are gray in color.

B. The infant has a total bilirubin level of 0.3 mg/dL. A bilirubin level of 0.3 mg/dL is within the expected reference range & indicates the surgery was successful. If the surgery correction was successful, the infant's stools should turn yellow & then brown in color. Gray stools indicated continued biliary obstruction.

A mother calls the clinic nurse stating that she is giving her school age child polyethylene glycol in juice daily for four days, and her child is only passing thin watery stools. The child is still resisting stool training and cries. What is the nurse's most appropriate response? A. The nurse tells the mother to continue encouraging toilet training time. B. The nurse tells the mother to add sennosides or bisacodyl at bedtime. C. The nurse encourages the mother to keep waiting for the medication to work. D. The nurse advises the mother to stop the medication and increase fiber and fluids.

B. The nurse tells the mother to add sennosides or bisacodyl at bedtime. Encopresis occurs when the child holds stool in the rectum. Fear of painful elimination is a common cause. If a child has an impaction, encopresis will worsen the problem. It presents as watery-like stools or accidentally soiling clothes. Increasing fiber and fluids along with ambulation is always crucial. However, it is often necessary to add over the counter (OTC) medications. Sometimes a child with encopresis will need a stool softener combined with a laxative for effective elimination. If these are not effective or this is a consistent problem, the child needs to visit a healthcare provider for further evaluation.

A nurse is providing post-op teaching to a parent of a 3-month-old infant who is recovering from an umbilical hernia repair. Which of the following statement by the parent indicates an understanding of the teaching? A. "I will expect the site to bulge when my baby cries." B. "I will place a belly band around my baby's abdomen." C. "I will fold my baby's diaper away from the incision." D. "I will bathe my child in the bathtub daily."

C. "I will fold my baby's diaper away from the incision." To prevent infection, the parent should be able to describe & demonstrate proper folding of the diaper to protect the surgical incision from contamination. The parent should not use a belly band because they can lead to bowel strangulation. The parent should sponge-bathe the infant until the post-op visit when the provider removes the dressing.

A child is diagnosed with Ulcerative Colitis. Which manifestation differs from that of Crohn's disease. A. Pain B. Anorexia C. Rectal bleeding D. Joint pain

C. Rectal bleeding The other symptoms are shared with Crohn's disease.

While providing care to a child with a possible diagnosis of intussusception, which clinical manifestation will the registered nurse (RN) expect to assess? Select all that apply. A. hard formed brown stool B. vomiting green bile C. blood streaked mucus stool D. non-projectile vomiting E. guarding abdominal pain

C. blood streaked mucus stool D. non-projectile vomiting E. guarding abdominal pain Intussusception is defined as a telescoping of one portion of the colon into another portion of the colon. The clinical manifestations have a sudden onset. The initial clinical manifestation is collicky type abdominal pain that is intermittent. As the obstruction worsens, the pain is accompanied by non-projectile vomiting. The child will guard the abdomen and, during episodes of pain, draw their knees up to their chest. As ischemia worsens the child will develop blood streaked mucus stool that has the appearance of currant jelly.

While performing an objective abdominal assessment, what assessment finding will alert the registered nurse (RN) of the presence of intussusception? A. abdominal distention B. presence of ascites C. protruding umbilicus D. sausage-shaped abdominal mass

D. sausage-shaped abdominal mass. Intussusception is defined as a telescoping of one portion of the colon into another portion of the colon. The clinical manifestations have a sudden onset. In addition to the clinical manifestations of intermittent abdominal pain, guarding, vomiting and blood streaked mucus type stool, there is a specific objective assessment that can confirm intussusception. When performing an abdominal assessment, a palpable abdominal mass may be present. The distinct shape of a mass that occurs with intussusception is sausage-shaped.

Which information will the registered nurse (RN) present to the mother of a newborn diagnosed with hirschsprung disease? Select all that apply. A. "This disease is an abnormality of the colon your baby was born with." B. "This disease is causing the colon to not be able to pass stool out as intended." C. "This disease is a congenital anomaly that affects the large intestine." D. "This disease is a congenital anomaly that indicates you did something during the pregnancy to cause." E. "This disease is a congenital anomaly that affects the peristalsis of your colon."

A. "This disease is an abnormality of the colon your baby was born with." B. "This disease is causing the colon to not be able to pass stool out as intended." Hirschsprung disease is a congenital anomaly that affects the large intestine. This disease can affect the entire colon, but is usually confined to the distal colon. With hirschsprung disease, there are missing nerve cells in the colon. The loss of nerve cells results in the inability of the anal sphincter to relax. This results in an absence of peristalsis in the colon causing a bowel obstruction. "This disease is a congenital anomaly that affects the peristalsis of your colon" is not the information the RN will provide. It is important to provide the information in lay terms to the mother. "This disease is a congenital anomaly that affects the large intestine" is not the information the RN will provide. It is important to provide the information in lay terms to the mother.

The nurse is assigned to an infant who just had cleft palate repair. She knows that the main goal is to protect the suture line. Which action by the parent tells the nurse additional teaching is needed? A. After feeding has been completed, dad lays the baby supine in the crib. B. The nurse observes the dad feeding the infant while holding in an upright position. C. Dad rocks the infant at the first sign of distress or upset. D. Dad checks the infant to make sure the elbow restraints are still positioned properly.

A. After feeding has been completed, dad lays the baby supine in the crib. After surgical repair of cleft lip and cleft palate, the top priorities in care include protecting the suture line and preventing aspiration. Parents must be educated to not place any object into the infant's mouth. They must also be educated during this time to not allow the baby to cry since crying stresses the suture line. Parents are encouraged to hold their infants more. They are also educated to prevent aspiration from regurgitation or post operative secretions. The infant should be held upright during feedings, placed on their back, supine, when placed in the crib with the head of the bed elevated. Elbow restraints are also used and should be monitored by parents and the nursing staff.

A nurse is preparing to feed an infant who has a cleft lip & palate. Which of the following actions should the nurse plan to take? A. Burp the infant at least 2 to 3 times during the feeding. B. Remove the nipple from the infant's mouth if swallowing become audible. C. Stop the feeding if formula appears in the nasal cavity of the infant. D. Discourage the parents from participating in the feeding prior to a surgical repair.

A. Burp the infant at least 2 to 3 times during the feeding. Infants who have a cleft lip & palate will swallow an increased amount of air during a feeding due to a lack of separation between the oral & nasal cavities. Infants should be burped after every ounce of formula consumed. Formula is expected to appear in the nose due to lack of separation between the oral & nasal cavities.

A mom calls the phone nurse stating that her child has been crying every time stool is passed. Mom is asking what she needs to do to help her child before coming to the health care provider (HCP). Select all that apply. A. Tell the mother to have the child drink more water and juice. B. Instruct the mother to have her child drink more milk. C. Advise mother to have the child eat more fruits and vegetables. D. Encourage the mother by reminding her that all children are picky eaters. E. Encourage mother to use whole grain breads and pastas.

A. Tell the mother to have the child drink more water and juice. C. Advise mother to have the child eat more fruits and vegetables. E. Encourage mother to use whole grain breads and pastas. Constipation is defined as stool that is infrequent, hard and difficult to pass. In order to relieve and avoid constipation, children need a healthy balance of fiber and fluids along with movement or activity. Fiber is found in whole grains, fruits and vegetables, but it must be combined with plenty of water and liquids to work properly. Too much fiber alone will only add bulk to the stool, thus making it harder to pass. Water and fluids work with fiber to soften the stool to make it easier to pass. Always remember your F's! Fibers and fluids go hand in hand, and they are useless alone.

A nurse is caring for an infant who has biliary atresia. Which of the following manifestations should the nurse expect? SATA. A. Yellow sclera B. Rapid weight gain C. Tar-colored stools D. Abdominal distention E. Dark urine

A. Yellow sclera D. Abdominal distention E. Dark urine Biliary atresia is a progressive process that leads to the destruction of the biliary tree. Yellow sclerae are an early manifestation of biliary atresia caused by obstruction of the biliary tress, resulting in cholestasis. Abdominal distention is due to hepatomegaly. Dark urine is due to conjugated bilirubin escaping from the liver & being excreted in the urine. Infants who have biliary atresia have difficulty metabolizing fat, leading to poor weight gain. Acholic or gray stools are a clinical manifestation of biliary atresia. Pale, putty-colored stools are due to the lack of bilirubin in the intestinal tract.

While providing care to the child diagnosed with intussusception, which clinical manifestation alerts the registered nurse (RN) to the potential of a perforated colon/peritonitis? Select all that apply. A. elevated temperature B. bradycardia C. abdominal rigidity D. rebound tenderness E. increased BP

A. elevated temperature C. abdominal rigidity D. rebound tenderness Intussusception is defined as a telescoping of one portion of the colon into another portion of the colon. This telescoping of the colon results in colon obstruction and decreased blood flow. Unless corrected this can result in ischemia and colon perforation. The result of this damage is the development of peritonitis. The clinical manifestations of peritonitis include: fever, abdominal rigidness, and rebound tenderness. As the peritonitis worsens, the child will develop tachycardia, diaphoresis, progressing into shock.

An infant diagnosed with pyloric stenosis is admitted to the hospital. Which diagnostic findings would the nurse expect to find? Select all that apply. A. High white blood cell count B. Low potassium C. Elevated hematocrit D. Low chloride level E. Low pH level

B. Low potassium C. Elevated hematocrit D. Low chloride level Pyloric stenosis is the narrowing of the pyloric region of the stomach. This can lead to an obstruction in the GI tract resulting in forceful vomiting after feedings. When vomiting occurs, electrolytes leave the body. Potassium and chloride are two electrolytes that will be low when an infant has been excessively vomiting. However, the infant will experience metabolic alkalosis, which means it will have a high pH content. This is due to the infant vomiting the acid in the stomach along with the nutrients that were just ingested. The hematocrit will also be high because the baby's body is dry from dehydration. White blood cell counts should be in the normal range because pyloric stenosis is not caused by an infection. When the body is dry, counts are high. Where there is flow, electrolytes go.

A nurse is recommending dietary modifications for a patient who has GERD. The nurse should suggest eliminating which of the following foods from the patient's diet? SATA. A. Carrots B. Oranges C. Tomatoes D. Potatoes E. Caffeine F. Peppermint G. Fatty foods H. Whole wheat

B. Oranges C. Tomatoes E. Caffeine F. Peppermint G. Fatty foods Symptoms of GERD worsen following the oral intake of substances that decrease lower esophageal stricture (LES) pressure. These include caffeine, chocolate, fatty foods, fried foods, spicy foods, citrus fruits, tomatoes, peppermint, alcohol, and nicotine.

A young child comes into the hospital in the icteric phase of hepatitis. Which symptoms will be present? SATA. A. Malaise B. Pale stool C. Dark urine D. Fever E. Nausea F. Jaundice G. Hepatomegaly

B. Pale stool C. Dark urine F. Jaundice The rest of the symptoms occur in the prodromal phase. Older children & adults will continue to have prodromal symptoms, but in young children, the prodromal symptoms will resolve.

In a child with hirschsprung disease, which clinical manifestation(s) would alert the nurse that the child could have a bowel perforation?Select all that apply. A. absence of meconium B. elevated temperature C. presence of hard brown stool D. vomiting green bile E. foul smelling diarrhea

B. elevated temperature E. foul smelling diarrhea Hirschsprung disease is a congenital anomaly that affects the large intestine. This disease can affect the entire colon, but is usually confined to the distal colon. The decreased or inability to pass stool will cause the infant to develop a bowel obstruction. Clinical manifestations of a bowel obstruction include: distended abdomen, vomiting green bile, absence of meconium, and refusal to feed. This obstruction can progress into a bowel perforation. Clinical manifestations of a bowel perforation include elevated temperature and foul smelling diarrhea. Remember that a perforation will open up the colon, but now there is an infection. Think fever-foul-smelly-diarrhea.

While providing care for the child diagnosed with intussusception, what intervention will the registered nurse (RN) expect the healthcare provider to order? A. nothing by mouth for three days B. percussion (air) enema C. one bottle of magnesium sulfate D. six oral docusate sodium tablets

B. percussion (air) enema Intussusception is defined as a telescoping of one portion of the colon into another portion of the colon. The goal of treatment is to reduce the telescoping of the colon. The primary treatment involves administering a pneumatic (air) enema. The action of the enema potentially unfolds the telescoping of the colon. This allows for blood flow to be restored to the colon and removes the obstruction. The presence of the passage of a normal brown stool is an indicator of success from the enema, which is reported to the healthcare provider. If the enema is not successful, surgery is indicated.

A nurse has just completed teaching with a mother of a child diagnosed with a cleft palate. Which statement by the mother indicates that she needs more review? A. "I will need a special bottle or nipple with a cross-cut opening since my baby cannot form a good suction." B. "I need to make my baby eat slowly for 20-30 minutes while sitting up." C. "I need to aim the bottle's nipple straight in and to the side of my baby's mouth." D. "I need to stop and burp my baby often while feeding so that he doesn't choke on spit up."

C. "I need to aim the bottle's nipple straight in and to the side of my baby's mouth." Cleft lip and cleft palate are congenital deformities in which the lip or palate did not close properly before birth. Surgical repair will be performed to correct the deformity during the first year of life. Until it is repaired, parents must be educated in ways to protect the airway and prevent aspiration. The baby will need a special bottle or a cross cut nipple to assist with suction to drink formula. Parents should aim the bottle down and away from the open palate. Babies must eat slowly, burp often, and be held upright to prevent regurgitation and aspiration.

The nurse enters the room of an infant who is an hour post op from a pyloric stenosis repair. The mother is crying because the baby vomited a small amount immediately after feeding. As the nurse consoles the mother, what is the best response to give to the mother? A. "I need to go call the healthcare provider to take the baby back to surgery." B. "As long as it is not projectile, the baby will be fine." C. "It is most likely because the anesthesia hasn't worn off yet." D. "Keep feeding the baby until he holds the formula down."

C. "It is most likely because the anesthesia hasn't worn off yet." Babies with pyloric stenosis are treated with surgery called pyloromyotomy. In this surgery, the pyloric muscles are opened so that food can pass through into the duodenum of the small intestine. Once surgery is complete, feedings can resume as normal without projectile vomiting. It is important for the parents to be educated to resume these feedings once the anesthesia has worn off and the baby is fully awake. Anesthesia can cause nausea and vomiting, so it is important to teach parents that this can occur, but is no reason to be alarmed. Encourage parents to help the child eat slowly during the first few feedings. Ravenous babies tend to eat too fast and vomit as well. Another reason for vomiting after surgery is inadequate burping during feedings. Parents will need to allow their infant to eat slowly at first with multiple breaks for burping.

After a visit with the healthcare provider, a mother tells the nurse that she does not understand why her child was prescribed laxatives and stool softeners when the child has been having liquid stools along with infrequent hard stools. What would be the most appropriate response from the nurse? A. "You will need to discuss this further with the health care provider." B. "Medications are one option, but your child needs to increase their dietary fiber." C. "Sometimes liquid stool leaks around the hardened stool that is trapped in the colon." D. "Your child will need to drink more water and fluids every day to relieve constipation."

C. "Sometimes liquid stool leaks around the hardened stool that is trapped in the colon." Children occasionally experience encopresis. Encopresis is a condition where the child resists having a bowel movement. When a child withholds stool, fecal impactions develop and block the colon. Some children with impactions experience accidents and leakage of liquid stool that seeps around the blockage. In addition to increasing dietary fiber and fluids, children will need medications such as laxatives and stool softeners to assist in elimination of the excess stool in the colon.

While providing post-operative care for a newborn after a colon resection and temporary colostomy, which assessment finding related to the colostomy will the registered nurse (RN) report to the healthcare provider? Select all that apply. A. red moist appearance of the stoma B. pink meaty appearance of the stoma C. pale purplish coloring of the stoma D. dusky blue coloring of the stoma E. gray tinged edges of the stoma

C. pale purplish coloring of the stoma D. dusky blue coloring of the stoma E. gray tinged edges of the stoma Hirschsprung disease is a congenital anomaly that affects the large intestine. The decreased or inability to pass stool will cause the infant to develop a bowel obstruction. This obstruction can progress into a bowel perforation. The priority treatment for an infant diagnosed with hirschsprung disease is surgical intervention to perform a colon resection. The colon resection will involve the development of a temporary colostomy. It is important to observe the stoma for signs of complications. Stoma assessments to report to the healthcare provider include: gray tinged edges of the stoma or a stoma color that is blue, pale, purple, or dusky in appearance.