ch42: GI
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Gluten is found in most wheat products, rye, barley and possibly oats." "Most children with celiac disease are diagnosed within the first year of life." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The entire family will need to eat a gluten-free diet." "The only treatment for celiac disease is a strict gluten-free diet."
"Gluten is found in most wheat products, rye, barley and possibly oats." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.
The nurse is assessing a toddler and palpates a sausage-shaped mass in the upper mid abdomen. When taking the toddler's history, what question would the nurse ask the parent first? "Has your toddler been having different colored stools?" "Can you describe any pain your toddler is having?" "How is your toddler's appetite?" "Has your toddler been around anyone who has been sick?"
"Has your toddler been having different colored stools?" A sausage-shaped mass in the upper mid abdomen is a classic sign of intussusception. Intussusception occurs when the proximal segment of the bowel "telescopes" into a more distal segment of the bowel, thus the sausage-shaped mass. Another classic sign of intussusception is stools that appear like currant jelly. These are stools which are bloody and mixed with mucus. This should be the question the nurse asks first. Next, the nurse should ask about the pain. The pain with intussusception has a sudden onset and is intermittent and crampy. The appetite of the child generally is poor due to abdominal pressure and pain. Intussusception is not a contagious or infectious disease.
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 a lot of diarrhea every day because of how my small intestine is damaged." "It's unusual for someone my age to get Crohn disease." "I have to be careful because I am prone to not absorbing nutrients." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines."
"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 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 use a cotton tipped applicator to apply the medication to her mouth." "I will add the nystatin to her bottle four times per day." "I will watch for diaper rash." "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." 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 parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? "Do not worry; you are just feeding your infant too much." "Infants this age commonly spit up." "Thicken the formula by adding oat cereal." "Your child might have an allergy."
"Infants this age commonly spit up." In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed. Therefore, 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. Adding oat cereal to the infant formula should only be done when medically indicated and under the recommendation of a health care provider. The parent's report is not a cause for concern, so the health care provider does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the parent not to worry does not address the parent's concern, and telling the parent that he or she is feeding the child too much implies that he or she is doing something wrong.
A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "There are many types of flour besides wheat." "There is gluten hidden in unexpected foods." "My daughter is eating more vegetables." "My daughter can eat any kind of fruit."
"My daughter can eat any kind of fruit." While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.
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? "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." "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."
"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.
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? "What foods has your child eaten during the last few days?" "How many times a day does your child urinate?" "How long has your child been toilet trained?" "Tell me about the types of stools your child has been having."
"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.
The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Meatloaf, green beans, peanut butter cookie, and fat-free milk Ham and cheese sandwich, orange slices, chips, and whole milk Whole wheat pasta, meatballs, carrot sticks, apple, and water Baked salmon, potato slices, vanilla ice cream, and apple juice
Baked salmon, potato slices, vanilla ice cream, and apple juice Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Surgery Barium enema Endoscopic retrograde cholangiopancreatography Upper endoscopy
Barium enema4 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.
A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? food poisoning ulcerative colitis Hirschsprung disease Crohn disease
Crohn disease Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.
A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? High calorie, high fiber High carbohydrate, high protein Low calorie, high carbohydrate Low fiber, low calorie
High carbohydrate, high protein The goal of nutritional intervention is to provide adequate nutrient intake to optimize normal growth and development—including pubertal development, which is frequently delayed—and to prevent and correct nutrient deficiencies. Adequate nutrition with a high-protein and high-carbohydrate diet may be recommended.
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 Preparing family for home care Maintaining skin integrity
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 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Short-bowel/short-gut syndrome Volvulus with malrotation Necrotizing enterocolitis Intussusception
Intussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.
A parent brings the 2-week-old infant to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. If breastfeeding, switch to feeding the infant formula. Feed the infant a formula thickened with rice cereal. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. Feed the infant while holding the infant in an upright position. Consult a pediatric surgeon regarding having a myotomy procedure performed.
Keep the infant upright by holding them and/or elevating the head of the crib after feeding. Feed the infant a formula thickened with rice cereal. Feed the infant while holding the infant in an upright position. The traditional treatment of gastroesophageal reflux in the infant is to feed a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding the infant in an upright position and then keeping the infant upright by holding them and/or elevating the head of the crib 30 degrees for 30 to 45 minutes after feeding so gravity can help prevent reflux. There is no need for the parent to switch from breastfeeding to formula-feeding. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the infant in a more upright position during and following feeding; these procedures would not be appropriate at this point.
A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? Wrapping an elastic band around the child's waist should correct the problem. No intervention is needed, as the opening will most likely close spontaneously. Surgery at age 1 to 2 years will likely be needed to repair the condition. Taping a silver dollar over the area will help reduce the hernia.
No intervention is needed, as the opening will most likely close spontaneously. An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.
The nurse is performing an assessment on a child suspected of having an inguinal hernia. Which assessment technique(s) should be used to assess for the presence of the hernia? Select all that apply. Palpate the inguinal canal while the child blows up a balloon. Palpate the inguinal canal and ask the child to turn the head and cough. Ask the child to inhale forcefully while the inguinal canal is palpated. Ask the child to hold the breath and grunt forcefully. Press the palm of one hand on the abdomen and then withdraw the hand.
Palpate the inguinal canal while the child blows up a balloon. Palpate the inguinal canal and ask the child to turn the head and cough. The inguinal hernia is a protrusion of bowel into the inguinal ring. To assess, the nurse palpates the external inguinal canals for the presence of inguinal hernias, often elicited by having the child turn the head and cough, or blow up a balloon. Coughing causes an increase in internal pressure. Pressing on the abdomen and then withdrawing the hands is a means to assess for rebound tenderness and does not provide an assessment for an inguinal hernia. Asking the child to hold the breath does not check for the hernia. Asking the child to forcefully inhale does not assess for the presence of an inguinal hernia. Holding one's breath and forceful exhalation does not alter the pressure in the lower abdomen.
A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? Vomiting immediately after feeding Refusal to eat Chronic diarrhea Vomiting about 2 hours after feeding
Vomiting immediately after feeding With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.
A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? acute upper GI bleeding gastroesophageal reflux intussusception GI tract obstruction
acute upper GI bleeding Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.
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. bananas skim milk applesauce wheat bread rye bread
bananas skim milk applesauce 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.
he health care provider prescribes an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the newborn and finds which symptoms that are indicative of this disease? Select all that apply. bilious vomiting abdominal distention displaced anus absence of stool in the rectum enterocolitis presence of a fistula
bilious vomiting abdominal distention absence of stool in the rectum enterocolitis Hirschsprung disease is a movement disorder of the intestinal tract. The ganglion are missing, which causes inadequate motility. The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance with bilious aspirates, and vomiting. In anorectal malformations, the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina.
A nurse examining a neonate is unable to identify the fetal stomach. The nurse knows that this sign strongly indicates which condition? pyloric stenosis duodenal atresia esophageal atresia (EA) hernia
esophageal atresia (EA) Inability to identify the fetal stomach strongly suggests EA. The upper abdomen is typically distended in pyloric stenosis and duodenal atresia. Hernias typically present as a bulge in the groin area.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant sausage-shaped mass in the upper mid abdomen perianal fissures and skin tags
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.
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? hiatal hernia inguinal hernia umbilical hernia diaphragmatic hernia
inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.
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? diaphragmatic hernia umbilical hernia inguinal hernia hiatal hernia
inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues. umbilical hernia usually does not need repair.
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? mother age 42 with pregnancy maternal use of acetaminophen in third trimester preterm birth history of hypoxia at birth
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 teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply. occurs with feeding no appearance of distress followed by dry retching forceful expulsion of stomach contents timing unrelated to feeding
no appearance of distress occurs with feeding Regurgitation occurs with feeding; the infant does not exhibit signs of distress. Forceful expulsion of stomach contents that is followed by dry retching unrelated to feeding are characteristics of vomiting.
A toddler is being seen in the clinic. The parents describe a 2-day history of vomiting and diarrhea. The nurse's assessment finds the toddler is listless, has pale and slightly dry mucous membranes, and has decreased skin turgor. Based on this assessment, what intervention would the nurse implement first? oral rehydration therapy bolus IV fluids administer an antiemetic administer an antidiarrheal
oral rehydration therapy This toddler is exhibiting signs of moderate dehydration. In addition to dry mucous membranes, being listless, and having decreased skin turgor, the nurse may also assess a higher heart rate than expected, mildly sunken eye orbits, delayed capillary refill, and the urine output of less than 1ml/kg/hr. The treatment for moderate dehydration is oral rehydration therapy (ORT). The toddler should receive 50 to 100 ml/kg over a 4-hour period. The initial intake should be very small, about 0.5 to 2 ounces every 15 minutes. This can be progressed as the toddler tolerates. If the toddler vomits, the ORT should be held for 1 hour before restarting. A bolus IV is used to treat severe dehydration. Administering an antiemetic or antidiarrheal may or may not be needed, so these cannot be the first choice for treatment.