Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder

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 Whole wheat pasta, meatballs, carrot sticks, apple, and water Baked salmon, potato slices, vanilla ice cream, and apple juice Ham and cheese sandwich, orange slices, chips, and whole milk

Baked salmon, potato slices, vanilla ice cream, and apple juice RATIONALE: 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? Barium enema Surgery Upper endoscopy Endoscopic retrograde cholangiopancreatography

Barium enema RATIONALE: 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 parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Gastroenteritis Hirschsprung disease Appendicitis Pancreatitis

Gastroenteritis RATIONALE: Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

The nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern? stomach irritation aspiration stunted growth nutritional deficiency

aspiration RATIONALE: The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.

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 applesauce wheat bread rye bread skim milk

bananas applesauce skim milk RATIONALE: 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.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? evaluate gastric pH determine esophageal contractility confirm pancreatitis detect Helicobacter pylori

detect Helicobacter pylori RATIONALE: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? esophageal atresia (EA) hernia pyloric stenosis cleft palate

esophageal atresia (EA) RATIONALE: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "The health care provider will remove about half of the herniated contents during the procedure." "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery."

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." RATIONALE: A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.

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?" "Tell me about the types of stools your child has been having." "How long has your child been toilet trained?" "How many times a day does your child urinate?"

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

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? "The surgery creates an opening between the stomach and abdominal wall." "The surgery will create an opening to the small intestine." "The surgery will create an opening to the large intestine." "The surgery is performed to create an opening between the esophagus and the neck."

"The surgery creates an opening between the stomach and abdominal wall." RATIONALE: Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Enzymes in amniotic fluid can cause the development of esophageal atresia." "Babies with esophageal atresia produce an excessive amount of amniotic fluid."

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." RATIONALE: Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Hirschsprung disease Gastroenteritis Short bowel syndrome (SBS) Ulcerative colitis (UC)

Hirschsprung disease RATIONALE: 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 abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed. A partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach.

In this disorder the sphincter that leads into the stomach is relaxed. RATIONALE: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Soft and flat fontanels (fontanelles) Pale and slightly dry mucosa Tenting of skin Blood pressure of 80/42 mm Hg

Tenting of skin RATIONALE: Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: inflammatory bowel disease. gastroesophageal reflux disease. cystic fibrosis. Hirschsprung disease.

gastroesophageal reflux disease. RATIONALE: Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? sausage-shaped mass in the upper mid abdomen abdominal pain and irritability perianal fissures and skin tags hard, moveable "olive-like mass" in the upper right quadrant

hard, moveable "olive-like mass" in the upper right quadrant RATIONALE: 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 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? preterm birth history of hypoxia at birth mother age 42 with pregnancy maternal use of acetaminophen in third trimester

mother age 42 with pregnancy RATIONALE: 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.

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing."

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." RATIONALE: An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.

The nurse is working with the mother of a toddler experiencing constipation. What information regarding childhood constipation should the nurse share with the mother? Select all that apply. "You should not give your son laxatives." "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." "Reward your child for sitting on the toilet as asked, not just when he has a bowel movement." "If your child has a fecal impaction, you can give him an enema." "Reward your child with a sticker only when he has a bowel movement."

"Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." "Reward your child for sitting on the toilet as asked, not just when he has a bowel movement." "If your child has a fecal impaction, you can give him an enema." RATIONALE: Proper education for constipation in children includes educating the families about the importance of compliance with medication use. Many children present to their physician or nurse practitioner with fecal impaction or partial impaction. Teach parents how to disimpact their children at home; this often requires an enema or stimulation therapy. To facilitate daily bowel evacuation, the child should sit on the toilet twice a day (after breakfast and dinner) for 5 to 15 minutes. Instruct the family to keep a "star" or reward chart to encourage compliance. Parents should award the star for compliance with time sitting on the toilet and should not reserve rewards for successful bowel movements only.

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying."

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." RATIONALE: The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will weigh her every morning at the same time." "I will teach her mother to give her small drinks frequently." "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will monitor her IV line to help maintain her fluid volume."

"I will make sure there is plenty of orange juice available. It's her favorite juice." RATIONALE: Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

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? "Your child might have an allergy." "Do not worry; you are just feeding your infant too much." "Infants this age commonly spit up." "Thicken the formula by adding oat cereal."

"Infants this age commonly spit up." RATIONALE: 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.

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? "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." "The soup we eat at our house is all made from scratch." "I have learned to make my own bread with no gluten."

"She loves hot dogs, and we always cut hers up into small pieces." RATIONALE: 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 student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "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." "The entire family will need to eat a gluten-free diet."

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." RATIONALE: 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 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 Maintaining skin integrity Preparing family for home care

Improving hydration RATIONALE: 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.

An infant brought to the emergency department has been vomiting for 2 days. The nurse assesses the infant and finds sunken fontanels (fontanelles), tenting skin, dry mucus membranes and no urine output for 12 hours. Which intervention(s) will the nurse complete as first-line care for this infant? Select all that apply. Start oral rehydration. Insert a peripheral IV. Begin maintenance IV fluids. Administer an antiemetic. Administer a prescribed IV fluid bolus.

Insert a peripheral IV. Administer an antiemetic. Administer a prescribed IV fluid bolus. RATIONALE: This infant is showing signs of severe dehydration. These symptoms include sunken fontanels (fontanelles), tenting of the skin, dry mucus membranes, delayed capillary refill, an increased heart rate and a urine output of less than 1ml/kg/hr. The nurse will need to insert a peripheral IV and begin the prescribed bolus IV infusion. After the bolus has been completed, the infant would need to be reassessed for urine output and symptom improvement. The health care provider would then prescribe another IV bolus or begin maintenance IV fluids. Antiemetics can be prescribed if necessary. Oral rehydration is used for mild or moderate dehydration.

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 Necrotizing enterocolitis Intussusception Volvulus with malrotation

Intussusception RATIONALE: 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 mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? Is curdled and extremely sour smelling Continues until stomach is empty Only occurs with feeding Is projected 1 ft away from infant

Only occurs with feeding RATIONALE: Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? Maintenance of electrolyte balance Reduction of hypertension Prevention of T-cell rejection of the transplanted liver Prevention of hypoglycemia

Prevention of hypoglycemia RATIONALE: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by fingerstick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine and nitroprusside may be needed to reduce hypertension.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Administer antibiotic therapy Feed the child a cracker Administer IV potassium Take a stool culture

Take a stool culture RATIONALE: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.

Which nursing interventions are most helpful for the 6-week-old who continues to vomit stomach contents after feeding? Select all that apply. Thicken formula with rice cereal. Place infant in a side-lying position. Complete daily weights. Offer small, frequent feedings. Lay infant flat after day feedings.

Thicken formula with rice cereal. Place infant in a side-lying position. Complete daily weights. Offer small, frequent feedings. RATIONALE: The infant is experiencing gastroesophageal reflux (GER). It is most helpful to add rice cereal to thicken formula, which decreases the risk of aspiration. Although most children are placed in the supine position for daytime and nighttime sleeping, the child with GER is placed in a prone position with the head elevated after daytime feedings and for several hours before the client goes to sleep at night to lessen the reflux of stomach acid. Daily weights are completed to monitor growth. Small frequent feedings aid in digestion.

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? administer an antiemetic bolus IV fluids administer an antidiarrheal oral rehydration therapy

oral rehydration therapy RATIONALE: 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.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress. ischemia. dehydration. painless rectal bleeding.

painless rectal bleeding. RATIONALE: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease? passed a meconium stool in the first 24 to 48 hours of life passed a meconium plug has had diarrhea for 3 days constipated and passing gas for 2 days

passed a meconium plug RATIONALE: If the parent reports that the child passed a meconium plug, the infant should be evaluated for Hirschsprung disease. Constipation, not diarrhea, is associated with this condition; however, constipation alone would not necessarily warrant further evaluation for Hirschsprung disease. Passing a meconium stool in the first 24 to 48 hours of life is normal.

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: currant jelly stools. steatorrhea. projectile stools. severe diarrhea.

steatorrhea. RATIONALE: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.