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

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

hard, moveable "olive-like mass" in the upper right quadrant

A 9-month-old infant presents to the emergency department with vomiting and abdominal pain. While assessing the client, the nurse notes the client screaming intermittently and drawing up legs toward chest a palpable mass in upper right quadrant (above). What does the nurse anticipate in this child's stools? jellylike, bloody stools narrow, ribbon-like stools foul-smelling, fatty stools loose, watery stools

jellylike, bloody stools

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? gastroesophageal reflux pyloric stenosis peptic ulcer disease appendicitis

pyloric stenosis

Which congenital condition leads to the infant being hungry, irritable, losing weight, and rapidly becoming dehydrated with the potential of metabolic alkalosis? intussusception pyloric stenosis colic aganglionic megacolon

pyloric stenosis

A nurse is providing care to an 11-month-old infant diagnosed with intussusception. When assessing the appearance of the child's stool, the nurse expects to note which finding?

red, currant jelly-like stool

The parents of a 4-week-old report that their infant has forceful vomiting but seems very hungry immediately after vomiting. Upon further questioning, the nurse notifies the physician of the findings and pyloric stenosis is suspected. The nurse prepares the parents for the possibility of which diagnostic procedures and treatment? pyloric ultrasound physical examination of the abdomen upper GI series surgical repair CT scan

upper GI series pyloric ultrasound physical examination of the abdomen surgical repair

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? "Can you describe any pain your toddler is having?" "Has your toddler been around anyone who has been sick?" "Has your toddler been having different colored stools?" "How is your toddler's appetite?"

"Has your toddler been having different colored stools?"

The nurse is providing preoperative teaching for the parents of an 8-month-old child with Hirschsprung disease who will have two-stage surgery as treatment. Which statement by the parents demonstrates the need for further teaching? "After the surgery, we will slowly re-introduce easy-to-digest solids." "Our child will have a nasogastric tube for the first day after the surgery to receive nutrition." "We will be able to resume breastfeeding about one day after the surgery." "Our child will have a colostomy from the first surgery and a second surgery to repair the bowel."

"Our child will have a nasogastric tube for the first day after the surgery to receive nutrition."

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

"The treatment for the disorder will be a surgical procedure."

The parent of a child diagnosed with intussusception asks the nurse why the child's stool looks so strange. How should the nurse reply? "The stool looks like that from the barium used to reduce the intussusception." "I know it concerns you, but the stool is normal for the problem your child is having." "Your child's stool is mixed with blood and mucus, so it looks very different." "Your child's stool looks like that because the intestine is inflamed."

"Your child's stool is mixed with blood and mucus, so it looks very different."

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 congenital aganglionic megacolon? A thickened, elongated muscle causes an obstruction at the end of the stomach. A partial or complete intestinal obstruction occurs. In this disorder the sphincter that leads into the stomach is relaxed. There are recurrent paroxysmal bouts of abdominal pain.

A partial or complete intestinal obstruction occurs.

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 accurately related to the diagnosis of pyloric stenosis? A partial or complete intestinal obstruction occurs. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed. A thickened, elongated muscle causes an obstruction at the end of the stomach.

A thickened, elongated muscle causes an obstruction at the end of the stomach.

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

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? Bilious vomiting Projectile vomiting Effortless vomiting Bloody vomiting

Bilious vomiting

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?

Improving hydration

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

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Projectile vomiting

What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is a partial or complete mechanical obstruction in the intestine. There is a relaxed sphincter in the lower portion of the esophagus. There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion.

There is a partial or complete mechanical obstruction in the intestine.

A child has been diagnosed with pinworms. What home care instruction(s) will the nurse give the parent? Select all that apply. Change the bedding and wash in hot water. Encourage all family members to get treated with an anthelminthic. Restrict the child and siblings from sleeping in the same room. Wash the hands after toileting and before meals. Only one dosage of anthelmintic is needed. Trim all nails short.

Trim all nails short. Wash the hands after toileting and before meals. Change the bedding and wash in hot water. Encourage all family members to get treated with an anthelminthic.

Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? Falling asleep at each feeding Vomiting Flatulence Semiformed bowel movements

Vomiting

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 Chronic diarrhea Vomiting about 2 hours after feeding Refusal to eat

Vomiting immediately after feeding