The Child with a Gastrointestinal Condition chapter 28

What are the 4 signs of rickets?

1. Bowlegs 2. Knock knees 3. Beading of the ribs "rachitic rosary" 4. Improper formation of teeth

Children with failure to thrive fall below what percentile in weight and height on growth chart?

3rd. Children with a diagnosis of failure to thrive must fall below the third percentile on a growth chart, though some authorities suggest the fifth. All other percentiles listed are not used.

A newborn's total body weight is about how much water?

77% Of an infant's total body weight, approximately 77% is water, as compared with 60% in adults. The other two percentages suggested are far too low to be normal for either infants or adults.

A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid base imbalance that the nurse would expect to occur from this persistent vomiting is:

Alkalosis

What is pylori stenosis?

An obstruction at the lower end of the stomach "pylorus" caused by an overgrowth "hypertrophy" of the circular muscles of the pylorus or by spasms of the sphincter.

When a child has pinworms, the nurse should know that:

Any family member with the symptoms should be treated.All symptomatic members of the family should be treated for pinworms to prevent reinfection. This type of parasite spreads from one person to another, particularly where large groups of children are in close contact with one another. The route of entry is the mouth; the child becomes infected by ingesting the eggs. Reinfection takes place by way of contact from the rectum to the fingers to the mouth or by way of the rectum to the clothing to the fingers to the mouth. It is detected by placing cellophane against the anus to look for physical evidence, rather than sending a stool sample to the lab. Hospitalization is not necessary. Pregnant members of the household should not be treated with mebendazole.

Treatment of choice for intussusception is reduction through the use of an.

Barium enema

Why are tap water enemas are never given to children?

Because they can lead to water intoxication and death.

The finding in a newborn suggestive of tracheoesophageal fistula is:

Choking on the first feeding.

To prevent scurvy, the nurse would encourage parents to include what in a child's diet?

Citrus, raw, leafy in the child's diet.

Children with intussusception may have bowel movements containing blood and mucus and no feces. These are called:

Currant jelly stools. Stools containing blood and mucus have a currant-jelly appearance. They are not exclusively mucoid or occult blood; nor are they predominantly fatty.

A complication of vomiting associated with pyloric stenosis is?

Dehydration

Which approach might best support maternal attachment when caring for a child with failure to thrive?

Encourage the mother to participate in the child's care. Maternal attachment can be facilitated by listening and helping the mother to understand her feelings and by assisting her to participate in the child's daily care. Criticizing or suggesting a parenting class based solely on this diagnosis is discouraging and unwarranted, while leaving the room when the mother visits is a nonhelpful response.

What diagnostic test permits visualization of the upper GI tract?

Endoscopy Endoscopy is used to visualize the upper GI tract. Colonoscopy and sigmoidoscopy are both used for the lower GI tract; and proctoscopy is used to visualize the prostate.

Which action should the nurse take before adding potassium to a child's IV?

Establish that the child is voiding. Renal function should be established prior to giving potassium because it is excreted by the kidneys. Replacement potassium is administered only after normal urinary excretion is confirmed. Its administration is not dependent on baseline BP, oral fluid tolerance, or use of a cardiac monitor. Documentation must include accurate assessment of intake and output, vital signs, daily weight, skin and fontanelles, mucous membranes, and level of consciousness.

In children under age 2 years, a greater percentage of body water is contained in what compartment?

Extracellular

Failure to thrive (FTT) describes infants and children who?

Fail to gain and offer lose weight without an obvious cause.

The nurse doing a newborn assessment knows the earliest sign of Hirschsprung's disease is:

Failure to pass meconium. Failure to pass meconium stools within 24-48 hours of birth is a symptom of Hirschsprung's disease, as opposed to having acute, sudden diarrhea. Large, bulky, and frothy stools are associated with celiac disease, and ribbon stools are associated with this disease later in infancy, more than in the neonate where failure to pass meconium stools is the outstanding sign to look for.

With appendicitis, vomiting begins before abdominal pain. (True or False)

False, appendicitis, vomiting does not begin before abdominal pain.

Fever is a reliable sign of appendicitis in children. (True or False)

False, fever is not a reliable sign of appendicitis in children.

What is the priority goal of nursing care for the infant with gastroenteritis is preventing or correcting?

Fluid and electrolyte imbalance.

What are the common tests used to diagnose gastrointestinal disorders?

GI series, Barium enema, Flat plate of the abdomen, Complete blood count with differential, Sigmoidoscopy, Endoscopy, Colonoscopy, Ultrasonography, Liver blood tests and biopsy, Malabsorption tests, ESR, Stool culture, and Rectal biopsy.

What is the surgical repair of a hernia called?

Herniorrhaphy.

How is Hirschsprung's disease treated and what may be necessary for the infant to have temporary?

Hirschsprung's disease is treated with surgically. It may be necessary for the infant to have an colostomy temporary.

What is state of equilibrium of the body?

Homeostasis

What is loss of more water than electrolytes?

Hypertonic

What is loss of more electrolytes than water?

Hypotonic

The greatest threat to life in isotonic dehydration is:

Hypovolemic shock. Hypovolemic shock is the greatest risk to life in isotonic dehydration, not hypervolemic shock. Potassium levels are more likely to increase than decrease (decreased levels are associated with hypertonic dehydration, not isotonic). Finally, mucous membranes are dry, not clammy.

What is constriction or irreducibility?

Incarceration

What is protrusion of part of the intestine through the umbilical ring?

Inguinal hernia

Activated charcoal should not be given with what because it will neutralize both, rendering both ineffective in the treatment of poisoning?

Ipecac

What is loss of equal amounts of water and electrolytes?

Isotonic

What is the most common sign of pinworms?

Itching of the anal area

Which signs and symptoms are characteristic of pinworms?

Itching, irritability, and restlessness. Itching, irritability, and restlessness are signs of pinworms. There is no association with nausea, vomiting, diarrhea, fever, or weight loss.

Kwashiorkor results from what a severe deficiency?

Kwashiorkor results from a severe deficiency of protein in the child's diet.

A child appears apathetic and weak. His growth is below normal for his age. There is a white streak in the child's hair. The nurse recognizes these signs as characteristic of:

Kwashiorkor. Because protein is the basis of melanin, which is a substance that provides color to hair, melanin becomes deficient in kwashiorkor. This is the reason that the earliest sign of this protein malnutrition is a white streak in the hair of the child (depigmentation). The child looks apathetic and weak. The classic symptoms of rickets are bowlegs; knockknees; beading of the ribs, called the rachitic rosary; and improper formation of the teeth. The symptoms of scurvy include joint pains, bleeding gums, loose teeth, and lack of energy. The primary manifestation of gastroesophageal reflux are vomiting, weight loss, and failure to thrive.

Stools in the child with celiac disease are?

Large, bulky, frothy.

The nurse should explain to parents that infants are more susceptible to accidental ingestion of foreign bodies because they are:

Likely to put everything in their mouths. Because children are so curious about their environment, they want to experience everything and often put things into their mouths that are not to be eaten. It is this curiosity, and not constant hunger, that prompts this natural behavior. It is not an attention-seeking behavior! For that reason, they should not be left unattended frequently.

An overdose of acetaminophen can result in what damage?

Liver damage

The organ damaged by acetaminophen poisoning is the:

Liver. Because acetaminophen is metabolized in the liver, overdose results in hepatic destruction, as opposed to damaging gallbladder, pancreas, or stomach. Treatment within 8 hours of ingestion can reduce the risk of liver damage, but a delay of more than 24 hours may increase the risk of liver damage. Levels of liver enzymes (ALT and AST) usually peak within 96 hours and are monitored along with prothrombin times.

What are the nursing interventions for an infant hospitalized for gastroenteritis?

Maintain a record of intake and output. Skin care and frequent diaper changes to prevent excoriation. Record daily weight. Keep infant warm. Assess hydration status. Maintain enteric precautions. Provide parent teaching: good hand hygiene and infection control practices, proper food handling, feeding techniques.

Celiac disease is the leading cause of what in children?

Malabsorption problem in children.

Describe the treatment of pinworms.

Mebendazole (Vermox) is a single-dose, chewable tablet and is the drug of choice for children older than age 2. The child must be taught good handwashing, especially after bowel movements. Fingernails are kept short and a soothing ointment can be applied to the rectum.

Name and describe the most common congenital malformation of the gastrointestinal tract.

Meckel's diverticulum, a blind pouch of intestine formed in prenatal life if the vitelline duct fails to fully close.

Interpret the following arterial blood gas values to determine the acid base imbalance. pH: 7.32 PaCO2: 37 HCO3: 20

Metabolic acidosis

A child's arterial blood gas results are: pH7.30, PaCO2: 36, HCO3: 21. The nurse determines the child is experiencing which acid base imbalance?

Metabolic acidosis. A process of elimination demonstrates this to be metabolic acidosis. To begin with, the pH is lower than the normal value indicating acidosis, not alkalosis. The Paco2 is in the normal range, indicating that the problem is not respiratory alkalosis. The HCO3 value falls within the acidic range. Thus, the lower than normal pH and HCO3 values indicate metabolic acidosis.

Describe the initial onset of intussusception and infant behaviors.

Onset is sudden. The infant feels severe pain in the abdomen, cries loudly, strains with effort, kicks, and draws legs up to the abdomen. Initial intervals of comfort shorten. The child vomits. Bowel movements diminish and bowel movements of blood and mucus that contain no feces are common about 12 hours after onset of the obstruction.

A 6 year old has mild diarrhea. How would the nurse advise the child's parents about the fluid and food intake?

Oral rehydrating solutions such as Pedialyte or Infalyte with a gradual introduction of a soft, bland diet. Resume regular diet within 2-3 days.

What is the primary source of leading poisoning?

Paint from old, deteriorating builds.

What does persistent vomiting can result in?

Persistent vomiting can result in dehydration and electrolyte imbalance.

What is eating nonfood items?

Pica

Which information would the nurse give to parents of an infant with gastroesophageal reflux disease?

Place in upright prone position after feeding. An elevated prone position after eating (4) helps minimize the symptoms until the child grows and the reflux disappears. Using an infant seat can increase the problem because the child is in a slumped posture, which increases intraabdominal pressure. Increasing times between feedings increases the chance of excessive hunger, which can lead to overfeeding, exacerbating the problem. Halfstrength formula will not help. Instead, the infant may need increased caloric values at each feeding—such as adding cereal to the formula.

What is lead poisoning?

Plumbism

What is vomiting in which the stomach contents are forcibly ejected?

Projectile vomiting

The nurse taking a history from parents of an infant with pylori stenosis would expect them to report the infant experience which sign?

Projectile vomiting. Projectile vomiting is a classic sign of pyloric stenosis. The infant may eject a distance of 3-4 feet when in a side-lying position. Pyloric stenosis (narrowing) is an obstruction at the lower end of the stomach (pylorus) caused by an overgrowth (hypertrophy) of the circular muscles of the pylorus or by spasms of the sphincter. Thus, projectile vomiting is the outstanding manifestation, not anorexia, and not lower GI disturbances such as constipation or diarrhea.

What operation to correct pyloric stenosis?

Pyloromyotomy

What are the goals in the treatment of poisoning?

Remove the poison. Prevent further absorption. Call Poison Control Center. Provide supportive care and seek medical help

Interpret the following arterial blood gas values to determine the acid base imbalance. pH: 7.48 PaCO2: 33 HCO3: 24

Respiratory alkalosis

Describe gastroesophageal reflux.

Results when the lower esophageal sphincter is relaxed or not competent, which allows stomach contents to be easily regurgitated into the esophagus.

To prevent aspiration of vomitus after feeding, and infant should be placed in what position?

Right side lying

What is the greatest threat to life in isotonic dehydration?

Shock or hypovolemia

Describe the progression of feeding of an infant after posteroperative correction of pyloric stenosis.

Small amounts of glucose water that gradually increase until a regular formula can be taken and retained. Overfeeding is avoided.

Signs and symptoms of dehydration in the infant with diarrhea includes:

Sunken eyes and fontanelle. Dry skin. Dry tongue and mucous membranes. Decreased urination.

Describe assessment findings in a newborn who has pyloric stenosis.

Sunken fontanelle, inelastic or "tenting" skin, reduced urine output, signs of malnutrition.

You are speaking to a parent whose child has mild diarrhea. The parent explains that she has been giving the child a BRAT diet. Is this an appropriate intervention? If not, what will you recommend for this child?

The BRAT diet is not recommended for treatment of diarrhea, as it is not nutritionally sound enough to support growth and development. The child can drink oral rehydration solutions and gradually advance diet to soft, bland foods. A regular diet can be resumed in 2-3 days. Rationales for this exercise will depend on individual student responses. The parents will be anxious about the child's prognosis. They may feel responsible and guilty for this accident. The nurse should be nonjudgmental and supportive of the parents. Encourage the parents to express their feelings. Prior to discharge, measures to childproof the home and prevent future ingestions should be discussed with the parents.

What will and infant with tracheoesophageal fistful do during the first feeding is given?

The infant with tracheoesophageal fistula will vomit and choke when the first feeding is given.

How is nystatin "Mycostatin" applied to the mouth of a child with thrush?

The mouth is swabbed three or four times a day between feedings with a sterile applicator moistened with the prescribed solution.

What would be included in the nurse's documentation for a child who is vomiting?

Time, Amount, Color, Consistency, Force, Frequency, Whether proceeded by nausea or feeding.

A nurse is giving a newborn her first feeding when the baby starts coughing and choking. This is indicative of which condition?

Tracheoesphageal Artesia. Coughing, choking, cyanosis, and apnea during feeding are signs of tracheoesophageal atresia. Symptoms of celiac disease are not evident until 6 months to 2 years of age, when foods containing gluten are introduced to the infant. Enterocolitis is associated with abnormal bowel movements rather than choking, and pyloric stenosis is manifested by projectile vomiting.

Abdominal pain associated with appendicitis in a child is localized in the right lower quadrant. (True or False)

True, abdominal pain is associated with appendicitis in a child is localized in the right lower quadrant.

The child with appendicitis may exhibit guarding an rebound tenderness when the nurse performs and abdominal assessment. (True or False)

True, the child with appendicitis may exhibit guarding an rebound tenderness when the nurse performs and abdominal assessment.

After a feeding, an infant with gastroesophageal reflux should be placed in which position?

Upright prone position or propped on the left side.

Scurvy results from a deficiency of foods containing in what diet?

Vitamin C.

What is the describe incidence of rickets in the world is attributed to?

Vitamin supplements and vitamin D-fortified foods.

On the 2nd day of hospitalization for a 3 month old brought in for the treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment?

Weight loss of 4 oz

What kind of food can you find gluten?

Wheat, barley, oats, rye

What are the foods in high fiber foods to recommend to an older child who is experiencing constipation?

Whole-grain breads and cereals Raw vegetables and fruits Bran Popcorn

The earliest sign of Hirschsprung's disease is failure to pass meconium stools within how many hours after birth?

Within 24 to 48 hours after birth.