Ch 45: Nursing Care of a Family when a child has a Gastrointestinal Disorder

4 Pg. 1267 Typically, 1 tablespoon (5 ml) of rice cereal is added for each ounce of formula. This infant is drinking 4 oz (120 ml) of formula, thus 4 tablespoons (20 ml) of rice cereal will be added.

16. An infant is diagnosed with gastrointestinal reflux. The nurse instructs the parent to feed the infant formula thickened with rice cereal. The infant typically drinks 4 oz (120 ml) of formula at a feeding. How much rice cereal would the nurse instruct the parent to add to the feeding?

b) 0.5 to 1 ml/kg/hr Pg. 1262 The child's hourly output should be 0.5 to 1 ml/kg/hour. Output of 0.5 to 1 mLl/kg/shift and 2 to 4 ml/kg/shift would be inadequate output for the child. Output of 2 to 4 ml/kg/hr is higher than necessary for adequate hydration.

22. The nurse has admitted a child to the pediatric unit with diarrhea and vomiting. Accurate intake and output are important care measures for the child. The nurse correctly assesses that output parameters should be: a) 2 to 4 ml/kg/shift b) 0.5 to 1 ml/kg/hr c) 2 to 4 ml/kg/hr d) 0.5 to 1 ml/kg/shift

a) Improving hydration Pg. 1268 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.

33. 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? a) Improving hydration b) Preparing family for home care c) Maintaining skin integrity d) Promoting comfort

c) Red, currant jelly-like stool Pg. In approximately 70% of cases of intussusception, frank or occult blood is seen in the stool. The stool is described as having a "red currant jelly" appearance due to the blood and mucus it contains. It would not appear dark green. Clay-colored stools would reflect biliary obstruction. Hard, large stools would suggest constipation.

37. 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? a) Loose, dark green stool b) Hard, formed large brown stool c) Red, currant jelly-like stool d) Clay-colored, watery stools

b) Some foods in the U.S. have been fortified with vitamin D Pg. 1288 Whole milk and evaporated milk fortified with 400 U of vitamin D per quart are available throughout the United States, which decreases the vitamin D deficiency of children in the U.S. Vitamin D can be administered orally in the form of fish liver oil or synthetic vitamin, but this is not common for children in the U.S. Water is not fortified with vitamin D, and some communities in the U.S. do not get adequate sunshine to meet vitamin D needs.

4. The incidence of vitamin D deficiency in the United States is less than in many countries. What is the most likely reason for this? a) Many children in the U.S. take daily vitamin supplements b) Some foods in the U.S. have been fortified with vitamin D c) The amount of ultraviolet sunlight each day in the U.S. is adequate to provide needed vitamin D d) The water in many towns and cities in the U.S. has vitamin D added

b) Help the child find a comfortable position Pg. 1278 The child's symptoms indicate possible appendicitis. When appendicitis is suspected, laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Heat to the abdomen is also contraindicated because of the danger of rupture of the appendix. Medicating with analgesics is inappropriate, because medication may conceal signs of tenderness that are important for diagnosis. Comfort can be provided through positioning.

29. The nurse admits a 7-year-old child who reports pain in the lower right quadrant of the abdomen, nausea, and constipation. An assessment shows that the child has a fever of 101°F (38.3℃). Which nursing intervention should the nurse implement to safely address the child's reported pain? a) Give the child an analgesic such as acetaminophen b) Help the child find a comfortable position c) Place a heating pad or hot water bottle on the abdomen d) Request a prescription for a laxative

a) Palpation Pg. 1278 Palpation should be the last part of the abdominal examination. Inspection, auscultation, and percussion should be done before palpation.

31. When examining the abdomen of a child, which technique would the nurse use last? a) Palpation b) Percussion c) Inspection d) Auscultation

a) Maintaining the intravenous (IV) fluid rate as ordered Pg. 1263 The nurse should maintain an IV line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, and popsicles should be avoided as they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.

5. The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care? a) Maintaining the intravenous (IV) fluid rate as ordered b) Offering Kool-Aid or popsicles as tolerated c) Encouraging milk products to boost caloric intake d) Encouraging consumption of fruit juice

c) "It is important to increase the intake of protein for these children" Pg. 1287-1288 Kwashiorkor results from severe deficiency of protein with an adequate caloric intake. It accounts for most of the malnutrition in the world's children today. The highest incidence is in children 4 months to 5 years of age. Although strenuous efforts are being made around the world to prevent this condition, its causes are complex.

1. The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with Kwashiorkor. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of Kwashiorkor? a) "The cause of this disease can be treated very simply" b) "The highest incidence of this disease is seen in children who are adolescents" c) "It is important to increase the intake of protein for these children" d) "These children have a severe deficiency of vitamin D"

a) Lower right Pg. 1278 With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant is referred to as the McBurney point, an area of tenderness 1.5 to 2 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

10. A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? a) Lower right b) Upper right c) Lower left d) Upper left

a) In this disorder the sphincter that leads into the stomach is relaxed Pg. 1266 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.

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

a) "The treatment for the disorder will be a surgical procedure" Pg. 1284 Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

12. 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? a) "The treatment for the disorder will be a surgical procedure" b) "Your child will be treated with oral iron preparations to correct the anemia" c) "Your child will receive counseling so the underlying concerns will be addressed" d) "We will give enemas until clear and then teach you how to do these at home"

a) Calcium and phosphorus Pg. 1288 Rickets, a disease affecting the growth and calcification of bones, is caused by a lack of vitamin D. The absorption of calcium and phosphorus is diminished because of the lack of vitamin D, which is needed to regulate the use of these minerals. The absorption of the other nutrients is not affected by the lack of vitamin D.

13. The nurse recognizes that in the disorder referred to as rickets, the child has a lack of vitamin D. Because of the lack of vitamin D, the absorption of which of the following is decreased? a) Calcium and phosphorus b) Iron and potassium c) Vitamin C and thiamine d) Riboflavin and niacin

a) Hirschsprung disease Pg. 1282-1283 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.

14. 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? a) Hirschsprung disease b) Ulcerative colitis (UC) c) Short bowel syndrome (SBS) d) Gastroenteritis

a) Only occurs with feeding Pg. 1262 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.

15. 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? a) Only occurs with feeding b) Is curdled and extremely sour smelling c) Is projected 1 ft away from infant d) Continues until stomach is empty

a) Prepare the infant for surgery Pg. 1289 In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

17. In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? a) Prepare the infant for surgery b) Change the infant's diet to one that is lactose-free c) Assist in doing a barium enema procedure on the infant d) Medicate the infant with analgesics

c) Give the child small frequent feedings d) Keep the child upright for 30 minutes after feeding e) Administer a prokinetic to empty the stomach quickly Pg. 1266 For the infant with GERD, the parents should give the child small, frequent feedings, with frequent burping to control reflux. The parents also should keep the child upright for 30 to 45 minutes after feeding and thicken the formula with rice or oatmeal cereal. Prokinetic agents may be used to help empty the stomach more quickly, minimizing the amount of gastric contents in the stomach that the child can reflux. Omeprazole, a proton pump inhibitor, is an appropriate treatment for GERD and should be administered 1 to 1.5 half hours before meals.

18. The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The infant will be managed medically. What action(s) will the nurse incorporate into the teaching plan? Select all that apply. a) Administer omeprazole after meals b) Thin the formula with water to ease the flow c) Give the child small frequent feedings d) Keep the child upright for 30 minutes after feeding e) Administer a prokinetic to empty the stomach quickly

c) "Symptoms are not always clear to any of us. Also the thin wall of the appendix in a child perforates readily" Pg. 1277-1278 The statement about the symptoms and the thin appendiceal wall in a young child are true and give the parents information as well as help to relieve guilt feelings. "Don't feel bad...." and "Everything will be OK..." offer false assurance without information. The statement about antibiotics is not true.

19. How will the nurse respond to parents who express regret that they did not seek care for their young child early enough to prevent perforation of the child's appendix? a) "Unfortunately, antibiotics are not as effective in reducing perforation in children as they are in adults" b) "Everything will be OK. I know that you are worried, but the care here is excellent" c) "Symptoms are not always clear to any of us. Also the thin wall of the appendix in a child perforates readily" d) "Don't feel bad. Many children are admitted with a ruptured appendix, and they recover well"

d) Gastroenteritis Pg. 1263 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.

2. 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? a) Pancreatitis b) Appendicitis c) Hirschsprung disease d) Gastroenteritis

b) Deficiency of protein and calories Pg. 1288 Marasmus is a deficiency in calories as well as protein. Scurvy is caused by inadequate intake of vitamin C, and anemia is caused by lack of iron. Excess calories add to the concern of obesity in children. Excess vitamin C is excreted, and it is unusual to have an excess of iron or protein in the diet of children; those nutrients are more often inadequate in children's diets.

20. In understanding the disease of marasmus when seen in children, the nurse recognizes that the disease is caused because of which of the following? a) Excess of vitamin C and iron b) Deficiency of protein and calories c) Excess of protein and calories d) Deficiency of vitamin C and iron

c) pH of 7.25, HCO3 of 20 mEq/L (20 mmol/L) Pg. 1261 The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45. The level of bicarbonate (HCO3) in arterial blood is normally 22 to 26 mEq/L. Metabolic acidosis results from diarrhea as a great deal of sodium is lost with stool. With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). With metabolic alkalosis, pH will be elevated (near or above 7.45), and HCO3 level will be near or above 28 mEq/L.

21. A 7-year-old has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which analysis of the blood gases indicates that the illness has progressed to metabolic acidosis? a) pH of 7.35, HCO3 of 24 mEq/L (24 mmol/L) b) pH of 7.5, HCO3 of 29 mEq/L (29 mmol/L) c) pH of 7.25, HCO3 of 20 mEq/L (20 mmol/L) d) pH of 7.4, HCO3 of 26 mEq/L (26 mmol/L)

c) Inguinal hernia Pg. 1282-1283 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.

23. 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? a) Hiatal hernia b) Diaphragmatic hernia c) Inguinal hernia d) Umbilical hernia

a) Skim milk c) Applesauce e) Bananas Pg. 1280-1281 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.

24. 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. a) Skim milk b) Wheat bread c) Applesauce d) Rye bread e) Bananas

a) 1,600 mL Pg. 1260 Using the following formula of 100 ml/kg for the first 10 kg, plus 50 ml/kg for the next 10 kg, and then 20 ml/kg for the remaining kg, the child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.

25. The nurse is determining maintenance fluid requirements for a child who weighs 25 kg (55 lb). How much fluid would the child need per day? a) 1,600 mL b) 1,560 mL c) 1,700 mL d) 1,650 mL

d) Niacin Pg. 1288 Niacin insufficiency in the diet causes a disease known as pellagra, which presents with GI and neurologic symptoms. A diet deficient in thiamine causes beriberi. Lack of vitamin C causes scurvy, and lack of iron causes anemia.

26. The nurse is discussing the disease known as pellagra. This disease is due to a deficiency in which of the following? a) Vitamin C b) Thiamine c) Iron d) Niacin

b) Maintaining NPO status while restoring hydration and electrolyte balance Pg. 1268 NPO is needed to avoid vomiting and aspiration during surgery. Hydration and electrolyte replacement is often needed because of the history of vomiting, which causes loss of both fluid and electrolytes. Feeding when surgery is pending would not be safe. Hourly abdominal assessment would not yield needed information and would further disturb the infant. Pain is not the source of crying. The infant is hungry.

27. Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is: a) Providing adequate pain control b) Maintaining NPO status while restoring hydration and electrolyte balance c) Reducing vomiting by feeding small amounts of clear liquids or breast milk frequently d) Assessing the abdomen hourly for distention and bowel sounds

a) Kwashiorkor Pg. 1287-1288 The symptoms presented are classic signs of Kwashiorkor due to the protein deficiency.

28. A young child has presented to the pediatric unit with a swollen abdomen, edema, thin patchy hair, and irritability with growth retardation and muscle wasting. The nurse suspects a malnutrition disorder. The nurse identifies this child to most likely have which condition? a) Kwashiorkor b) Vitamin C deficiency c) Thiamine deficiency d) Vitamin D deficiency e) Marasmus

a) Aspiration Pg. 1268 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.

3. 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? a) Aspiration b) Stomach irritation c) Stunted growth d) Nutritional deficiency

c) Care for a temporary colostomy Pg. 1284 The aganglionic portion of the infant's colon will need to be removed. In most cases, bowel is allowed to rest and recoil for a period of time, necessitating a temporary colostomy. Later the colostomy can be closed and the two ends of the intestine rejoined. Thickening feedings will not relieve the colon distention and obstruction with stool. Pacifiers may be used and are soothing. Monitoring heart rate should not be necessary.

30. Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to: a) Carefully monitor heart rate b) Avoid use of a pacifier c) Care for a temporary colostomy d) Thicken formula feedings

b) "Tell me about the types of stools your child has been having" Pg. 1261-1263 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.

32. 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? a) "What foods has your child eaten during the last few days?" b) "Tell me about the types of stools your child has been having" c) "How many times a day does your child urinate?" d) "How long has your child been toilet trained?"

b) "He attends a day care center four days a week while I am at work" Pg. 1263 Giardiasis is caused by the protozoan parasite Giardia lamblia. It is a common cause of diarrhea and is prevalent in children who attend day care centers and other types of residential facilities; it may be found in contaminated mountain streams or pools frequented by diapered infants. Bubble baths can lead to urinary tract infections, but are not the cause of Giardiasis infestations. It is not related to either C. Diff or pinworms.

34. The nurse is doing teaching with the caregivers of toddler and preschool aged-children. One of the caregivers tells the group that her child had diarrhea and she was told that it was caused by giardiasis. Which statement made by the caregiver indicates the most likely situation in which the child contacted the disorder? a) "My mother is in a nursing home but I always make the kids wash their hands before we leave her" b) "He attends a day care center four days a week while I am at work" c) "I won't let his sister take bubble baths but I do let him take one a few times a week" d) "My son spent time with a neighbor who was diagnosed with pinworms"

a) The nurse encourages the child and family to express their fears Pg. 1278-1279 The child facing an emergency surgery may be extremely frightened and also may be in considerable pain. The family caregiver may be apprehensive about impending surgery. Explain to the child and the family what is happening and why, and encourage them to express their fears. Laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Oral fluids are withheld and the child is NPO before surgery. A heating pad is contraindicated because of the danger of rupture of the appendix.

35. The nurse is caring for a child admitted with acute appendicitis. Prior to the child going to the operating room for emergency surgery, which nursing intervention would the nurse most likely perform? a) The nurse encourages the child and family to express their fears b) The nurse gives the child laxatives to evacuate the colon c) The nurse administers oral fluids to prevent dehydration d) The nurse applies a heating pad to the abdomen to manage pain

c) Hard, moveable, olive-shaped mass in the right upper quadrant Pg. 1268 With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper mid-abdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.

36. The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? a) Tenderness over the McBurney point in the right lower quadrant b) Abdominal pain in the epigastric or umbilical region c) Hard, moveable, olive-shaped mass in the right upper quadrant d) Sausage-shaped mass in the upper mid-abdomen

c) Take a stool culture Pg. 1264 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.

38. 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? a) Administer IV potassium b) Administer antibiotic therapy c) Take a stool culture d) Feed the child a cracker

a) Intussusception Pg. 1275 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.

39. 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? a) Intussusception b) Necrotizing enterocolitis c) Short-bowel/short-gut syndrome d) Volvulus with malrotation

a) There is a partial or complete mechanical obstruction in the intestine Pg. 1283 Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder.

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

a) Painless rectal bleeding Pg. 1280 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.

6. The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: a) Painless rectal bleeding b) Respiratory distress c) Ischemia d) Dehydration

b) Pyloric stenosis Pg. 1262-1268 With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.

7. 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? a) Peptic ulcer disease b) Pyloric stenosis c) Gastroesophageal reflux d) Appendicitis

d) Currant jelly-like Pg. 1275 The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.

8. The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? a) Bloody b) Greasy c) Clay-colored d) Currant jelly-like

b) Cirrhosis of the liver Pg. 1273 Upon assessment, a prominent venous pattern may be seen in children with cirrhosis of the liver. Peristalsis may be visible in the thin, malnourished infant or in the infant with obstruction caused by pyloric stenosis.

9. The nurse performs an abdominal assessment of an infant and observes a prominent venous pattern. The nurse documents the findings and anticipates that this is a sign of which? a) Malnourishment b) Cirrhosis of the liver c) Pyloric stenosis d) Hirschsprung disease