Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation?
"Call the doctor immediately if the stoma is not pink/red and moist."
The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents, regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred?
"I have to be careful because I am prone to not absorbing nutrients."
The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day."
The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention?
Administration of adequate vitamin D
The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet?
Bananas
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
Detect Helicobacter pylori
A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent?
Do not rub or put pressure on the abdomen.
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)
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
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?
In this disorder the sphincter that leads into the stomach is relaxed.
The most common source of lead poisoning in children comes from which of the following sources?
Paint used in older homes
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?
Prevention of hypoglycemia
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 gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?
Pyloric stenosis
The nurse is working with a school district to ensure students do not develop food-borne illnesses. Which intervention should the nurse emphasize that supports the 2020 National Health Goals regarding food preparation?
Refrigerate foods promptly.
The nurse is caring for an infant recovering from surgery for pyloric stenosis. Which nursing diagnosis should the nurse use to guide care during the immediate postoperative period?
Risk for infection of incision line, related to disruption of skin barrier during surgery
The incidence of vitamin D deficiency in the United States is less than in many countries. What is the most likely reason for this?
Some foods in the U.S. have been fortified with vitamin D.
If an adolescent has hepatitis B, what would be an important nursing action?
Strict enforcement of standard precautions
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?
Tenting of skin
The nurse is collecting data from the caregivers of a child who is suspected of having a food allergy. Which clinical manifestation would likely have been noted in this child?
Urticaria and pruritus
A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at their son. What would be the best response from the nurse?
"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"
The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction?
"I will use syrup of ipecac to get it out of my child's system."
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?
"It is important to increase the intake of protein for these children."
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 nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?
"You will most likely have a blood test to check for certain antibodies."
The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred?
- "I will need to make sure to take all of the antibiotic prescribed." - "It's important to take my histamine agonist medication at the appropriate time." - "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer
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."
The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan? Select all that apply.
- Keeping the child upright for 30 minutes after feeding - Giving the child small frequent feedings - Administering prokinetics to empty the stomach quickly
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?
Aspiration
A school-aged child with Crohn's disease will receive enteral nutrition for the next 6 weeks. What should the nurse counsel the parents to do to support this child's needs?
Encourage the child to stay with the family during routine meal times.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?
Esophageal atresia
The nurse admits an infant who is nutritionally deprived. The infant is weak and seems somewhat uninterested in food. In developing the infant's plan of care, how often will the nurse most likely plan to feed this infant?
Every 2 or 3 hours
The nurse has admitted a child with a diagnosis of severe gastroenteritis. To help prevent the risk of transmitting infection to other clients, the nurse should:
Follow standard precautions.
A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect?
Gastroenteritis
An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care?
He will become fatigued easily.
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
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?
Intussusception
Which of the following is most correct regarding the gastrointestinal system of the child?
The child cannot break down and use complex carbohydrates in the same way the adult can.
A nurse notices a child chewing several pieces of something white. The child is also drooling and crying. A container that looks like an empty pill bottle is on the floor. The first action by the nurse would be to:
remove the substance from the child's mouth.
The nurse is caring for a 12-year-old girl with Crohn disease. A primary assessment the nurse would want to make when caring for her would be to note if:
she has a temperature.
