Exam 5 Families with Children- Gastrointestinal
The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
B
The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care? a. Restricting activity b. Following a gluten-free diet c. Following a lactose-free diet d. Giving medication to manage the condition
B
A nurse is caring for an infant who has just returned from the PACU following cleft lip and palate repair. Which of the following actions should the nurse take? Remove the packing in the mouth. Place the infant in a side-lying position. Offer a pacifier with sucrose. Assess the mouth with a tongue blade.
side lying
The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely to be included in the discharge teaching? 1. Administer Imodium as needed. 2. Administer Kaopectate as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.
3
The pathologic disturbance of pyloric stenosis results from: 1. Edema of the pyloric muscle 2. Ischemia of the pyloric muscle 3. Hypertrophy of the pyloric muscle 4. Neoplastic obstruction
3
A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.
1
An infant who has severe diarrhea and dehydration is hospitalized and is NPO. Intravenous fluids are ordered. What is the immediate goal of care? 1. Restoration of intravascular volume 2. Prevention of further diarrhea 3. Promotion of skin integrity 4. Maintenance of normal growth and development
1
What is the priority nursing intervention for an infant during the immediate postoperative period after surgical repair of a cleft lip? 1Minimize crying. 2Restrain continuously. 3Oxygenate frequently.
1
What signs and symptoms would alert the nurse to the possibility of intussusception? Select all that apply. 1. Onset is sudden 2. Kicking and drawing of legs 3. Failure to thrive 4. Bile stained vomit 5. Currant jelly stools
1, 2, 4, 5
After surgery for pyloric stenosis, the nurse could anticipate that the infant will: 1. Have nasogastric suction for 24 hours 2. Be fed clear liquids within 6 hours 3. Remain NPO for 24 to 48 hours 4. Be fed formula within 4 hours
2
The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.
2
The nurse is caring for a 9-month-old infant who is allowed only clear fluids. What are the most appropriate liquids for the nurse to offer? 1. 7-Up and ginger ale 2. Pedialyte and glucose water 3. Half-strength formula 4. Tea and clear broth
2
A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.
3
A child is admitted with dehydration following a 24-hour history of vomiting and diarrhea. Oral rehydration therapy is ordered. A nurse should: 1. give 40 to 50 mL/kg of water every 4 hours. 2. give 40 to 50 mL/kg of rehydration solution every 4 hours. 3. give 40 to 50 mL/kg of rehydration solution over 4 hours. 4. give as much rehydration solution as child can tolerate.
3
Following surgery for repair of a cleft lip, it is important to prevent excessive crying by the infant. What should the nurse do to accomplish this? 1. Give the baby a pacifier to meet his/her sucking needs. 2. Place the baby in the usual sleeping position, which is on the abdomen. 3. Ask the baby's mother to stay and hold the child. 4. Request a special nurse to hold the infant.
3
Following surgery for pyloric stenosis, a 5-week- old infant is started on glucose water. When will infant formula be started? 1. Following the return of bowel sounds 2. After vital signs are stable 3. When the infant is able to retain clear liquids 4. When there is no evidence of diarrhea
3 Once the infant retains small, frequent feedings of glucose for 24 hours, the nurse may begin small, frequent feedings of formula until the infant returns to a normal feeding schedule. Answer 1 is not correct because bowel sounds need to be present before starting clear liquids. A decrease in bowel sounds is not normally a problem in the child who has undergone surgical correction for pyloric stenosis because the surgery does not enter the stomach itself but rather the pyloric muscle. Answer 2 is not correct
A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran (ondansetron). 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.
4
A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these assessment findings, the nurse should further assess the client for which of the following complications?... 1. Deficient fluid volume. 2. Intestinal obstruction. 3. Bowel ischemia. 4. Peritonitis
4
The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.
4
The nurse is caring for an 8-month-old infant who has had diarrhea for two days. Which is the most useful in assessing the degree of dehydration? 1. Number of stools 2. Skin turgor 3. Mucus membranes 4. Daily weight
4
For a 9-month-old infant, which finding is inconsistent with GERD? A) Weight gain B) Vomiting C) Irritability D) Wheezing
A
Your patient was admitted 3 days ago for treatment of severe malnourishment secondary to Celiac Disease. The patient is doing well and will be discharged tomorrow. When you arrive to the patient's room, the patient's friends and family are visiting and have brought dinner for the patient. Which food item below should the patient avoid consuming? A. Pork barbeque sandwich B. Steak and steamed broccoli C. Braised chicken with carrots D. Vegetables and rice
A
Lab test: Enzyme immunoassay (stool sample) Nursing Interventions / Plan of Care • Contact Precautions • Diagnosed via Stool Sample • Baseline Height & Weight • Daily Weights at same time each day| I & O's • AVOID Rectal Temp • Monitor Urine & Stool • Initiate IV Fluids | High Dehydration Potential
A nurse is assessing a child who has a rotavirus infection. Which of the following findings should the nurse expect? Select all that apply. A. Fever B. Vomiting C. Watery stools D. Bloody stools E. Confusion
The nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescriptions that the nurse anticipates will be prescribed. Select all that apply. a. Initiate an IV line. b. Maintain an NPO status. c. Administer a Fleet enema. d. Administer intravenous antibiotics. e. Administer preoperative medications. f. Place a heating pad on the abdomen to decrease pain
A, B ,D, E
A nurse is providing interventions for a dehydrated child.Select all appropriate nursing interventions from the following options (A-E). A. "Administering oral rehydration solution (ORS).".. B. "Keeping the child in a cold environment.".. C. "Monitoring the child's vital signs.".. D. "Providing heavy meals at regular intervals.".. E. "Educating the child and caregivers about dehydration."..
A, C, E
The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse should plan for which appropriate nursing action? a. Rinsing the mouth with water b. Cleaning the mouth with diluted hydrogen peroxide c. Using a soft lemon and glycerin swab to clean the mouth d. Using cotton swabs saturated with half-strength povidone-iodine to clean the mouth
A. Clean incision site w/ NS, water, or diluted hydrogen peroxide
A nurse is caring for a child who has Meckel's diverticulum. Which of the following manifestations should the nurse expect? Select all that apply. Abdominal pain Fever Mucus and blood in stools Vomiting Rapid, shallow breathing
Abdominal pain mucus/blood in stools
A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the primary health care provider to prescribe? a. Increase intake of water with a diet high in carbohydrates. b. Consume oral rehydration fluid, advancing to a regular diet. c. Begin fluid replacement immediately with intravenous fluids. d. Begin a diet of bananas, rice, apples, pears, and toast with juice
B
The nurse provides home care instructions to the mother of a child who had a cleft palate repair 4 days ago. Which statement by the mother indicates the need for further instruction? a. "I will use a short nipple on the bottle." b. "I need to buy some straws for drinking." c. "I can give my child the pacifier in 2 weeks." d. "I may give my baby food mixed with water."
B
Under which of the following conditions can celiac disease be classified? A. Infection B.Malabsorption C. Inflammatory bowel disease D. None of these
B
You're helping a mother, whose child was recently diagnosed with Celiac Disease, read food labels. Which items below, if listed as the ingredients, should the mother avoid feeding her child? A. Millet B. Wheat C. Malt D. Corn E. Buckwheat F. Rye
B, C, F
A nurse is assessing a child for dehydration.Which of the following should the nurse evaluate during the physical examination? A. "The child's favorite foods and beverages.".. B. "The child's school attendance and activities.".. C. "The child's skin turgor and mucous membranes.".. D. "The child's vaccination history."..
C
A pediatric client is diagnosed with gastroesophageal reflux disorder (GERD). The nurse is observing a return demonstration of the caregiver preparing and feeding the infant formula. Which observation demonstrates correct procedure for preventing GERD symptoms? A) Burping the infant after 4 ounces of formula are taken B) Thinning the formula with water prior to feeding C) Positioning the infant upright for a minimum of 30 minutes D) Warming the formula prior to feeding
C
The healthcare provider is teaching a patient diagnosed with celiac disease about the disease process. Which of the following statements made by the patient would indicate a correct understanding of the teaching? (Choice A "I'm glad that I can still eat bread made with rye flour." (Choice B "I have an allergy to the proteins that are found in wheat." (Choice C "My immune system reacts to gluten and damages my gut." (Choice D "The bacteria in my gut are not able to ferment the gluten."
C
The parents of a child diagnosed with celiac disease tell the healthcare provider, "Our baby is getting a lot of bruises lately." The healthcare provider explains that the bruising is most likely caused by a deficiency in which of these nutrients? A Vitamin D B Iron C Vitamin K D Folate
C
Cleft lip-palate
CL results from incomplete fusion of the oral cavity during intrauterine life. CP results from incomplete fusion of the palates during intrauterine life Can occur together or can appear alone. Can be unilateral or bilateral.
Celiac Disease
Chronic Autoimmune Disorder of the Small Intestine • Impaired Absorption of Nutrients & Fat • Gluten & intestinal mucosa get damaged by autoimmune response Leads to Malnourishment
PYLORIC STENOSIS - Thickening of the pyloric sphincter which creates an obstruction - Usually occurs the first few weeks of life
Clinical Manifestations Vomiting often occurs with a feeding but can happen several hours after a feeding & becomes projectile as obstruction worsens. Nonbilious vomit can be blood tinged Constant hunger Olive-shaped mass in the right upper quadrant of the abdomen & possible peristaltic waves that moves from right to left when lying supine. Failure to gain weight & manifestations of dehydration(pallor, cool lips, dry skin & mucous membranes, decreased skin turgor, diminished urinary output, concentrated urine, thirst, rapid pulse, sunken eyes)
Nursing Care: Stabilize the child prior to the procedure. IV fluids to correct & prevent dehydration NG tube for decompression - Teach family/child about nonsurgical procedure - Treatment is an air enema performed by a radiologist; with or without co
Clinical Manifestations: Sudden episodic abdominal pain Screaming with drawing knees to chest during episodes of pain Abdominal mass (sausage-shaped) Stools mixed with blood & mucus that resemble consistency of red currant jelly Vomiting Fever Tender, distended abdomen
Meckel's Diverticulum
Complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development.
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left lower quadrant b) Left upper quadrant c) Right upper quadrant d) Right lower quadrant
D
Bobby, a 13 year old is being seen in the emergency room for possible appendicitis. An important nursing action to perform when preparing Bobby for an appendectomy is to: a) administer saline enemas to cleanse the bowels b) apply heat to reduce pain c) measure abdominal girth d) continuously monitor pain
D
Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which of the following? A."Currant jelly" stools B.Regurgitation C.Steatorrhea D.Projectile vomiting
D
The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? a. Provide less frequent, larger feedings. b. Burp the infant less frequently during feedings. c. Thin the feedings by adding water to the formula. d. Thicken the feedings by adding rice cereal to the formula.
D
The parents of a child are concerned about the appearance of their child's stools. Which of the following descriptions is consistent with the stools produced by a patient diagnosed with celiac disease? A Long and ribbon-like B Green and watery C Red and gel-like D Light tan and oily
D
Which client requires immediate nursing intervention? The client who: a) complains of epigastric pain after eating. b) complains of anorexia and periumbilical pain. c) presents with ribbonlike stools. d) presents with a rigid, boardlike abdomen
D
At 18 months of age a child born with a cleft lip and palate is readmitted for palate surgery. Why does the nurse teach the parents not to brush their child's teeth immediately after the surgery? The suture line might be injured. A toothbrush might be frightening. The child will probably have no teeth. A toothbrush has not been used before.
suture line might be injured
Removal of the Ruptured Appendix - Laparoscopic or open surgery Preop Nursing Actions: Electrolyte & fluid replacement NG tube for decompression IV antibiotics Postop Nursing Actions: Assess respiratory status & maintain airway O2 as prescribed V/S Analgesics for pain Assess surgical site for bleeding or other abnormalities Assess bowel sounds/function IV fluids & antibiotics NPO status NG tube to low continuous suction Provide wound irrigation care for open surgical sites with antibacterial solution or saline-soaked gauze. Provide drain care.
FINDINGS TO REPORT: Assess for peritonitis: fever, irritability, rigid abdomen, abdominal distention, tachycardia, rapid shallow breathing, pallor, chills, sudden relief of pain after perforation followed by a diffuse increase in pain.
GERD/Gastroesophageal Reflux Disease
GER is gastric contents reflux back up into the esophagus, making esophageal mucosa vulnerable to injury from gastric acid GERD is tissue damage from GER GER is self limiting & usually resolves by 1 year of age.
Nutritional Interventions • Consult RD • Gluten-Free Diet | High Calories & Protein Gluten-Free Foods Milk / Cheese | Check for Lactose Intolerance Corn / Soy / Millet / Buckwheat / Rice / Tapioca / Chia Eggs Legumes Potatoes Fruit / Veggies Plain Meat
Gluten Rich Foods: Wheat Any type of Bread containing wheat Barley Seasonings Rye Canned Soup Beer | Nice Anything processed Malt | Milkshakes Pasta
APPENDICITIS
Inflammation of the vermiform appendix caused from an obstruction of the lumen of the appendix. Average client is 10
DEHYDRATION Isotonic: Water & Sodium Lost in EQUAL amounts Major Loss of Fluid from ECF Reduction in Circulating Fluid HYPOVOLEMIC SHOCK Sodium Levels | WNL Hypotonic: Electrolyte Loss > Water Loss Water Moves from ECF to ICF Physical Manifestations are more severe with smaller fluid loss Shock is Likely Sodium Levels | Low < 130 mEq/L Hypertonic: Water Loss > Electrolyte Loss Fluid Shifts from ICF to ECF causing Cerebral Edema Shock is LESS likely Neuro Changes can Occur Changes in LOC Irritability Hyperreflexia Sodium Levels | High > 150 mEq/L
Mild Dehydration: Weight Loss Infants | 3-5% Children | 3-4% Manifestations Cap refill| < 2s Normal: Behavior, Mucus Membranes, Anterior Fontanelle HR, & BP WNL Possible Slight Thirst
Clinical Manifestations Abdominal pain in the RLQ Rigid abdomen Decreased or absent bowel sounds Fever Diarrhea or constipation Lethargy Tachycardia Rapid, shallow breathing Anorexia Possible vomiting
Nursing Care Prep child/family for surgery using developmentally appropriate techniques. Avoid applying heat to abdomen Avoid enemas or laxatives
Clinical Manifestations (SAD MARS) / Assessment of Celiac • Steatorrhea • Abdominal Bloating / Cramps • Diarrhea • Muscle Wasting • Anemia - Vitamin Deficiencies • Rickets- Impaired Bone Development • Small in Stature w/ Delayed Maturity weight less than expected
Nursing Interventions / Plan of Care • Focus of effects of the Disorder- | Health & Nutrition • Pharmacological Interventions Vitamin / Mineral Supplements Iron & Folic Acid | Anemia Vitamin K Steroids
Post Op | Cleft Palate Change Positions Frequently- facilitates Drainage & Breathing Can be placed on abdomen in immediate postop period IV Fluids until patient can eat & drink NPO for 4 hours then allowed liquids only Liquids first 3-4 days then progress to soft diet No straw, tongue depressor, hard pacifier, rigid utensils, hard-tipped sippy cups, or suction catheters Elbow restraints can be used to prevent infant from injuring the repair. Monitor S/S of Airway Obstruction,Hemorrhage, & Laryngeal Spasm Facemasks for O2 Delivery
Nutritional Interventions: • Isolated Cleft Lip Encourage Breast Feeding Wide-Based Nipple for bottle feeding Squeeze Infant's cheeks together during feeding to decrease the gap • Cleft Palate / Palate + Lip Position Infant Upright while cradling during feeding Specialized Bottle w/ one-way valve & a specially cut nipple Burp Infant Frequently Syringe feeding can be necessary for infants who are unsuccessful w/ other methods
Nursing Interventions / Plan of Care | Rehydration Therapy: REPLACE FLUIDS Oral Rehydration for Mild / Moderate dehydration Mild | 50 mL/kg q 4-6 hr Moderate | 100 mL/kg q 4-6 hr Replacement of Diarrhea Losses | 10 mL/kg for each stool
Parenteral as Prescribed | Unable to drink orally, Severe Dehydration or Continue Vomiting -Isotonic & Hypotonic Dehydration Isotonic Fluid at 20 mL/kg bolus May require repeat - Hypertonic Dehydration RAPID FLUID REPLACEMENT IS CONTRAINDICATED Risk for Cerebral Edema Maintenance IV fluids as prescribed No Potassium Replacement until kidney Function is Verified • Urine Output • Cap Refill • VS • Daily Weights | I & O's
Post-Op | Both VS, O2 sat, Pain Management w/ appropriate tool Keep Infant Pain Free - Crying & Stress on Repair Analgesics Monitor Sx Sites for bleeding, Crusting, Infection Avoid Infant sucking on Nipple of Pacifier NOTHING IN THE MOUTH. | Absolutely Nothing. No Spoons/forks Daily Weights | I & O's Interaction between Pt & Family | Coping & Support Apply Elbow Restraints | Remove periodically to assess skin, allow limb movement, & provide comfort
Post-Op | Cleft Lip Integrity of Postop Protective Device to ensure Proper Positioning Position Infant on Back & Upright or Side-Lying during immediate postop period Use elbow restraints Remove periodically to assess skin, allow limb movement, and provide for comfort Clean incision site w/ NS, water, or diluted hydrogen peroxide Antibiotic Ointment if prescribed Gently Aspirate Secretions of Mouth & Nasopharynx | Prevent Resp. Complications DO NOT PUT ANYTHING IN THE MOUTH
Nursing Care - prepare the child for surgery Pyloromyotomy- performed by laparoscope Preop nursing actions IV fluids for correction of dehydration & electrolyte imbalances NG tube for decompression NPO I&O Daily weights
Postop nursing actions Obtain routine postop vital signs Provide IV fluids Daily weights & I&O Analgesics for pain Monitor for infection Start clear liquids 4-6 hours after surgery. Advance to breastmilk or formula as tolerated 24 hours after surgery. Document tolerance to feedings
Clinical Manifestations: Rectal bleeding; usually painless Abdominal pain Bloody, mucus stools Lab tests: CBC & metabolic panel Diagnostic Evaluation: Radionuclide scan- Meckel's scan/ the most effective test. Nursing Care: Prep family/child for surgery using developmentally appropriate techniques. Surgical removal of the diverticulum
Pre-Op Nursing Actions: Blood transfusion to correct hypovolemia IV fluid & electrolyte replacement O2 as ordered IV antibiotics Bed rest Closely monitor blood loss in stools Post-op Nursing Actions: Assess respiratory status & maintain airway Supplemental O2 VS Analgesics for pain Assess surgical site for bleeding or other issues Assess bowel sounds & function IV fluids & antibiotics Maintain NPO status NG tube to low continuous suction Client education: watch for manifestations of infection
Clinical Manifestations: Cleft lip- visible separation from the upper lip toward the nose Cleft palate- visible or palpable opening of the palate connecting the mouth & nasal cavity. Nursing Care: Support/encourage parents in the general care of child Promote parent-infant bonding Promote healthy self esteem thruout child's development Priority Nursing Intervention: • Cleft Lip - Repaired between 2-3 mo. Revisions in Severe Defects • Cleft Palate -Repaired between 6-12 mo. Requires a 2nd Surgery Usually
Pre-Op | Both Inspect Lip & Palate; Gloved Finger to palpate Assess Ability to Suck Baseline Weight Interaction between Pt & Family | Coping & Support Consult Social Services Educate Parents | Proper Feeding & Care Assess ability to Feed
Surgical Procedure Laparoscopic surgery Removal of the non ruptured appendix
Preop Nursing Actions: IV replacement fluids IV antibiotics Postop Nursing Actions: Assess respiratory status & maintain airway O2 as prescribed V/S Analgesics for pain Assess surgical site for bleeding or any other abnormalities Assess bowel sounds & bowel function
Client education Inform school/daycare of infection; child stays home during incubation period Use commercially prepared ORS when diarrhea occurs Avoid fruit juices, carbonated sodas, & gelatin: high carbs Avoid caffeine due to mild diuretic effect Avoid chicken/beef broth- high in sodium Prevention measures: immunization for rotavirus Frequent skin care to prevent breakdown
Prevent spread of infectious disease Change bed linens & underwear daily for several days Avoid shaking linens Keep child's toys away from others; clean toys/child care areas thoroughly. Shower frequently Avoid undercooked or under refrigerated food Proper hand hygiene after toileting & changing diapers Don't share dishes/utensils. Wash in hot soapy water or in dishwasher Clip nails & discourage nail biting/thumb sucking Clean toilet areas.
Clinical Manifestations Infants: Spitting up or forceful vomiting Irritability Excessive crying Blood in vomit Arching back & stiffening Respiratory issues Failure to thrive Apnea Children: Heartburn Abdominal pain Difficulty swallowing Chronic cough Noncardiac chest pain
Priority Nursing Intervention / Nutritional Interventions - Small Frequent Meals - Thicken Formula w/ 1 tsp to 1 tbsp rice cereal per 1 oz formula • Avoid Foods that cause GER - Caffeine - Spicy or Fried Foods - Citrus - Peppermint • Assist with Weigh Control • Position Pt with head elevated after meals • Supine for sleep Treating GERD: • Proton pump inhibitor(PPI) Omeprazole, esomeprazole, pantoprazole, rabeprazole - H2 Antagonist - Ranitidine, cimetidine, famotidine • High Risk of Pneumonia
Intussusception
Proximal segment of the bowel telescopes into a more distal segment, resulting in lymphatic & venous obstruction causing edema in the area. With progression, ischemia & increased mucus into the intestine will occur. Common in infants & children ages 3 months to 6 years.
A nurse on a pediatric unit is caring for a group of clients who have gastrointestinal disorders. Match the disorder with the expected findings Pyloric stenosis Intussusception Sausage like mass Constant hunger Projectile vomiting Red currant like jelly stools Olive shaped mass in RUQ Sudden episodic abdominal pain
Sausage like mass- Intussusception Constant hunger- pyloric Projectile vomiting- pyloric Red currant like jelly stools- intussusception Olive shaped mass in RUQ- pyloric Sudden episodic abdominal pain- intussusception
Moderate Dehydration Weight Loss Infants | 6-9% Children | 6-8% Manifestations Cap Refill - 2-4s HR slightly elevated Normal to Orthostatic BP Dry Mucous Membranes & Decreased Tears / Skin Turgor Normal to Sunken Anterior Fontanelle Possible Thirst & Irritability
Severe Dehydration Weight Loss Infants | > 10% Children | > 10% Manifestations Cap Refill | > 4s Tachycardia Orthostatic BP Shock Very Dry Mucous Membranes & Tented Skin Hyperpnea No Tears Sunken Eyeballs & Anterior Fontanelle Oliguria or Anuria Extreme Thirst
ORAL REHYDRATION THERAPY
Start replacement with an oral replacement solution(ORS) of 75-90 mEq of sodium/L at 40-50ml/kg over 4 hours. Determine need for further rehydration after initial replacement. Initiate maintenance therapy with ORS of 40-60 mEq of Sodium/L & limit to 150ml/kg/day. Give ORS alternately with intake of other liquids: formula, milk, breastmilk Give infant's water, breast milk or lactose free formula is supplementary fluid is needed Older children may resume regular diets - Replace each diarrheal stool with 10ml/kg of ORS for ongoing diarrhea.
Rotavirus
Viral infection Transmitted by fecal-oral route Incubation period is 48 hours Clinical Manifestations of Rotavirus: Diarrhea: most common cause in children younger than 5yo Affects children of all ages Fever Onset of foul-smelling, watery stool Diarrhea for 5-7 days Vomiting for approx 2 days
Treatment for intussusception is
air enema performed by a radiologist; with or without contrast
According to Maslow's hierarchy of needs, which nursing diagnosis for the pediatric patient with cleft palate needs to be addressed first? Alterated nutrition, less than body requirements. Risk for altered parenting. Altered family processes. Alteration in comfort.
altered nutrition
an 18 yr old is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis A) urinary retention B) gastric hyperacidity C) rebound tenderness D) increased lower bowel motility
c
A nurse is teaching a parent of an infant who has gastrointestinal reflux disease. Which of the following should the nurse include in the teaching? Select all that apply. Offer frequent feedings. Thicken formula with rice cereal. Use a bottle with a one-way valve. Position infant upright after feedings Use a wide-based nipple for feedings.
frequent feedings thicken formula with rice position upright
A nurse is caring for a child who has had watery diarrhea for the past 3 days. Which of the following actions should the nurse take? Offer chicken broth. Initiate oral rehydration therapy. Start hypertonic IV solution. Keep NPO until the diarrhea subsides
initiate oral rehydration
Which of the following microbes is the most common cause of infectious vomiting and diarrhea in infants and small children? Norovirus Rotavirus E. coli bacteria Giardia parasite
rotavirus
Which item should a nurse use to feed an infant born with a unilateral cleft lip and palate? Plastic spoon Cross-cut nipple Parenteral infusion Rubber-tipped syringe
rubber tipped
