Week 6 GI and Cancer unit

A preschool-aged child is about to be admitted to the pediatric intensive care unit after surgery for removal of a brain tumor. The nurse manager should intervene immediately when the child's nurse does what?

Adjusts the bed to the Trendelenburg position Raising the foot of the bed increases blood flow to the brain, thereby increasing intracranial pressure. An increase in temperature may occur after a craniotomy as a result of stimulation of the hypothalamus. A hypothermic blanket should be ready if the temperature climbs precipitously. Monitoring of vital signs is a critical component of postoperative care. IV infusions must be regulated precisely to minimize the possibility of cerebral edema.

What is the priority nursing intervention for an infant during the immediate postoperative period after surgical repair of a cleft lip?

Minimize crying. Rationale Crying will put tension on the suture line and should be prevented. The elbow restraints should be removed periodically when the infant is under constant supervision. The infant should not have respiratory difficulty and does not need oxygenation. The infant needs to be cuddled frequently; the parents are encouraged to hold the infant as much as possible.

A nurse is caring for a child with newly diagnosed acute lymphoblastic leukemia. What clinical findings does the nurse anticipate when assessing the child?

Pallor Fatigue Multiple bruises Pallor is the result of anemia associated with leukemia. Fatigue is the result of anemia associated with leukemia. Multiple bruises are the result of thrombocytopenia associated with leukemia. Jaundice usually indicates liver damage or excessive hemolysis and is not an early sign of leukemia. Edema is not a manifestation of the disease because the pathophysiology does not involve transport of fluids.

A nurse is caring for a 3-month-old infant whose abdomen is distended and whose vomitus is bile stained. The nurse suspects an intestinal obstruction. What clinical manifestations support this suspicion?

Paroxysmal pain Grunting respirations Paroxysmal pain is related to the peristaltic action associated with intestinal obstruction. Abdominal distention pushes the diaphragm upward, causing respiratory distress characterized by grunting respirations. Weak pulse, hypotonicity, and high-pitched cry are unrelated to intestinal obstruction; a high-pitched cry is related to neurologic problems.

A young child with acute nonlymphoid leukemia is admitted to the pediatric unit with a fever and neutropenia. What are the most appropriate nursing interventions to minimize the complications associated with neutropenia?

Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques Children with leukemia most often die of infection; a low neutrophil count is associated with myelosuppressant therapy. Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques are the best ways to minimize complications. Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion are not appropriate measures to prevent infection resulting from neutropenia; they are appropriate for treating the anemia. Avoiding rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture are not appropriate measures to prevent infection resulting from neutropenia; they are more appropriate for preventing bleeding. Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes are not appropriate measures to prevent infection resulting from neutropenia; they are used to ease and treat stomatitis.

A 1-month-old infant is admitted to the pediatric unit with a tentative diagnosis of Hirschsprung disease (congenital aganglionic megacolon). What procedure does the nurse expect to be used to confirm the diagnosis?

Rectal biopsy A full-thickness rectal biopsy involves the removal of some rectal tissue, which is examined microscopically for the absence of ganglion cells. A colonoscopy is not necessary to obtain a rectal biopsy specimen. A saline enema may relieve the obstruction, but it is not a definitive diagnostic tool; a barium enema may be used for diagnosis after the age of 2 months. A fiberoptic nasoenteric tube is not used to identify the cause of intestinal obstruction in infants.

A nurse is feeding an infant who recently underwent surgical repair of a cleft lip. What does the nurse plan to do for the infant just after each feeding?

Rinse the suture line. Meticulous care of the suture line is necessary, because inflammation and sloughing of tissue disrupt healing. Burping should be done throughout the feeding. Placing the infant on the abdomen is contraindicated, not only because the infant may rub the face on the sheet and irritate the suture line but also because this position has been linked to sudden infant death syndrome. The infant may be held at any time.

A nurse is caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS). What is most important for the nurse to assess?

Signs of dehydration HPS causes partial and then complete obstruction. Nonprojectile vomiting progresses to projectile vomiting, which rapidly leads to dehydration. The infant's cry is not affected by HPS; pain, except for the pain of hunger, does not appear to be associated with this condition. An infant with a tracheoesophageal fistula, not HPS, is expected to cough up feedings. The characteristics of the stool are not relevant in the assessment of an infant with HPS.

A nurse is caring for a preschool-age child with leukemia who is undergoing chemotherapy and may have a fever. What factors should the nurse consider before taking this child's temperature?

-Rectal temperatures are too upsetting for this age group. -Oral temperatures are accurate in children with leukemia. -Rectal temperatures are avoided to reduce the risk of rectal trauma. Rectal temperatures are considered invasive by the preschool-age child; however, it is not the only reason to avoid taking this child's temperature rectally. Oral temperatures are accurate, as long as the child can hold the thermometer in the mouth correctly. Chemotherapy causes alterations in mucous membranes; a rectal thermometer could damage delicate rectal tissue. A skin sensor is accurate as long as the instructions provided by the product are followed. Tympanic temperatures are accurate as long as proper technique is used.

A 3-year-old child is admitted to the pediatric unit with a tentative diagnosis of Wilms tumor. The nurse obtains the child's health history from the parents. What does the child's history reveal that will help establish the diagnosis?

Abdominal swelling Wilms tumor is a nephroblastoma that is first observed as a firm, painless intraabdominal mass located on one side of the abdomen. Periorbital edema is a sign of glomerulonephritis, not Wilms tumor. Projectile vomiting is indicative of central nervous system problems or a gastrointestinal obstruction, not Wilms tumor. A low-grade fever is a nonspecific sign of many illnesses, not necessarily Wilms tumor.

A 6-month-old infant is to be on nothing-by-mouth (NPO) status for 4 hours before surgery for cleft palate repair. What is the most important concern for the infant before surgery?

Altered fluid intake before surgery A 6-month-old, whose body weight is approximately 75% water, is very susceptible to fluid changes and ensuing dehydration. Although children with cleft palate breathe through the mouth, it does not impair their breathing; the surgery is performed before 2 years of age, before speech patterns become fixed, not because the cleft lip impairs breathing patterns. Although the parents may be anxious, the infant is too young to be aware of the impending hospitalization. Regressed behavior should not be a problem for a short-term hospitalization.

An infant with hypertrophic pyloric stenosis is admitted to the pediatric unit. What does the nurse expect to find when palpating the infant's abdomen?

An olive-sized mass in the right upper quadrant Rationale The olive-like mass is caused by the thickened muscle (hypertrophy) of the pyloric sphincter. The obstruction is above the intestinal area; the colon is not involved. There is no significant tenderness in the abdomen. There is little or no peristalsis in the intestines.

An infant with a cleft lip is fed with a special nipple. What should the nurse teach the parents about feeding their infant to minimize regurgitation?

Burp frequently during a feeding. Because of the cleft (opening) in the lip, infants with this condition tend to suck in excessive air; burping helps prevent regurgitation of formula. Thickened formula is given to infants with reflux problems, such as vomiting after each feeding. The semi-Fowler position may be used for infants with reflux problems; this infant should be held during feedings. The bottle should never be propped, because aspiration may occur.

After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What assessment should the nurse document that will aid confirmation of the diagnosis?

Characteristics of stools Because intussusception creates intestinal obstruction in which the intestine "telescopes" and becomes trapped, passage of intestinal contents is lessened; stools are red and look like currant jelly because of the mixing of stool with blood and mucus. Frequency of crying is not specific to a diagnosis of intussusception. Accurate intake and output records are important, but they are not essential for confirming this diagnosis. Bowel sounds will not be affected significantly with intussusception.

A 3-week-old infant has surgery for esophageal atresia. What is the immediate postoperative nursing care priority for this infant?

Checking the patency of the nasogastric tube A nasogastric tube is used after surgery to decompress the stomach and limit tension on the suture line. As another means of limiting pressure on the suture line, oral feedings should not be implemented in the immediate postoperative period when the nasogastric tube is in place. Vomiting indicates obstruction of the nasogastric tube; this is why the initial action should be to check the patency of the tube. It is too soon for signs of infection to occur.

A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states what?

Do not palpate the abdomen. Palpation increases the risk of tumor rupture and is contraindicated. There are no data to indicate that surgery is scheduled; therefore there is no reason to maintain nothing-by-mouth (NPO) status. There is no contraindication to intravenous medication. Recording of intake and output may or may not be instituted; it is not specific to children with Wilms tumor.

A nurse is obtaining a health history from the mother of a 15-month-old toddler with celiac disease. The nurse expects the mother to indicate what about her toddler?

Has bulky, foul, frothy stools Steatorrhea (fatty, foul-smelling, frothy, bulky stools) occurs with celiac disease because of an intolerance to gluten; toxic substances, which can damage the intestinal mucosal cells, accumulate and cause diarrhea. Drinking large amounts of fluid is a response to dehydration. With celiac disease some thirst may occur, but it is not continuous. Although infants with celiac disease are irritable, this sign is too vague for accurate evaluation. Irritability is symptomatic of a variety of problems, ranging from cutting of teeth to leukemia. Concentrated urine is associated with a urinary tract infection or dehydration; this sign is too vague to permit accurate evaluation.

A nurse is reviewing the health history and laboratory results of a school-aged child admitted to the pediatric unit with acute nonlymphoid leukemia (acute myeloid leukemia). What clinical findings does the nurse expect?

Listlessness Bone marrow depression Listlessness in a child with leukemia is caused by anemia; anemia is expected in children with leukemia because of generalized bone marrow depression. Depressed bone marrow production of formed elements of blood is characteristic of nonlymphoid leukemia; it leads to neutropenia and increases susceptibility to infection. Urine output will be within expected limits; there is no kidney involvement at this stage of the disease. There are more, not fewer, stem cells in the peripheral blood and bone marrow; the production of mature blood cells is depressed. The swallowing reflex is not affected.

When providing care to a 6-year-old child with leukemia, a nurse notes blood on the pillowcase and several bloody tissues. What blood component value on the child's laboratory results should the nurse verify?

Platelets The platelet count is reduced as a result of the bone marrow depression associated with leukemia and chemotherapy. Bleeding will result from the decreased clotting ability of the blood. Neutrophils are white blood cells; they do not influence bleeding. The red blood cell count is an indirect indicator of the hematocrit and hemoglobin levels, neither of which is the reason for or cause of the bleeding. Lymphoblasts may be found in the blood of children with leukemia but do not influence bleeding.

A nurse is planning to assess the vomitus of an infant with pyloric stenosis. Why does the nurse anticipate that the vomitus will be white rather than bile-stained?

There is an obstruction above the opening of the common bile duct. The common bile duct enters the duodenum. The pyloric sphincter is located between the end of the stomach and the beginning of the duodenum; therefore when it is hypertrophied the tight sphincter prevents any mixing of vomited formula with bile. Pyloric stenosis involves hypertrophy and hyperplasia of the muscle of the pyloric sphincter; the bile duct is intact. The bile duct enters the duodenum at a site different from the pyloric sphincter and is uninvolved in pyloric stenosis. The area affected in pyloric stenosis is the pyloric sphincter (which is between the stomach and duodenum), not the cardiac sphincter (which is between the stomach and esophagus).