Pediatric GI Disorders
A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now is fine. What is the nurse's first action? A) Determine prenatal status of the mother and child B) Prepare the child for immediate surgery C) Palpate the stomach for a mass D) Administer barium enema
Answer: C. The nurse would further assess the child. The nurse suspects this child to possibly have intussusception. A "sausage-like" mass in the upper mid-abdomen is a hallmark sign of intussusception. It may not be present at this time, but it would be important to assess for this finding. A barium enema is often used to treat this disorder. Surgery can also be used. The prenatal status of the mother/child would not be a priority assessment.
The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Select the nurse's best response. 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."
1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.
When discussing with the child's mother the recommended diet for a child who is experiencing diarrhea, which teaching point made by the nurse is incorrect? 1) Avoid fruit juice and gelatin, because these are high in glucose. 2) We want your child to get back to his regular diet as quickly as possible. 3) We recommend the BRAT diet for children until they can resume their regular diet. 4) We really like to avoid the use of clear liquids in a child with diarrhea.
Answer: 3) The BRAT diet is not recommended anymore.
The nurse understands that the young child is at a greater risk of developing fluid loss than an adult because of which of the following? Select all that apply: A) Greater body surface area B) Thinner skin C) Renal immaturity D) Higher likelihood of febrile illness E) Higher basic metabolic rate
Answer: A, C, D, and E.
The nurse knows that Nissen fundoplication involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.
2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal sphincter or cardiac sphincter.
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. Continue breastfeeding per routine. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.
The nurse is administering Prilosec (omeprazole) to a 3-month-old with gastro -esophageal reflux (GER). The child's parents ask the nurse how the medication works. Select the nurse's best response. 1. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." 2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." 3. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." 4. "Prilosec relaxes the pressure of the lower esophageal sphincter."
2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up."
The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."
2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" The breast can help fill in the cleft and help the infant create suction.
The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response. 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males." 4. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."
3. "Pyloric stenosis can run in families. It is more common among males."
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." 3. "The baby is always hungry after vomiting so I refeed." 4. "The baby is happy in spite of getting really upset after spitting up."
3. "The baby is always hungry after vomiting so I refeed." Infants with pyloric stenosis are always hungry and often appear malnourished.
The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."
3. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." In most cases of intussusception in young children, an enema is successful in reducing the intussusception.
Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply. 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed.
4,5 4.Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down. Burping the infant frequently may help decrease spitting up by expelling air from the stomach more often.
The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child 1/2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."
4. "Give your child 1/2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave." Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO to allow the stomach to rest and then restart fluids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.
The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."
4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."
The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports.
1,2,3,4 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation.
The nurse receives a call from the mother of a 6-month-old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. 1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." 2. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." 3. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." 4. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."
1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.
Which manifestation would the nurse expect to see in a 4-week-old infant with biliary atresia? 1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine. 2. Abdominal distention, multiple bruises, bloody stools, and hematuria. 3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times. 4. No manifestations until the disease has progressed to the advanced stage.
1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the absence of bile pigments. The urine is tea-colored due to the excretion of bile salts.
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.
1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention.
The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right lower lobe. Which action is most appropriate? 1. Teach the child how to use an incentive spirometer. 2. Encourage the child to blow bubbles. 3. Obtain an order for intravenous antibiotics. 4. Obtain an order for Tylenol (acetaminophen).
2. Encourage the child to blow bubbles. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.
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. Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube(NGT) to low wall suction. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.
Which discharge instruction for a child diagnosed with encopresis should the nurse question? 1. Limit the intake of milk. 2. Offer a diet high in protein. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist.
2. Offer a diet high in protein. A diet high in protein will cause more constipation.
Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.
3. Obtain stool sample and prepare child for jejunal biopsy. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.
A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate? 1. Natural supplements and herbs. 2. Stimulant laxative. 3. Osmotic agent. 4. Pharmacological measures are not used in pediatric constipation.
3. Osmotic agent. A stool softener is the drug of choice because it will lead to easier evacuation.
The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.
3. Supine. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.
Which is the best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.
3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain.
The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."
4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved." The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.
The nurse is to receive a 4-year-old from the recovery room after an appendectomy. The parents have not seen the child since surgery and ask what to expect. Select the nurse's best response. 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4. "Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."
4. "Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously." In the immediate post-operative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.
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. Cheese, banana slices, rice cakes, and whole milk.
The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.
4. Prepare to get the infant ready for immediate surgical correction. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.
The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."
1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well."
21. 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. Immediately notify the physician of the child's status. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.
The nurse is caring for an infant who has been diagnosed with short bowel syndrome(SBS). The parent asks how the disease will affect the child. Select the nurse's best response. 1. "Because your child has a shorter intestine than most, your child will likely experience constipation and will need to be placed on a bowel regimen." 2. "Because your child has a shorter intestine than most, he will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in other ways." 3. "Unfortunately, most children with this diagnosis do not do very well." 4. "The prognosis and course of the disease have changed because hyperalimentation is available."
2. "Because your child has a shorter intestine than most, he will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in other ways."
Which child can be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 3. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output. 4. A 10-year-old who has just returned from a Scout camping trip and has had several episodes of diarrhea.
2. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. It is common for children to have a relapse of diarrhea after resuming a regular diet.
The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."
3. "Encourage your child to drink more fluids." Increasing fluid consumption helps to decrease the hardness of the stool.
The nurse is caring for a 3-month-old infant who has short bowel syndrome (SBS)and has been receiving total parenteral nutrition (TPN). The parents ask if their child will ever be able to eat. Select the nurse's best response. 1. "Children with SBS are never able to eat and must receive all of their nutrition in intravenous form." 2. "You will have to start feeding your child because children cannot be on TPN longer than 6 months." 3. "We will start feeding your child soon so that the bowel continues to receive stimulation." 4. "Your child will start receiving tube feedings soon but will never be able to eat by mouth."
3. "We will start feeding your child soon so that the bowel continues to receive stimulation." It is important to begin feedings as soon as the bowel is healed so that it receives stimulation and does not atrophy.
The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive Zantac (rantadine). Based on the medication's mechanism of action, when should this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.
3. 30 minutes before the feeding. Zantac decreases gastric acid secretion and should be administered 30 minutes before a feeding.
The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.
3. Immediately obtain all vital signs with a quick head-to-toe assessment. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.
A nurse working at a children's hospital receives report on four patients who were just admitted to the unit within the past hour. Which nurse should the nurse assess first? 1) A 9-month-old infant who has been vomiting for the past 12 hours who has a fever of 100.3. 2) A 4-month-old who is resting quietly right now with reports of jelly-like stools and severe pain for the past 6 hours. 3) A 2-year-old who with a fractured femur who was medicated 30 minutes ago for pain. 4) A 3-month-old who has passed runny stools frequently overnight with sunken anterior and posterior fontanelles.
Answer: 2) Jelly-like stools and severe pain indicate intussusception, and this is a medical emergency. Afterwards, the nurse should assess the child with sunken fontanelles, as this indicates severe dehydration.
A group of student nurses are reviewing nursing diagnoses for cleft lip and cleft palate. The students recognize which of the following as priority nursing diagnosis for children with cleft lip and cleft palate? 1) Ineffective bonding related to inability to maintain effective mother-child feeding habits 2) Altered nutrition: less than body requirements related to excessive feeding time and child fatigue 3) Risk for altered self perception related to nasal quality of speech and delays in speech development 4) Risk for infection related to build-up of fluid in the middle ear and chronic otitis media
Answer: 2) Our biggest concerns in a child with cleft lip and cleft palate are nutrition (including the risk for aspiration/choking) and bonding. However, nutrition trumps bonding.
You are taking care of an infant who has come back from having cleft lip and palate repair. The nurse would include all of the following in the plan of care except: A) Use of pacifier to prevent vigorous crying B) Holding, cuddling and rocking of infant C) Arm restraints or mummy restraint D) Placing infant in the supine position
Answer: A. It would be important to protect the palate operative site by avoiding putting items in the mouth that might disrupt the sutures such as suction catheters, spoons, straws, pacifiers, or plastic syringes. It would be important to keep the infant from rubbing the surgical sight. To prevent this the infant will be placed in the supine or side-lying position and arm restraints are often used. Holding, cuddling and rocking the infant can help soothe and comfort the infant after surgery.
The nurse is caring for the child with cleft lip and palate. Which of the following does the nurse understand as a complication of this disorder? Select all that apply: A) Heart malformation B) Otitis media C) Altered dentation D) Speech impediments E) Encopresis
Answer: B, C, and D. These are complications that can occur with cleft lip and palate. Others include feeding difficulties, aspiration, and hearing loss (related to ear infections).
Which of the following assessment findings would the nurse most expect to find in the child who has been diagnosed with having hypertrophic pyloric stenosis? A) Currant jelly stools and a palpable, hard mass in the right upper quadrant B) Projectile vomiting and hunger soon afterwards C) Weight loss and bloody diarrhea D) Severe, crampy abdominal pain and lethargy
Answer: B. Pyloric stenosis is where the pylorus becomes edematous and large blocking the entrance out of the stomach. Projectile (forceful vomiting) and hunger afterwards would be expected in pyloric stenosis, as all nutrition is being blocked from heading into the small intestine. Other symptoms include a palpable mass in the right upper quadrant, weight loss, dehydration, and lethargy. Currant jelly stools and diarrhea would not be expected with this disorder because of the blockage created.
A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now, the infant appears fine. Which of the following GI disorders does the nurse suspect? A) Hypertrophic pyloric stenosis B) Celiac disease C) Intussusception D) Encopresis
Answer: C. Intussusception is when a proximal portion of the bowel "telescopes" into a more distal portion. This produces sudden onset, crampy abdominal pain accompanied by currant jelly stools, vomiting, crying/knee drawing up, and lethargy. This disorder is episodic and often the bowel will suddenly reduce down temporarily eliminating symptoms.
When planning care for the infant diagnosed with cleft lip and palate, which action would the nurse take in relation to the priority nursing diagnosis for this child? A) Prevent the baby from vigorously crying B) Burp the baby well throughout feedings C) Temporarily refrain from having the baby breastfeed D) Encourage mother to use false palate covering when feeding baby
Answer: D. A false palate covering will help prevent the baby from aspirating while breastfeeding by providing a covering for the cleft palate. Adaptive nipples can also be used for this purpose. Burping the baby would be important to include in the plan of care, but would not be for the priority nursing diagnosis of risk for aspiration. It would not be necessary to have the baby refrain from breastfeeding. Preventing the baby from vigorously crying would be important postoperatively to prevent sutures from ripping.
