Peds-GI
A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition?
"Does the vomit contain sour undigested food without bile, and is the infant constipated?"
The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which question to the mother will most specifically elicit information regarding this disorder?
"Does your infant have foul-smelling, ribbon-like stools?"
A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful?
"Special cells are not present in the rectum, which caused the disease." Hirschsprung's disease also is known as congenital aganglionosis or megacolon. It results from the absence of ganglion cells in the rectum
parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder?
Appendicitis Clinical manifestations of Hirschsprung's disease include constipation, abdominal distention, and ribbon-like, foul-smelling stools.
The mother of an 18-month-old child tells the clinic nurse that the child has been having some mild diarrhea and describes the child's stools as "mushy." The mother tells the nurse that the child is tolerating fluids and solid foods. The most appropriate suggestion regarding the child's diet would be to give the child which items?
Applesauce, strained bananas, and strained carrots The ABCs (applesauce, strained bananas, and strained carrots), rice, potatoes, and other bland foods without dairy products are advised. dairy products and foods that irritate the gastrointestinal tract should be avoided
The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant?
Blood pH of 7.50 The normal pH is 7.35 to 7.45. Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis due to vomiting
An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child?
Change the formula to predigested formula and feed small, frequent feedings. For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula. After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed.
The parents of a child with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond?
Cleft-lip repair is usually performed during the first weeks of life.
A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the health care provider to prescribe?
Consume oral rehydration fluid, advancing to a regular diet.
During a home care visit, an older client complains of chronic constipation. What should the nurse tell the client to do?
Increase fluid intake to at least eight glasses a day and increase dietary fiber. Increase of fluid intake and dietary fiber will help change the consistency of the stool, making it easier to pass.
An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time?
Left lateral position
A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?
Metabolic alkalosis Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting
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?
Metabolic alkalosis metabolic alkalosis results from vomiting pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder.
An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems to never get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child?
Prepare the family for surgery for the child. Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.
The nurse is developing a plan of care for an infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, which position should the nurse suggest to document in the plan of care?
Prone with the head of the bed elevated
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?
Thicken the feedings by adding rice cereal to the formula.
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?
Thicken the feedings by adding rice cereal to the formula. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Frequent feedings* small more frequent feedings*
A nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescription(s) that the nurse anticipates will be prescribed. Select all that apply.
Initiate an IV line. Maintain an NPO status. Administer intravenous antibiotics. Administer preoperative medications.
A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 pounds 2 ounces. The parents state that his preadmission weight was 18 pounds 4 ounces. Based on weight alone, what type of dehydration does the nurse expect?
Moderate dehydration Mild dehydration is a weight loss of 3% to 5%; moderate dehydration is 6% to 10%; severe dehydration is greater than 10% weight loss. All types of dehydration are acute situations
A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively?
Placing the adolescent in a fetal position, side-lying with legs drawn up to chest. A client with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area.
Which interventions should the nurse include when preparing a care plan for a child with hepatitis? Select all that apply.
Providing a low-fat, well-balanced diet. Teaching the child effective hand-washing techniques. Instructing the parents to avoid administering medications unless prescribed. Because the infection can be transmitted to others, playing with other children in the playroom is not an appropriate intervention. Since jaundice is an expected finding, notifying the HCP is unnecessary. Planning for an indefinite period of home schooling is not necessary.
A nurse is assessing a child with a diagnosis of suspected appendicitis. In assessing the intensity and progression of the pain, the nurse palpates the child at McBurney's point. In performing this assessment, the nurse understands that McBurney's point is located midway between which area?
Right anterior superior iliac crest and umbilicus
The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms?
Projectile vomiting clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration including a decrease in urine output.
The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant?
Foul-smelling ribbon-like stools Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations. chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like, foul-smelling stools is a clinical manifestation of this disorder.
