Chapter 20: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder - ML3

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? "Offer 'magic mouthwash' followed by a popsicle." "Encourage him to have some soda." "Offer him some orange juice." "Try some Anbesol or Kank-A."

"Offer 'magic mouthwash' followed by a popsicle."

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease? "The soup we eat at our house is all made from scratch." "She loves hot dogs, and we always cut hers up into small pieces." "I have learned to make my own bread with no gluten." "Even though milk and pudding are good for her, we don't give her those foods."

"She loves hot dogs, and we always cut hers up into small pieces."

The nurse is caring for a child following surgery due to a motor vehicle accident. The child suffered extensive damage to the small intestine resulting in short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." Which is the best response by the nurse? "I know it must be difficult for you to wrap your heads around this situation but there was nothing you could have done to prevent this from happening." "I cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments." "There are so many new treatments available every day. There may be something to correct this in the near future." "Having a chronic condition is difficult but you have to be strong for your child. You are your child's main support and will be needed."

"I cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments."

The nurse is providing discharge teaching regarding oral fluid rehydration to a mother who brought her child to the clinic because of vomiting over the past 2 days. The child is mildly dehydrated. Which comments by the mother indicated learning occurred? "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." "My child can drink milk if he feels like it to help in rehydration." "Oral rehydration solutions (ORS) are good sources of fluids for rehydration." "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "Solutions like Pedialyte are not necessary for mild dehydration."

"Oral rehydration solutions (ORS) are good sources of fluids for rehydration." "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting."

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? Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease Short bowel syndrome (SBS)

Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

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? Preparing family for home care Promoting comfort Maintaining skin integrity Improving hydration

Improving hydration Explanation: Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? GI tract obstruction intussusception gastroesophageal reflux acute upper GI bleeding

acute upper GI bleeding Explanation: Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: gastroesophageal reflux disease. cystic fibrosis. Hirschsprung disease. inflammatory bowel disease.

gastroesophageal reflux disease. Explanation: Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

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. Drink cool fluids to reduce the temperature. Use a heating pad to decrease the abdominal discomfort. Place an ice pack over the place of the discomfort.

Do not rub or put pressure on the abdomen. Explanation: The nurse would instruct the child/parent to not rub or put pressure on the abdomen as palpating an inflamed appendix may cause it to rupture. A child with appendicitis will be NPO for surgery and therefore not instructed to drink. Heat to the abdomen may also cause the inflamed appendix to rupture. Ice is not an effective intervention.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? Only occurs with feeding Is projected 1 ft away from infant Is curdled and extremely sour smelling Continues until stomach is empty

Only occurs with feeding

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? Refusal to eat Vomiting about 2 hours after feeding Chronic diarrhea Vomiting immediately after feeding

Vomiting immediately after feeding

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? "The surgery is performed to create an opening between the esophagus and the neck." "The surgery creates an opening between the stomach and abdominal wall." "The surgery will create an opening to the small intestine." "The surgery will create an opening to the large intestine."

"The surgery creates an opening between the stomach and abdominal wall."

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Ham and cheese sandwich, orange slices, chips, and whole milk Whole wheat pasta, meatballs, carrot sticks, apple, and water Baked salmon, potato slices, vanilla ice cream, and apple juice Meatloaf, green beans, peanut butter cookie, and fat-free milk

Baked salmon, potato slices, vanilla ice cream, and apple juice

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Appendicitis Pancreatitis Gastroenteritis Hirschsprung disease

Gastroenteritis

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? A partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.

In this disorder the sphincter that leads into the stomach is relaxed.

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? Listening for bowel sounds Observing the abdominal skin Determining the infant's ability to suck on a pacifier Turning the infant every 4 hours

Listening for bowel sounds

he nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis? Prolonged bleeding Chronic cough Persistent constipation Irregular breathing

Persistent constipation

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Prepare the infant for surgery. Medicate the infant with analgesics. Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant.

Prepare the infant for surgery. Explanation: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Explosive diarrhea Projectile vomiting Severe abdominal pain Frequent urination

Projectile vomiting

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Pale and slightly dry mucosa Blood pressure of 80/42 mm Hg Tenting of skin Soft and flat fontanels (fontanelles)

Tenting of skin

The nurse is caring for a newborn following delivery who has been diagnosed with gastroschisis. Which action(s) by the nurse indicates knowledge of appropriate care for this disorder? Select all that apply. The nurse assesses the color of the newborn's abdominal organs. The nurse covers the abdominal contents with a nonadherent clean dressing to prevent infection. The nurse places the newborn in a radiant warmer to maintain the newborn's temperature. The nurse notifies the parents that surgical repair will be done when the newborn reaches 1 month of age. The nurse closely monitors the hydration status of the newborn for signs of dehydration.

The nurse assesses the color of the newborn's abdominal organs. The nurse places the newborn in a radiant warmer to maintain the newborn's temperature. The nurse closely monitors the hydration status of the newborn for signs of dehydration.

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." "Most children with celiac disease are diagnosed within the first year of life." "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 entire family will need to eat a gluten-free diet."

The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders."

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. applesauce bananas skim milk rye bread wheat bread

applesauce bananas skim milk

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 omphalocele gastroschisis hiatal hernia

esophageal atresia

The nurse recommends rotavirus vaccine for which group of clients? neonates infants toddlers preschoolers

infants

A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? Select all that apply. steatorrhea constipation diarrhea failure to thrive sunken abdomen polycythemia

steatorrhea constipation diarrhea failure to thrive

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: steatorrhea. severe diarrhea. currant jelly stools. projectile stools.

steatorrhea. (fatty stool)

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." "Gather all of your supplies before you begin." "You may need adhesive remover to ease pouch removal." "You must be meticulous in caring for the surrounding skin."

"Call the doctor immediately if the stoma is not pink/red and moist."

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

A 9-year-old child has undergone a temporary colostomy in the ascending colon several days ago. The nurse has just completed discharge teaching to the child and the parents. Which statements by the child or parents warrants additional instruction from the nurse? Select all that apply. "It is important to change the pouch and skin appliance every other day to decrease the risk of problems with the skin." "I know the location of the colostomy may cause stool to be of somewhat liquid consistency so the appliance will need to be emptied frequently." "This is probably going to be very difficult for our child with returning to school because of the care of the appliance and pouching system." "We will need to use an antimicrobial soap to cleanse the area around the stoma in order to prevent any skin infection." "We should let the doctor know right away if the stoma becomes pale."

"It is important to change the pouch and skin appliance every other day to decrease the risk of problems with the skin." "We will need to use an antimicrobial soap to cleanse the area around the stoma in order to prevent any skin infection."

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? Upper left Upper right Lower left Lower right

Lower right

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

The nurse is preparing to perform ostomy care on a pediatric client. The nurse has explained the procedure to the child and caregiver. Place the remaining steps of the procedure in the order the nurse will complete them. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Obtain and set up equipment. 2Remove the old pouch. 3Assess the stoma and surrounding skin. 4Clean the stoma and skin as needed, allowing it to dry thoroughly. 5Measure the stoma. 6Mark the new pouch backing, and cut the new backing to size. 7Apply the new pouch.

Obtain and set up equipment. Remove the old pouch. Assess the stoma and surrounding skin. Clean the stoma and skin as needed, allowing it to dry thoroughly. Measure the stoma. Mark the new pouch backing, and cut the new backing to size. Apply the new pouch

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick 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 Prevention of T-cell rejection of the transplanted liver Maintenance of electrolyte balance Reduction of hypertension

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 offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? pyloric stenosis peptic ulcer disease gastroesophageal reflux appendicitis

pyloric stenosis Explanation: With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.