Chapter 42: Ricci - Children with Alteration in Bowel Elimination/GI Disorders

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Enzymes in amniotic fluid can cause the development of esophageal atresia." "Babies with esophageal atresia produce an excessive amount of amniotic fluid." "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." Explanation: Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.

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? "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." "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." "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." Explanation: An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? "My son could have some appearance-related self-esteem issues." "I need to watch for pain, tenderness, or redness." "An incarcerated hernia is rare, but it can occur." "I can tape a quarter over the hernia to reduce it."

"I can tape a quarter over the hernia to reduce it." Explanation: The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, which although rare with umbilical hernias, can occur.She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "I have a lot of diarrhea every day because of how my small intestine is damaged." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have to be careful because I am prone to not absorbing nutrients." "It's unusual for someone my age to get Crohn disease."

"I have to be careful because I am prone to not absorbing nutrients." Explanation: Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease affecting the intestine(s) in a continuous pattern.

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? "He should retain the solution for 5 to 10 minutes." "He will require 250 to 500 mL of enema solution." "I should wash my hands and then wear gloves." "I should position him on his abdomen with knees bent."

"I should position him on his abdomen with knees bent." Explanation: A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will make sure to clean all of her toys before I give them to her." "I will add the nystatin to her bottle four times per day." "I will use a cotton tipped applicator to apply the medication to her mouth." "I will watch for diaper rash."

"I will add the nystatin to her bottle four times per day." Explanation: Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will teach her mother to give her small drinks frequently." "I will weigh her every morning at the same time." "I will monitor her IV line to help maintain her fluid volume." "I will make sure there is plenty of orange juice available. It's her favorite juice."

"I will make sure there is plenty of orange juice available. It's her favorite juice." Explanation: Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? "Do not worry; you are just feeding your infant too much." "Infants this age commonly spit up." "Thicken the formula by adding oat cereal." "Your child might have an allergy."

"Infants this age commonly spit up." Explanation: In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed. Therefore, infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. Adding oat cereal to the infant formula should only be done when medically indicated and under the recommendation of a health care provider. The parent's report is not a cause for concern, so the health care provider does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the parent not to worry does not address the parent's concern, and telling the parent that he or she is feeding the child too much implies that he or she is doing something wrong.

The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? "Have you tried using a toothbrush to get it off?" "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it."

"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Explanation: Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "There are many types of flour besides wheat." "There is gluten hidden in unexpected foods." "My daughter is eating more vegetables." "My daughter can eat any kind of fruit."

"My daughter can eat any kind of fruit." Explanation: While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.

The nurse is caring for an infant. The infant's mother asks the nurse, "What did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? "Regurgitation is when an infant can't tolerate their formula. You will need to switch." "Regurgitation is just another term for vomiting. All infants vomit some." "Regurgitation is not normal in infants. She will need more testing to see what is causing this." "Regurgitation is the backflow of stomach contents up into the esophagus or mouth."

"Regurgitation is the backflow of stomach contents up into the esophagus or mouth." Explanation: Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age.

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "The health care provider will remove about half of the herniated contents during the procedure."

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." Explanation: A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.

The nurse is caring for a newborn diagnosed with imperforate anus following delivery. The physician has discussed the treatment options and prognosis with the parents. The nurse is talking with the parents and determines that learning has occurred when the parents make which statement? "We know we will need to use baby wipes around the anal area after surgery to prevent infection." "We are worried that our child may have other congenital problems that we aren't aware of." "We aren't sure if our baby will need surgery at some point for this problem." "Since our baby has a defect high in the anorectal opening there is a good chance that stool continence won't be a problem."

"We are worried that our child may have other congenital problems that we aren't aware of." Explanation: Imperforate anus is a congenital malformation of the anorectal opening. Other congenital anomalies may be associated with imperforate anus in 50% of cases. Surgical intervention is needed for both high and low types of imperforate anus. After repair, only about 30% with a high defect will achieve continence. To decrease the drying associated with frequent cleaning, avoid baby wipes and frequent use of soap and water.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "We might notice some of the medication in her stool." "This drug helps to control the abdominal cramping." "We should not stop this medication abruptly." "She might lose some weight initially."

"We should not stop this medication abruptly." Explanation: Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "You will most likely have viral studies." "You will most likely have a blood test to check for certain antibodies." "You will most likely have an ultrasound evaluation." "You will most likely be tested for ammonia levels."

"You will most likely have a blood test to check for certain antibodies."

Which client most likely has ulcerative colitis rather than Crohn disease? 12-year-old with oral temperature of 101.6° F (38.7° C) 14-year-old female with full-thickness chronic inflammation of the intestinal mucosa 18-year-old male with abdominal pain 16-year-old female with continuous distribution of disease in the colon, distal to proximal

16-year-old female with continuous distribution of disease in the colon, distal to proximal Explanation: Ulcerative colitis is usually continuous through the colon while the distribution of Crohn disease is segmental. Crohn disease affects the full thickness of the intestine while ulcerative colitis is more superficial. Both conditions share age at onset of 10 to 20 years, with abdominal pain and fever in 40% to 50% of cases.

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

Baked salmon, potato slices, vanilla ice cream, and apple juice Explanation: Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Surgery Endoscopic retrograde cholangiopancreatography Upper endoscopy Barium enema

Barium enema Explanation: A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

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 must be meticulous in caring for the surrounding skin." "You may need adhesive remover to ease pouch removal."

Call the doctor immediately if the stoma is not pink/red and moist." Explanation: A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

A parent brings the 2-week-old infant to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. If breastfeeding, switch to feeding the infant formula. Consult a pediatric surgeon regarding having a myotomy procedure performed. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. Feed the infant while holding the infant in an upright position. Feed the infant a formula thickened with rice cereal.

Feed the infant a formula thickened with rice cereal. Feed the infant while holding the infant in an upright position. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. The traditional treatment of gastroesophageal reflux in the infant is to feed a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding the infant in an upright position and then keeping the infant upright by holding them and/or elevating the head of the crib 30 degrees for 30 to 45 minutes after feeding so gravity can help prevent reflux. There is no need for the parent to switch from breastfeeding to formula-feeding. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the infant in a more upright position during and following feeding; these procedures would not be appropriate at this point.

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? Pancreatitis Appendicitis Gastroenteritis Hirschsprung disease

Gastroenteritis Explanation: Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

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

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

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 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Short-bowel/short-gut syndrome Volvulus with malrotation Intussusception Necrotizing enterocolitis

Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.

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 right Upper left Lower left Lower right

Lower right Explanation: With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant is referred to as the McBurney point, an area of tenderness 1.5 to 2 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? Wrapping an elastic band around the child's waist should correct the problem. Surgery at age 1 to 2 years will likely be needed to repair the condition. Taping a silver dollar over the area will help reduce the hernia. No intervention is needed, as the opening will most likely close spontaneously.

No intervention is needed, as the opening will most likely close spontaneously. Explanation: An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.

The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question? serum amylase levels NPO nasogastric tube placed to suction PO pain management

PO pain management Explanation: Maintain NPO status and nasogastric tube suction and patency. Administer intravenous fluids to keep the child hydrated and correct any alterations in fluid and electrolyte balance. Pain management is crucial in children with pancreatitis; due to NPO status, medications are typically prescribed intravenously. Serial monitoring of serum amylase levels will determine when oral feeding may be restarted.

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

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 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. A nasogastric (NG) tube is inserted for gastric decompression in an infant with 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? Projectile vomiting Severe abdominal pain Frequent urination Explosive diarrhea

Projectile vomiting Explanation: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue? Some patches are light in color and other patches are dark in color. There are also white patches on the erupted teeth. The patches are thick, white plaques on the tongue. There are also plaques on the buccal mucosa.

Some patches are light in color and other patches are dark in color. Explanation: A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Oral candidiasis (thrush) is characterized by thick, white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the infant may have by that age.

An adolescent has hepatitis B. What would be the most important nursing action? Conscientious collection of stool for ova and parasites Strict enforcement of standard precautions Strict calculation of caloric and vitamin B intake Close observation to detect cerebral hallucinations

Strict enforcement of standard precautions Explanation: Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions. Using standard precautions of gloves and good handwashing will help prevent spread of the disease. Ova and parasites are not present with hepatitis B. A good diet with adequate protein and vitamins will help the body heal, so these should not be restricted. The nurse observes for mental status changes. These can occur as a complication, but preventing spread of the disease is the nursing priority.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Take a stool culture Administer antibiotic therapy Administer IV potassium Feed the child a cracker

Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.

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

Tenting of skin Explanation: Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? The adolescent will be very irritable and perhaps require sedation. Hypothermia is common. The adolescent will become fatigued easily. The adolescent's urine will be dark and infectious.

The adolescent will become fatigued easily. Explanation: Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "The only treatment for celiac disease is a strict gluten-free diet." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "Most children with celiac disease are diagnosed within the first year of life." "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." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "Gluten is found in most wheat products, rye, barley and possibly oats." Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.

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? Vomiting immediately after feeding Vomiting about 2 hours after feeding Chronic diarrhea Refusal to eat

Vomiting immediately after feeding With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.

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 gastroesophageal reflux acute upper GI bleeding intussusception

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.

he 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. rye bread skim milk wheat bread bananas applesauce

applesauce bananas skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? evaluate gastric pH detect Helicobacter pylori confirm pancreatitis determine esophageal contractility

detect Helicobacter pylori Explanation: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? pyloric stenosis esophageal atresia (EA) cleft palate hernia

esophageal atresia (EA) Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

A nurse examining a neonate is unable to identify the fetal stomach. The nurse knows that this sign strongly indicates which condition? esophageal atresia (EA) hernia pyloric stenosis duodenal atresia

esophageal atresia (EA) Explanation: Inability to identify the fetal stomach strongly suggests EA. The upper abdomen is typically distended in pyloric stenosis and duodenal atresia. Hernias typically present as a bulge in the groin area.

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child? no joint swelling clear lung sounds report of a headache fever

fever Explanation: Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection. The progression of the disease will be reported to the health care provider. A headache may accompany the fever and is a sign of generally not feeling well. It does not indicate progression of the disease, thus does not need to be reported. Clear lung sounds and no swollen joints are good signs, but they are not associated with Crohn disease.

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: cystic fibrosis. Hirschsprung disease. gastroesophageal reflux 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.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? hard, moveable "olive-like mass" in the upper right quadrant perianal fissures and skin tags sausage-shaped mass in the upper mid abdomen abdominal pain and irritability

hard, moveable "olive-like mass" in the upper right quadrant Explanation: A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? umbilical hernia hiatal hernia diaphragmatic hernia inguinal hernia

inguinal hernia Explanation: An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? mother age 42 with pregnancy maternal use of acetaminophen in third trimester history of hypoxia at birth preterm birth

mother age 42 with pregnancy Explanation: Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply. followed by dry retching timing unrelated to feeding forceful expulsion of stomach contents no appearance of distress occurs with feeding

occurs with feeding no appearance of distress Regurgitation occurs with feeding; the infant does not exhibit signs of distress. Forceful expulsion of stomach contents that is followed by dry retching unrelated to feeding are characteristics of vomiting.

A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has: risk for fluid volume deficit. severe dehydration. malabsorption syndrome. failure to thrive.

severe dehydration. Explanation: A loss of more than 10% of body weight in a day is a sign of severe dehydration. Failure to thrive and malabsorption syndrome are long-term conditions, not objectively defined by a 24-hour weight change. This child is no longer at risk for a fluid volume deficit but is showing signs of dehydration.

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: projectile stools. steatorrhea. currant jelly stools. severe diarrhea.

steatorrhea. Explanation: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.

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: severe diarrhea. steatorrhea. projectile stools. currant jelly stools.

steatorrhea. Explanation: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.