PEDS GI
The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day?
1,600 mL Explanation: Using the following formula of 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, and then 20 mL/kg for the remaining kg, the child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.
Which statement best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. There is a passage of an excessive amount of meconium in the neonate. C. It results in excessive peristaltic movements within the gastrointestinal tract. D. It results in frequent evacuation of solids, liquids, and gas.
A. The colon has an aganglionic segment.
Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)? A. Deficient fluid volume B. Risk for aspiration C. Imbalanced nutrition: less than body requirements D. Impaired oral mucous membrane
D. Impaired oral mucous membrane
The pH of blood is normally slightly acidic, ranging from 6.85 to 6.95.
False Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45.
A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect?
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 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease
ANS: C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.
3. An 11-year-old girl with celiac disease was discharged from the hospital. An appropriate teaching was carried out by the nurse if the parents are aware of avoiding which of the following? A. Chicken B. Wheat C. Milk D. Rice
B: Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. A,C,D: Rice, milk, and chicken do not contain gluten and need not be avoided.
Your patient has projectile vomiting 30-60 minutes after feedings and is dehydrated. What condition do you suspect? A. Anorectal malformation B. Intussusception C. Pyloric stenosis D. Rectal stenosis
C
What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation
C. Coping with stress and adjusting to chronic illness
A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which findings would indicate to the nurse that the infant is experiencing severe dehydration? Select all that apply.
Sunken fontanels Bradycardia Cool mottled extremities
Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He 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. Explanation: The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.
The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown?
Apply a barrier/healing cream or paste on the skin. Explanation: The nurse should use a barrier/healing cream or paste on the skin around the stoma to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. The barrier wafer would be helpful, but does not address the skin breakdown.
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with Kwashiorkor. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of Kwashiorkor?
"It is important to increase the intake of protein for these children." Explanation: Kwashiorkor results from severe deficiency of protein with an adequate caloric intake. It accounts for most of the malnutrition in the world's children today. The highest incidence is in children 4 months to 5 years of age. Although strenuous efforts are being made around the world to prevent this condition, its causes are complex.
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. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction
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. 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. This accurate description gives the parents information that is clear and concise
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. 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.
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. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.
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. Zantac decreases gastric acid secretion and should be administered 30 minutes before a feeding.
The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passed a normal brown stool. What is the most appropriate nursing action? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.
A. Notify the physician.
Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.
A. Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature.
A parent of a child who is diagnosed with Crohn's Disease asks why her child can't have popcorn. What is your best response? A. Your child can have popcorn except when there is a flare-up of the disease. Limit fiber such as popcorn during a flare-up to reduce aggravating the intestine B. Popcorn can cause appendicitis C. Popcorn causes Crohn's Disease D. Popcorn can lead to perforation of the intestine
A. Your child can have popcorn except when there is a flare-up of the disease. Limit fiber such as popcorn during a flare-up to reduce aggravating the intestine
The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Pain is common. b. Weight loss is severe. c. Rectal bleeding is common. d. Diarrhea is moderate to severe. e. Anal and perianal lesions are rare.
ANS: A, B, D Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.
The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems
ANS: A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.
One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation
ANS: B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.
Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements
ANS: B The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended
The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain
ANS: B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.
A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.
ANS: C Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.
A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis
ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.
What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d.Intussusception
ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.
11. Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. In an infant seat B. In the supine position C. In the prone position D. On his side
C: Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A: Using an infant seat does not facilitate drainage. B: If the child is placed int he supine position, aspiration is a concern. D: Side-lying does not facilitate drainage as well as the prone position.
The 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?
Persistent constipation Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.
The nurse is doing teaching with the caregivers of toddler and preschool age children. One of the caregivers tells the group that her child had diarrhea and she was told that it was caused by giardiasis. Which of the following statements made by the caregiver indicates the most likely situation in which the child contacted the disorder?
"He attends a day care center four days a week while I am at work." Explanation: Giardiasis is caused by the protozoan parasite Giardia lamblia. It is a common cause of diarrhea and is prevalent in children who attend day care centers and other types of residential facilities; it may be found in contaminated mountain streams or pools frequented by diapered infants. Bubble baths can lead to urinary tract infections, but are not the cause of Giardiasis infestations.
Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea
B. Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools.
6. Will is being assessed by Nurse Lucas for possible intussusception; which of the following would be least likely to provide valuable information? A. Abdominal palpation B. Family history C. Pain pattern D. Stool inspection
B: Because intussusception is not believed to have familial tendency, obtaining a family history would provide the least amount of information. A,C,D: Stool inspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. "Currant jelly" stools, containing blood and mucus, are an indication of intussusception. Acute, episodic abdominal pain is characteristic of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant. Question 7 WRONG
1. Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)
B: For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. A: Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung's disease. C: The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. D: Hirschsprung's disease typically presents with chronic constipation.
9. Baby Ellie is diagnosed with gastroesophageal reflux (GER); which of the following nursing diagnoses would be inappropriate? A. Risk for aspiration B. Impaired oral mucous membrane C. Deficient fluid volume D. Imbalanced nutrition: Less than body requirements
B: GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower-esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder. A,C,D: Fluid volume deficit, risk for aspiration, and imbalanced nutrition are appropriate nursing diagnoses.
8. Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageL REFLUX (GER)? A. Urine B. Vomiting C. Weight D. Stools
B: Thickened feedings are used with GERto stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. A,D: No relationship exists between feedings and characteristics of stools and urine. C: If feedings are ineffective, this should be noted before there is any change in the child's weight.
15. Nurse Lonnie is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention
B: Ulcerative colitis causes profuse diarrhea. A,C,D: Intense abdominal cramps, anal fissures, and abdominal distensions are more common in Crohn's disease.
13. In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is TRUE? Select all that apply. A. It is a cartilaginous tube. B. It has upper and lower sphincters. C. It lies anterior to the trachea. D. It extends from the nasal cavity to the stomach. E. All statements describe the esophagus.
B: Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus. A: The esophagus is a muscular tube, lined with moist stratified squamous epithelium. C: It lies anterior to the vertebrae and posterior to the trachea within the mediastinum. D: It extends from the pharynx to the stomach. It is about 25 centimeters (cm) long.
5. Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? A. GI function B. Locomotion C. Sucking ability D. Respiratory status
C: Because of the defect, the child will be unable to form mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. A: GI functioning is not compromised in the child with a CL. B: Locomotion would be a problem for older infant because of the use of restraints. D: Respiratory status may be compromised if the child is fed improperly during post-operative period.
7. Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect
C: Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. A,B,D: Failure to pass meconium is not connected with celiac disease, intussusception, or abdominal-wall defect.
14. Mrs. Byers tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? A. Make the child seat with the family in the dining room until he finishes his meal B. Provide quiet environment for the child before meals C. Do not give snacks to the child before meals D. Put the child on a chair and feed him
C: If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a "busy toddler." He/she will not able to keep still for a long time.
A child experiences profuse watery diarrhea and is admitted to the pediatric unit with a diagnosis of gastroenteritis and dehydration. Which of these assessment findings would alert the healthcare provider to the presence of compensated shock? A: Hypotension B: Metabolic acidosis C: Narrow pulse pressure D:Pulmonary crackles
C:When a patient loses large amounts of fluids, the body will first attempt to compensate for the decreased circulating volume.
The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality?
Currant jelly-like Explanation: The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.
12. Nurse Joyce is assessing a child's cultural background, she should keep in mind that: A. Cultural background usually has little bearing on a family's health practices B. Physical characteristics mark the child as part of a particular culture C. Heritage dictates a group's shared values D. Behavioral patterns are passed from one generation to the next
D: A family's behavioral patterns and values are passed from one generation to the next. A: Cultural background commonly plays a major role in determining a family's health practices. B: Physical characteristics do not indicate a child's culture. C: Although heritage plays a role in culture, it does not dictate a group's shared values and its effect on culture is weaker than that of behavioral patterns.
10. Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would Nurse Nancy expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea
D: Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. A: Irritability, rather than lethargy, is more likely. B: Because of the fluid loss associated with the severe watery diarrhea, the child's weight is more likely to be decreased. C: Respiratory distress is unlikely in a routine upper respiratory tract infection.
2. Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which of the following? A. "Currant jelly" stools B. Regurgitation C. Steatorrhea D. Projectile vomiting
D: Projectile vomiting is a key sign of pyloric stenosis. B: Regurgitation is seen more commonly with gastroesophageal reflux. C: Steatorrhea occurs in malabsorption disorders such as celiac disease. A: "Currant jelly" stools are characteristic of intussusception.
4. Which of the following applies to the defect emerging from residual peritoneal fluid confined within the lower segment of the processus vaginalis? A. Inguinal hernia B. Incarcerated hernia C. Communicating hydrocele D. Noncommunicating hydrocele
D: With a noncommunicating hydrocele, most commonly seen at birth, residual peritoneal fluid is trapped within lower segment of the processus vaginalis (the tunica vaginalis). There is no communication with the peritoneal cavity and the fluid usually is absorbed during the first months after birth.
You are caring for newborn Jordan who is 1 hour old. You notice when you place a gloved finger in Jordan's mouth, there seems to be a hole in the top of his mouth. What condition do you suspect Jordan has? A. Tracheoesophageal fistula B. Hard palate fistula C. Cleft lip D. Omphalocele E. Cleft palate
E
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?
In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.
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?
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 in. (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.
The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care?
Maintaining the intravenous (IV) fluid rate as ordered Explanation: The nurse should maintain an IV line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, and popsicles should be avoided as they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:
Painless rectal bleeding Explanation: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick 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 Explanation: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by finger stick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine (Apresoline) and nitroprusside may be needed to reduce hypertension.
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 gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?
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 a 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.
The nurse is caring for a 6-month-old infant who was admitted to the emergency room 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 Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the GI 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, and 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 GI tract should be rested until the diarrhea stops.
Which type of nutrition would the nurse expect to administer to a preterm infant who was born at 34 weeks' gestation and has developed necrotizing enterocolitis (NEC)?
Total parenteral nutrition (TPN) Explanation: Total parenteral nutrition (TPN) should be administered to preterm infants with necrotizing enterocolitis. In NEC, there is acute inflammation of the bowel associated with ischemia. This can lead to bowel necrosis and perforation. Preterm infants are at higher risk of developing NEC, due to gastric immaturity and an increased risk of infections. When NEC is detected in the preterm infant, TPN should be administered and enteral feeding should be withheld until the condition stabilizes. Gavage feeding and trophic feeding are different forms of enteral feeding given to preterm infants, but not to those having NEC. Oral breastfeeding should also be withheld in NEC. NEC is treated with IV fluids, antibiotics, blood transfusion and surgical resection of the segment.
A 7-year-old boy has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which of the following blood test results would indicate that the boy is experiencing metabolic acidosis?
pH of 7.25, HCO3 of 20 mEq/L Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45. The level of bicarbonate (HCO3) in arterial blood is normally 22 to 26 mEq/L. Metabolic acidosis results from diarrhea as a great deal of sodium is lost with stool. With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). With metabolic alkalosis, pH will be elevated (near or above 7.45), and HCO3 level will be near or above 28 mEq/L.