Chapter 38: The Child with a Gastrointestinal/Endocrine Disorder
The nurse is instructing new parents on caring for their infant if gastroenteritis symptoms should occur. Which parental statement indicates understanding of appropriate care?
"I should take the baby's temperature and call my health care provider." Explanation: Infants are susceptible to high fevers due to their difficulty with thermoregulation. Coupled with diarrhea, these symptoms are potentially dangerous in an infant because their fluid stores can be exhausted easily
The nurse is caring for a child prescribed vancomycin 15 mg/kg IV every 6 hours for peritonitis. The child weights 45 lb (20.5 kg). How many milligrams will the nurse administer to this child in 24 hours?
1230 Explanation: The nurse will administer 1230 milligrams to this child is 24 hours. To calculate, first determine how many milligrams are given per dose by multiplying the child's weight (kg) by 15 mg. 15 mg x 20.5 kg = 307.5 mg per dose. The child is prescribed a dose every 6 hours. To determine how many doses the child will get in 24 hours, divide 24 by 6. 24/6 = 4. Now, multiply the number of doses given a day by the milligrams given in each dose to determine the total milligrams given in 24 hours. 4 x 307.5 mg = 1230 mg in 24 hours
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
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 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
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. 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
The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents?
Having a wound, ostomy, and continence nurse meet with them. Explanation: Although explaining about the diagnosis and surgery, reinforcing that the ostomy will be temporary, and teaching them about medications would be appropriate, the parents are voicing concerns about caring for the ostomy. Therefore, having a wound, ostomy, and continence nurse meet with them would address these concerns and help them deal with the anxieties and care of a newly placed stoma
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 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 6-month-old infant who has been nutritionally deprived. The infant appears weak and uninterested in eating. Which nursing interventions are most helpful? Select all that apply. Prop the bottle in the crib for accessibility. Use a hard, small-holed nipple. Schedule feedings every 2 to 3 hours. Limit feedings to approximately 20 minutes. Be relaxed when feeding to promote relaxation.
Schedule feedings every 2 to 3 hours. Limit feedings to approximately 20 minutes. Be relaxed when feeding to promote relaxation It is most important to provide a calm, relaxing environment when feeding the infant. Feedings should be a time of human interaction; never prop a bottle. Use a soft, large hole (large enough to allow the formula to drip without pressure) nipple. Hard, small-holed nipples cause frustration and expend excess energy to suck. Feedings are scheduled every 2 to 3 hours lasting 20 to 30 minutes because most babies can handle small feedings better than larger ones.
The nurse is presenting information related to intestinal parasite infections to a group of community health nurses. One member of the group asks the nurse how she might know if a child had a pinworm infestation. The nurse correctly answers this question by stating which of the following?
The primary symptom of pinworms is intense perianal itching. Explanation: Intense perianal itching is the primary symptom of pinworms.
A nurse caring for clients in a free women's health clinic counsels women on infant nutrition and formula preparation. Which of the following is an appropriate guideline for the proper use of infant formula?
Use a soy-based formula for infants with lactase deficiency. Explanation: Soy-based infant formulas use a soy protein instead of cow's milk protein and are designed for infants with lactase deficiency, galactosemia, or allergy to cow's milk protein. The amount of water used to mix the formula may be varied to alter the caloric and nutrient density of infant formulas. Mixing powdered infant formula with oral electrolyte or rehydrating solutions can cause electrolyte imbalance. Normal caloric density of infant formula is 20 calories per ounce
Noah is an 18-month-old boy who is brought to the emergency department with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that this condition is most likely the result of which of the following?
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. In this situation, pneumonia is not associated with cystic fibrosis, Hirschsprung disease, or inflammatory bowel disease
The nurse is educating a family on celiac disease. Which is conclusive and confirms the diagnosis?
biopsy of the intestine through endoscopy showing changes in villi Explanation: All of the options relate to ways of determining if there is a possibility that a client has celiac syndrome. Conclusive diagnosis is made with an endoscopy and biopsy of the intestine
The nurse is advising a group of new parents on how to care for their infant at home if the baby develops mild diarrhea. Which statement indicates that teaching has been effective?
"I should offer Pedialyte after 1 hour and frequently thereafter to prevent dehydration." Explanation: Mild diarrhea is not considered serious and at the end of approximately 1 hour, parents can begin to offer an oral rehydration solution such as Pedialyte in small amounts. Infants may develop a temporary lactase deficiency after diarrhea that leads to lactose intolerance. With this, a child cannot take formula or breast milk without new diarrhea beginning. Parents should alert their health care provider if they feel this is happening as the infant will need to be introduced to a lactose-free formula initially before being returned to the usual formula or to breast milk. An elevated temperature is seen in severe diarrhea. The parents should be cautioned to contact their health care provider prior to initiating over-the-counter drugs such as kaolin and pectin (Kaopectate) to halt diarrhea because toxic levels of these can occur quickly
The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction?
"I will use syrup of ipecac to get it out of my child's system." Explanation: The CDC no longer recommends that the syrup of ipecac be used in the home for treatment of poisoning and, furthermore, recommends that it be disposed of safely. All the other statements are accurate. Depending on the amount of detergent ingested, the parent is instructed to first terminate any exposure and then possibly transport the child to a health care facility
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. 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.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?
Effortless vomiting just after the child has eaten Explanation: The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease
After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider?
Give the child a glass of orange juice. Explanation: The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia
A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system?
Hormonal secretion Explanation: The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health
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?
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
What should be included in the teaching plan for a child with type 1 diabetes who is going home on insulin therapy?
It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. Explanation: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child
A young child has presented to the pediatric unit with a swollen abdomen, edema, thin patchy hair, and irritability with growth retardation and muscle wasting. The nurse suspects a malnutrition disorder. The nurse identifies this child to most likely have which condition?
Kwashiorkor Explanation: The symptoms presented are classic signs of Kwashiorkor due to the protein deficiency
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 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus
A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?
Metformin Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose.
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. Assess the stoma and surrounding skin. Obtain and set up equipment. Remove the old pouch. 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.
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. Explanation: The nurse would first gather the needed equipment to complete the procedure (washcloths, clean pouch and clamp, skin barrier powder, paste, and/or sealant, pen, scissors, and measuring pattern). The nurse would then wash hands and apply gloves. The stoma should now be assessed, then cleaned and allowed to thoroughly air dry. The nurse would then measure the stoma, mark the new backing, and cut the new backing. Last, the new pouch would be applied, gloves removed, hands washed, and any questions answered
Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply.
Polyuria Polydipsia Polyphagia Explanation: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus
Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Abrupt onset of symptoms Marked weight loss Polyuria Polydipsia Polyphagia
Polyuria Polydipsia Polyphagia Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
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
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?
Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route
The nurse is caring for an infant recovering from surgery for pyloric stenosis. Which nursing diagnosis should the nurse use to guide care during the immediate postoperative period?
Risk for infection of incision line, related to disruption of skin barrier during surgery Explanation: Because the incision line for a pyloric stenosis repair is near the diaper area, the child is at risk of developing a surgical infection. The diagnosis risk for infection of incision line is the most appropriate during the immediate postoperative period. Anxiety might be appropriate after the immediate postoperative period has passed. There is not enough information to determine if the infant is being given excessive fluid or if the infant is experiencing ineffective tissue perfusion
The nurse is caring for a school-aged child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2030 National Health Goals to reduce the long-term complications from this disease process?
Schedule the child and parents to attend diabetes education classes. Explanation: Endocrine disorders tend to be long-term with lifetime consequences. Reducing the incidence of consequences or improving care has long-term implications. A 2020 National Health Goal related to endocrine disorders includes increasing the proportion of persons with diabetes who receive formal diabetes education. To support this goal, the nurse should schedule the child and parents to attend diabetes education classes. There are no 2030 National Health Goals to address alteration in physical abilities, homeschooling with type 1 diabetes mellitus, or the need to be admitted to a rehabilitation facility to learn self-care
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 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.
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine. Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?
Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
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 Explanation: 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 nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus
The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention?
administration of adequate vitamin D Explanation: Rickets results from inadequate vitamin D; supplements are necessary. There is no direct need to increase calorie, thiamine or protein intake.
The nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern?
aspiration explanation: The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.
A child has presented to the clinic with diarrhea. The nurse should teach the parent to give which item to properly care for the child?
bananas Explanation: Milk may cause diarrhea to worsen. Only unsalted crackers and soups should be used to prevent further exacerbation of diarrhea. Bananas in small amounts provide nutritive value and do not exacerbate diarrhea
Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to:
care for a temporary colostomy. Explanation: The aganglionic portion of the infant's colon will need to be removed. In most cases, bowel is allowed to rest and recoil for a period of time, necessitating a temporary colostomy. Later the colostomy can be closed and the two ends of the intestine rejoined. Thickening feedings will not relieve the colon distention and obstruction with stool. Pacifiers may be used and are soothing. Monitoring heart rate should not be necessary
The nurse suspects that an infant is experiencing intussusception. What did the nurse assess in this infant? Select all that apply. crying as if in severe pain pulse rate of 78 beats/min and irregular sudden drawing up of the legs stool that looks like currant jelly leg drawing up, and the infant's crying repeats every 15 minutes
crying as if in severe pain sudden drawing up of the legs stool that looks like currant jelly leg drawing up, and the infant's crying repeats every 15 minutes With intussusception, the infant will suddenly draw up the legs and cry as if in severe pain. After the peristaltic wave that caused the discomfort passes, the infant is symptom-free but in approximately 15 minutes the same pattern repeats. After approximately 12 hours, blood can appear in the stool and stool looks like "currant jelly." A slow pulse rate is not typically assessed in an infant with intussusception
A child is diagnosed with gastroesophageal reflux disease and is prescribed drug therapy. The primary health care provider prescribes medication that suppresses acid secretion. The nurse would anticipate administering which drug?
esomeprazole Explanation: Proton pump inhibitors (esomeprazole, lansoprazole) are effective acid-suppressing agents and are superior in relieving symptoms. Antacid preparations and H2 blocking agents (e.g., famotidine, cimetidine) are used to provide symptomatic relief of esophagitis and to reduce the damaging effects of refluxed gastric contents on the esophageal mucosa. Prokinetic agents such as metoclopramide are used to enhance gastric emptying
Which health care provider order is the nurse correct to question if provided for a pediatric client with suspected appendicitis?
provide heat to abdomen Explanation: Due to the diagnosis of suspected appendicitis, the nurse would question an order to provide heat to the abdomen. Heat may cause a rupture of the appendix. All of the other orders are consistent with needed care
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?
recent weight loss Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects
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. 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.