PrepU: Chapter 42: Nursing Care of the Child with an Alteration in Bowel Elimination/GI Disorder
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? A. "Call the doctor immediately if the stoma is not pink/red and moist." B. "You may need adhesive remover to ease pouch removal." C. "You must be meticulous in caring for the surrounding skin." D. "Gather all of your supplies before you begin."
A. "Call the doctor immediately if the stoma is not pink/red and moist." 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.
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? A. "I can tape a quarter over the hernia to reduce it." B. "My son could have some appearance-related self-esteem issues." C. "I need to watch for pain, tenderness, or redness." D. "An incarcerated hernia is rare, but it can occur."
A. "I can tape a quarter over the hernia to reduce it." 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 student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. A. "The only treatment for celiac disease is a strict gluten-free diet." B. "The entire family will need to eat a gluten-free diet." C. "Gluten is found in most wheat products, rye, barley and possibly oats." D. "Most children with celiac disease are diagnosed within the first year of life." E. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders."
A. "The only treatment for celiac disease is a strict gluten-free diet." C. "Gluten is found in most wheat products, rye, barley and possibly oats." E. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." 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.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? A. Effortless vomiting just after the child has eaten B. Severe constipation with occasional ribbon-like stools C. Bouts of diarrhea with failure to gain weight D. Forceful vomiting followed by the child being eager to eat again
A. Effortless vomiting just after the child has eaten 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.
The newborn was diagnosed with esophageal atresia and a nasogastric tube was inserted. Which findings are most consistent with this condition? Select all that apply. A. The newborn coughed excessively during attempts to feed B. Coarse crackles were auscultated throughout all lung fields C. X-ray revealed that the nasogastric tube was coiled in the upper esophagus. D. The newborn's skin was very jaundiced. E. The newborn's mouth was very dry.
A. The newborn coughed excessively during attempts to feed B. Coarse crackles were auscultated throughout all lung fields C. X-ray revealed that the nasogastric tube was coiled in the upper esophagus. Newborns with esophageal atresia cough during attempts to feed, may have fluid in their lungs, and x-rays will show that nasogastric tubes just coil in the upper part of the esophagus because the esophagus does not extend to the stomach. They have increased salivation in their mouths and their skin may be dusky or cyanotic.
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? A. esophageal atresia (EA) B. pyloric stenosis C. cleft palate D. hernia
A. esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: A. painless rectal bleeding B. dehydration C. respiratory distress D. ischemia
A. painless rectal bleeding 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.
An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? A. the adolescent will become fatigued easily B. hypothermia is common C. the adolescent will be very irritable and perhaps require sedation D. the adolescent's urine will be dark and infectious
A. the adolescent will become fatigued easily 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.
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? A. "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." B. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." C. "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." D. "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."
B. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." 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 mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? A. "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." B. "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." C. "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." D. "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits."
B. "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.
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? A. "I will monitor her IV line to help maintain her fluid volume." B. "I will make sure there is plenty of orange juice available. It's her favorite juice." C. "I will weigh her every morning at the same time." D. "I will teach her mother to give her small drinks frequently."
B. "I will make sure there is plenty of orange juice available. It's her favorite juice." 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 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? A. "If you do not understand this, I need to cancel your surgery and have the health care provider come back." B. "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." C. "The health care provider will remove about half of the herniated contents during the procedure." D. "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery."
B. "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." 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 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? A. "You will most likely have an ultrasound evaluation." B. "You will most likely have a blood test to check for certain antibodies." C. "You will most likely have viral studies." D. "You will most likely be tested for ammonia levels."
B. "You will most likely have a blood test to check for certain antibodies." Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is performed to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.
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? A. Appendicitis B. Gastroenteritis C. Pancreatitis D. Hirschsprung disease
B. Gastroenteritis 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.
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? A. a partial or complete intestinal obstruction occurs B. In this disorder the sphincter that leads into the stomach is relaxed C. There are recurrent paroxysmal bouts of abdominal pain D. a thickened, elongated muscle causes an obstruction at the end of the stomach
B. In this disorder the sphincter that leads into the stomach is relaxed 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 3-year-old child has been brought to the clinic for assessment of chronic constipation. After ruling out an organic cause, what will the nurse prioritize in the child's plan of care? A. teaching the child's caregivers how to safely administer an enema B. administering over-the-counter stool softeners but for no longer than 1 week C. teaching the child's caregivers the need to toilet the child hourly during the day D. teaching the child habits that promote normal bowel function
B. administering over-the-counter stool softeners but for no longer than 1 week Once any organic process is ruled out as a cause, constipation may initially be managed with dietary manipulation such as increasing fiber and fluids. However, behavior modification is necessary for most children. Children with severe constipation and withholding behavior may require laxative therapy until they relearn proper bowel habits and dietary measures begin to work. Over-the-counter stool softeners can be taken for constipation but should be based on the recommendation of the health care provider. The health care provider must be notified if symptoms persist despite taking the stool softener. Teaching specific interventions like the safe application of enema is only appropriate if the health care provider has recommended or prescribed a specific form of enema to be used. There are many forms of enema and teaching the parents without the health care provider's prescription can cause more harm than good. Frequent toileting may or may not be beneficial.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? A. gastroschisis B. esophageal atresia C. omphalocele D. hiatal hernia
B. esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.
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? A. preterm birth B. mother age 42 with pregnancy C. history of hypoxia at birth D. maternal use of acetaminophen in third trimester
B. mother age 42 with pregnancy 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.
An adolescent has hepatitis B. What would be the most important nursing action? A. conscientious collection of stool for ova and parasites B. strict enforcement of standard precautions C. strict calculation of caloric and vitamin B intake D. close observation to detect cerebral hallucinations
B. strict enforcement of standard precautions 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 collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? A. "How many times a day does your child urinate?" B. "How long has your child been toilet trained?" C. "Tell me about the types of stools your child has been having." D. "What foods has your child eaten during the last few days?"
C. "Tell me about the types of stools your child has been having." For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on the number and type of stools per day. Recent eating patterns, determining if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? A. Use a syringe plunger to administer the feeding. B. After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes. C. Check for gastric residual before starting feeding. D. Position the client with the head of the bed at a 20° angle.
C. Check for gastric residual before starting feeding. The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and the formula should be allowed to flow with gravity, not plunged unless the tube is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the G-tube open for 5 to 10 minutes after feeding to allow for escape of air.
The nurse is talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply. A. There are no ways to determine the presence of cleft lips or palates prior to delivery. B. The nuchal translucency test can be used to screen for cleft lips and palates. C. Ultrasounds can be used to assess for these conditions. D. The quadruple marker test can be used to detect these conditions. E. Most cleft lips and palates are found at delivery.
C. Ultrasounds can be used to assess for these conditions. E. Most cleft lips and palates are found at delivery. Ultrasounds can be used to identify the presence of cleft lips or palates. Most, however, are found after birth. The quadruple screening test assesses for potential down syndrome and neuro tube defects. Nuchal translucency testing is used to assess for Down syndrome.
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? A. determine esophageal contractility B. evaluate gastric pH C. detect H. pylori D. confirm pancreatitis
C. detect H. pylori 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.
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? A. report of a headache B. no joint swelling C. fever D. clear lung sounds
C. fever 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.
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? A. "I have a lot of diarrhea every day because of how my small intestine is damaged." B. "It's unusual for someone my age to get Crohn disease." C. "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." D. "I have to be careful because I am prone to not absorbing nutrients."
D. "I have to be careful because I am prone to not absorbing nutrients." 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 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? A. "I will make sure to clean all of her toys before I give them to her." B. "I will use a cotton tipped applicator to apply the medication to her mouth." C. "I will watch for diaper rash." D. "I will add the nystatin to her bottle four times per day."
D. "I will add the nystatin to her bottle four times per day." 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.
Which client most likely has ulcerative colitis rather than Crohn disease? A. 14-year-old female with full-thickness chronic inflammation of the intestinal mucosa B. 12-year-old with oral temperature of 101.6° F (38.7° C) C. 18-year-old male with abdominal pain D. 16-year-old female with continuous distribution of disease in the colon, distal to proximal
D. 16-year-old female with continuous distribution of disease in the colon, distal to proximal 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.
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: A. Hirschsprung disease B. inflammatory bowel disease C. cystic fibrosis D. GERD
D. GERD 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 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? A. diaphragmatic hernia B. hiatal hernia C. umbilical hernia D. inguinal hernia
D. inguinal hernia 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 emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? A. Assess the child's usual urinary voiding pattern B. Encourage fluid intake C. administer antacids as ordered D. prepare the child for admission to the hospital
D. prepare the child for admission to the hospital The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.
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? A. there are also plaques on the buccal mucosa B. the patches are thick, white plaques on the tongue C. there are also white patches on the erupted teeth D. some patches are light in color and other patches are dark in color
D. some patches are light in color and other patches are dark in color 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.
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? A. pale and slightly dry mucosa B. BP 80/42 C. soft and flat fontanels D. tenting of skin
D. tenting of skin 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.