UWorld GI/Nutrition - Child Health
During a diaper change, the newborn becomes cyanotic with frothy secretions from the mouth and nose. What action should the nurse perform first?
3. Perform nasal and oropharyngeal suction Pooling secretions in the mouth and throat cause laryngospasm, a protective airway mechanism that causes hypoxia when prolonged. The nurse should vigilantly monitor for and remove secretions (eg, frothy saliva) via manual and/or low, continuous suction to prevent pooling. If the newborn becomes cyanotic, the priority is to immediately suction the oropharynx because laryngospasm typically resolves with the removal of secretions (Option 3). Activating the rapid response team is not the first action because the nurse can perform interventions to reestablish normal airway and breathing prior to requesting additional assistance. Preparing to intubate the newborn is not the first action because the airway is obstructed due to secretions.
The client has been diagnosed with intussusception. The nurse should be most concerned about the child developing __ and __
1. Perforation 2. Bowel ischemia Ongoing obstruction compromises circulation, causing bowel ischemia, occult (hidden) bleeding, and increased leakage of mucus. Without spontaneous resolution or intervention, worsening obstruction and increased pressure in the affected bowel segment can lead to life-threatening bowel perforation and peritonitis. Ulcerative colitis --> toxic megacolon Necrotizing enterocolitis ---> ischemia and necrosis. Tracheoesophageal fistula (TEF) causes fluids (eg, milk, saliva) to accumulate in the proximal esophageal pouch, resulting in aspiration
The nurse is educating the parents of a 6-month-old about introducing solid foods into the infant's diet. Which parental statement indicates a need for further teaching?
2. "I can offer a variety of foods within the first week of introducing solids." The introduction of solid foods generally occurs at age 4-6 months. When introducing new foods, parents should allow several (eg, 4-7) days between each new food to observe for any reactions to a specific food. Allergic responses often worsen with subsequent exposure, so it is a priority to identify food allergies early (Option 2). After starting with iron-fortified cereal (mixed with formula, breast milk, or water), parents can begin offering soft fruits and vegetables
The nurse is talking about nutrition with the parent of a 1-year-old client. Which of the following statements by the parent would require follow-up?
2. "I let my child keep a bottle of milk in the crib during the night." Early childhood caries (ECC) (ie, extensive and rapid dental caries in the developing teeth) can occur when parents put a child to bed with a bottle of milk or sugary beverage to drink throughout the night or nap time (Option 2). The high-carbohydrate fluid pools around the teeth and nourishes decay-producing bacteria (Streptococcus mutans). Sucking on a bottle for extended periods can also push the jawline out of shape. Parents should not use bottles containing milk or sugary beverages as bedtime pacifiers.
The nurse is reviewing recommended dietary modifications with a client with celiac disease. Which of the following menu selections by the client would indicate a correct understanding of the teaching? Select all that apply. Celiac disease is an autoimmune disorder in which the body is unable to process gluten, a protein found in many grains (eg, barley, rye, wheat). When a client with celiac disease consumes gluten, the villi of the small intestine are damaged, and absorption of nutrients is impaired. Characteristics include signs of malabsorption (eg, abdominal discomfort, steatorrhea [ie, fatty, foul-smelling stool]) and malnutrition (eg, delayed growth, failure to thrive). Clients must adhere to a strict gluten-free diet for life.
2. Corn tortilla tacos with ground beef and cheese 3.Grilled chicken, baked potato, and strawberry yogurt 5. Rice noodles with chicken and broccoli Meats (eg, chicken, beef), fruits (eg, apple), vegetables (eg, corn, potato, broccoli), certain grains (eg, rice), and dairy products that contain no additives (eg, yogurt, cheese) are gluten free and allowed in the diet (Options 2, 3, and 5).
The nurse in the emergency department is assessing a 3-month-old client who has irritability, facial edema, a one-day history of diarrhea, and seizure activity. The parents state that the client has had adequate oral intake, but they have recently been diluting concentrated formula with excess water to save money. The nurse should recognize that the client is most likely experiencing
4. Hyponatremia due to water intoxication Water intoxication (ie, water overload) resulting in hyponatremia may occur in infants when formula is diluted with excess water to save money. Hyponatremia may also result from ingestion of plain water (eg, caregiver attempting to rehydrate an infant who has been ill). Infants have immature renal systems with a low glomerular filtration rate, which decreases their ability to excrete excess water and makes them susceptible to water intoxication. Symptoms of hyponatremia due to water intoxication include altered mental status (eg, irritability, lethargy), nausea and vomiting, diarrhea, and seizures. Edema may also be present (fluid overload) (Option 4). Formula must be prepared according to the manufacturer's instructions. Hypokalemia secondary to diarrhea may also present with irritability, but other expected manifestations would include muscle weakness and cardiac arrhythmias.
Emergency Department The parents report increasingly frequent, forceful vomiting after every feed over the last 4 days. The emesis appears to be undigested milk. The infant appears hungry again after each episode of vomiting. The infant is exclusively breastfed; the last bowel movement was yesterday; it was soft in consistency and yellow. The anterior fontanel is mildly sunken, and mucous membranes are dry. There is prominent peristalsis in the epigastric region with a palpable olive-shaped mass.
Hypertrophic pyloric stenosis is thickening of the pylorus muscle that blocks the passage of gastric contents into the intestines, resulting in postprandial projectile vomiting. Emesis is nonbilious because gastric contents (eg, breastmilk, formula) are unable to reach the intestines. Clinical manifestations include irritability, persistent hunger despite regular feedings, dehydration (eg, sunken anterior fontanel, dry mucous membranes), decreased stool formation, and a palpable olive-shaped epigastric mass. The diagnosis is confirmed with abdominal ultrasonography. The nurse should administer IV fluids to treat dehydration and monitor serum electrolytes due to the risk for hypokalemia (low potassium) from severe vomiting. Rotavirus = contact precuations and stool sample ) Hirschsprung disease = increased abdominal girth/distenition - bowel resection surgery
The nurse recognizes the child has most likely experienced
Spontaneous resolution Spontaneous resolution of intussusception is evidenced by the return of normal, brown stool. All symptoms, including abdominal cramping, completely resolve once the obstruction is successfully reduced. If spontaneous resolution is suspected, the nurse should promptly notify the health care provider to reevaluate the need for further intervention and to avoid unnecessary invasive procedures (eg, enemas, surgery).
Emergency Department A newborn is brought to the emergency department due to coughing and difficulty feeding. The client was born at home 6 hours ago via spontaneous vaginal birth. With each attempt to breastfeed, the client coughs, vomits, and "turns blue". The mother did not receive prenatal care. She reports a history of opioid use disorder but reports no opioid use during pregnancy. Vital signs: T 98.6 F (37 C), P 120, RR 50, and SpO2 95% on room air. Abdominal distension is present. Ballard scoring estimates the at 37 weeks gestation. Weight and length are consistent with the 25th and 50th percentiles for estimated age, respectively. Newborn abdominal distension and persistent coughing, vomiting, and cyanosis with each feed are concerning findings for structural cardiac or gastrointestinal congenital abnormalities.
When assessing a newborn, the nurse should monitor for abnormal abdominal and respiratory findings. Vomiting in newborns may occur due to overfeeding, excessive aerophagia (ie, swallowing air), or gastroesophageal reflux. However, abdominal distension and persistent coughing with vomiting are concerning for congenital gastrointestinal abnormalities, including pyloric stenosis, tracheoesophageal fistula, and necrotizing enterocolitis. In addition, cyanosis (ie, "turns blue") with each attempt to breastfeed is concerning for congenital heart defects or possible respiratory distress syndrome. The nurse should report these findings to the health care provider immediately because prompt intervention is associated with more favorable newborn outcomes.
The nurse is reviewing recommended dietary modifications with the parents of a 6-month-old client with phenylketonuria (PKU). Which of the following information should the nurse include? Select all that apply. {henylketonuria (fen-ul-key-toe-NU-ree-uh), also called PKU, is a rare inherited disorder that causes an amino acid called phenylalanine to build up in the body.
1. "A low-phenylalanine diet is required." - A low-phenylalanine diet is essential in the treatment of PKU (Option 1). Phenylalanine cannot be entirely eliminated from the diet because it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining safe phenylalanine levels (2-6 mg/dL [120-360 µmol/L] for clients age <12). 2."Meat and dairy products should not be introduced into the diet." "4."Specially prepared infant formula is necessary." - Other management strategies for clients with PKU include: - Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2) - Feeding infants specially prepared formulas that are low in phenylalanine (Option 4) - Encouraging consumption of natural foods low in phenylalanine (ie, most fruits and vegetables like a banana )
The nurse provides education to the parent of a 10-year-old client with irritable bowel syndrome (IBS). Which of the following parent statements indicate understanding? Select all that apply. Irritable bowel syndrome (IBS) is a common condition in children and is characterized by abdominal discomfort, diarrhea, and/or constipation. The exact cause of IBS is not known, but there may be environmental and genetic components. IBS is diagnosed by ruling out other gastrointestinal-related disorders (eg, lactose intolerance, food allergies, intestinal parasites).
1. "Adding a daily probiotic supplement may help to reduce my child's IBS symptoms. ."3."For constipation-predominant IBS, we will increase the amount of fiber in my child's diet." 4."I can help improve IBS symptoms by promoting healthy coping skills for my child, like talking about problems." There is no cure for IBS, but clients can improve symptoms by incorporating healthy options into their lifestyle, including: - Adding a daily probiotic supplement to the diet to support healthy gut microbiota (Option 1) - Adding moderate amounts of fiber to the diet (especially for constipation-predominant IBS) to improve gut microbiota and stool quality (Option 3) - Developing healthy coping skills (eg, talking about problems) to deal with stress and anxiety (Option 4) - Exercising regularly to promote gut motility (Option 5) - Avoiding foods or substances that may exacerbate symptoms of IBS (eg, high-fat foods, caffeinated beverages) Clients with IBS generally have an excess of mucus production in the bowel. Not a priority
For the past 8 hours, the client has had multiple 10-minute episodes of crying during which he draws his knees up to his chest. Each episode spontaneously resolves. There have also been multiple episodes of emesis. The last bowel movement occurred earlier today and was dark red with a "sticky" consistency, and it contained streaks of blood. The abdomen is soft and nondistended with mild right upper quadrant tenderness and a palpable sausage-shaped mass. The right lower abdominal quadrant feels empty to palpation. The client can say "mama" and three additional words and follows one-step directions. Drag the findings that are concerning to the box on the right.
1. Emesis 2. Abdominal Mass 3. Bowel movement 4. Episodes of crying 5. Abdominal tenderness - Multiple episodes of emesis may indicate feeding intolerance, increased intracranial pressure (eg, meningitis infection), or acute gastrointestinal infection. Recurrent episodes increase the client's risk for dehydration. - Right upper quadrant (RUQ) abdominal tenderness and a palpable mass can be associated with obstructive gastrointestinal conditions (eg, intussusception, pyloric stenosis). -cAbnormal bowel movements (eg, dark red, "sticky" stool with red streaks) may indicate infection, feeding intolerances, or intussusception. - Multiple prolonged episodes of crying and pulling knees to the chest are signs of distress or discomfort.
A 2-year-old in the emergency department is suspected of having intussusception. Which assessment finding should the nurse expect? Intussusception is an intestinal obstruction that occurs when a segment of the bowel folds (ie, telescopes) into another segment.
3. Stools mixed with blood and mucus Pressure gradually increases within the bowel, causing ischemia and leakage of blood and mucus into the lumen, which produces the characteristic stool mixed with blood and mucus (ie, red, "currant jelly"). Initially, some infants may have only general symptoms (eg, irritability, diarrhea, lethargy). Subsequently, episodes of sudden abdominal pain (cramping), drawing the knees up to the chest, and inconsolable crying are seen. After an episode, the infant may vomit and then appear otherwise normal. Assessment may show a sausage-shaped abdominal mass. Melena (dark red or black, sticky stool) = upper gastrointestinal (UGI) bleed. Oily or bulky, foul-smelling stool is an indication of excess fat in the stool (steatorrhea) from malabsorption = pancreatic insufficiency, cystic fibrosis, or celiac disease. Thin, ribbon-like stool = Hirschsprung disease (congenital aganglionic megacolon).
The nurse recognizes the newborn is most likely experiencing a tracheoesophageal fistula with esophageal atresia and will require interventions to prevent Necrotizing enterocolitis (NEC) is inflammation of the bowel that results in ischemia and necrosis of the intestine. It is most common in very low-birthweight and preterm newborns. Introduction of enteral feedings (eg, formula) is a major risk factor, perhaps due to the incomplete digestion and absorption of milk in the immature intestine, which provides a medium for bacterial growth. Because this newborn is full-term and an unrepaired EA/TEF does not allow contents into the intestines, NEC is unlikely.
Dehydration and Aspiration pneumonia Esophageal atresia and tracheoesophageal fistula (EA/TEF) are malformations of the trachea and esophagus that require surgical repair because ingested contents are unable to reach the stomach. Without intervention, the newborn is at risk for life-threatening dehydration. In addition, newborns with EA/TEF can experience aspiration from reflux of gastric contents through the fistula into the trachea and lungs. This impairs gas exchange in the alveoli and creates a medium for bacterial growth, potentially leading to aspiration pneumonia.
For each finding below, click to specify if the finding is consistent with the disease process of gastroenteritis or intussusception. Each finding may support more than one disease process.
Gastroenteritis: Vomiting, Changes in stool consistency and color - Gastroenteritis is inflammation of the gastric and intestinal mucosa, most often caused by a virus (eg, norovirus, adenovirus, rotavirus). Clinical manifestations include fever, vomiting, and changes in stool consistency and color (ie, loose, watery stools). Gastroenteritis increases the child's risk for dehydration; therefore, the nurse should monitor fluid and electrolyte balances and administer IV fluids if dehydration is suspected. Intussususception: Vomiting, Changes in stool consistency and color, Right lower abdominal quadrant (RLQ) feeling empty to palpation, Sausage-shaped mass in the right upper abdominal quadrant (RUQ) Intussusception occurs when a segment of the intestine prolapses and then telescopes into an adjacent segment. Clinical manifestations include vomiting, stool changes (ie, red, jelly-like stools), acute episodes of abdominal pain, and a sausage-shaped mass palpated in the right upper quadrant. The right lower quadrant often feels empty to palpation because of the proximal intestinal obstruction.
For each intervention, click to specify if the intervention is indicated or not indicated for the care of the client Nursing interventions for a child with intussusception include administering IV fluids and preparing the client for an air enema, and NPO status
Indicated: IV fluids, air enema - Administering IV fluids to maintain fluid volume status and prevent dehydration caused by emesis, loose stools, and nutritional status (eg, NPO). - Preparing the client for an air enema, which involves insertion of a catheter into the rectum, where air is then instilled. The pressure of the enema reduces the obstruction by pushing the telescoped segment of the intestine back into normal position. - Maintaining the client on NPO status to decrease peristalsis and promote bowel rest. Nasogastric decompression may also be indicated, depending on the severity of obstruction. Not Indicated: Stool culture collection, Hyperosmotic laxatives - Stool culture collection is not indicated because intussusception is NOT caused by bacterial infection. A stool culture would be indicated for prolonged gastroenteritis caused by bacteria (eg, Escherichia coli). -Hyperosmotic laxatives are not indicated for clients with bowel obstruction and inflammation (eg, intussusception) because of the risk for increased intestinal pressure and perforation.
The nurse is teaching the parents about intussusception. For each statement made by the nurse, click to specify if the statement is appropriate or not appropriate.
Not appropriate: "There is a high risk for recurrence, "This condition occurs because the intestine is twisted." - Informing the parent that the cause of intussusception is unknown. Intussusception is one of the most common causes of bowel obstruction in children age <6. - Describing the intestine as twisted is not appropriate because intussusception occurs when the bowel telescopes into itself. Twisting of the intestine is a volvulus, which compromises blood supply to the intestinal tissue and increases the risk for necrosis. Appropriate: "The cause in most cases is not known.", "Surgery may be indicated if the air enema is not successful." - Informing the parent that there is a high risk for intussusception recurrence is not appropriate. The likelihood of intussusception reoccurring is low after treatment (eg, air enema, surgery). -
The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? Select all that apply.
1. Calcium 4. Vitamin D Fiber-rich foods include whole grains, beans, and berries. . Dietary sources of iron include meats and spinach. Vitamin K is an important nutrient for coagulationl found in food sources such as dark green vegetables, fish, and eggs, not in cow's milk.
A 12-month-old client has a high blood lead level of 18 mcg/dL (0.87 µmol/L). The nurse educates the parents about lead poisoning. Which statements made by the parent indicate that teaching is successful? Select all that apply.
1. "I should get our home inspected for the source of the lead." 3. "I will wash my child's hands often, especially before eating." 5. "We will have to return for a follow-up lead level." Lead poisoning occurs from repeated lead exposure, either via ingestion of lead-based paints (eg, walls, toys), glazes (eg, pottery) or water from lead pipes, or by inhalation of contaminated dust or soil found around older homes. Elevated blood lead levels (BLLs) impair neural, blood, and renal development. A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened. Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease (Option 5). Chelation therapy may be required if levels remain elevated. The priority intervention for clients with elevated BLLs is preventing continued exposure. The home environment should be assessed for lead sources (Option 1). Pediatric and pregnant clients should not live in homes being renovated until the work is complete. Handwashing, especially before eating, is important to remove lead residue (Option 3). Hard surfaces should be wet-dusted or mopped at least weekly. Hot tap water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present. Taps should be flushed for several minutes to clear out contaminated water before use.
The nurse is gathering data on a 5-week-old admitted with a suspected diagnosis of pyloric stenosis. The nurse should expect to find which laboratory value? Hypertrophic pyloric stenosis results in recurrent projectile vomiting, which leads to dehydration and hypokalemic metabolic alkalosis. Dehydration is manifested by hemoconcentration (elevated hematocrit) and elevated blood urea nitrogen (BUN).
1. Blood pH of 7.1 pyloric stenosis, a hypertrophied pyloric muscle causes postprandial projectile vomiting secondary to an obstruction at the gastric outlet. An olive-shaped mass may be palpated in the epigastric area just to the right of the umbilicus. Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. Infants will be hungry constantly despite regular feedings. A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration (Option 2). Elevated blood urea nitrogen is also a sign of dehydration. (Option 1) The stomach contains acid, which becomes depleted with excess vomiting (or during nasogastric [NG] suctioning), leading to metabolic alkalosis (increased bicarbonate and pH of >7.45). However, vomiting or prolonged NG suctioning would cause hypokalemia ) A white blood cell count of 28,500/mm3 (28.5 x 109/L) is elevated, indicating infection. However, pyloric stenosis is not an infectious process.
The nurse assesses a child with intussusception. Which assessment findings require priority intervention? Intestinal perforation and peritonitis are common complications of intestinal obstruction (eg, intussusception). Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness and is a surgical emergency
1. Abdominal rigidity with guarding Intussusception occurs when part of the intestine telescopes into another adjacent part and causes a blockage. This leads to swelling and decreased blood supply to the intestine. Tissue death as well as perforation to the bowel may result. If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection. This can quickly lead to sepsis and multiple organ failure. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly. Absence of tears in a painful procedure during which the client is crying is a sign of dehydration. This is very COMMON in clients with intussusception and should be treated A classic sign of intussusception is blood-streaked mucous stool, sometimes referred to as "currant jelly-like" stool. This is EXPECTED with intussusception. Treatment is an enema of either air or barium to unfold the intestine. A "sausage-shaped" right-sided mass (RUQ) is COMMONLY felt on palpation in clients with intussusception. This is an EXPECTED finding for this condition.
The parent of a 21-day-old male infant reports that the infant is "throwing up a lot." Which assessments should the nurse make to help determine if pyloric stenosis is an issue? Select all that apply. Pyloric stenosis is a hypertrophy of the pyloric sphincter that eventually causes complete obstruction. Classic signs include projectile nonbilious vomiting, an olive-shaped right upper quadrant (RUQ) mass, weight loss, dehydration, and/or electrolyte imbalance (metabolic alkalosis).
1. Assess the parent's feeding technique 4. Check if the vomiting is projectile 5.Compare current weight to birth weight In pyloric stenosis, there is gradual hypertrophy of the pylorus until symptom onset at age 3-5 weeks. It is common in first-born boys and the etiology is unclear. Pyloric stenosis presents with postprandial projectile vomiting (ejected up to 3 feet) followed by hunger (eg, "hungry vomiter"). This is clearly distinguished from the "wet burps" infants have due to a weak lower esophageal sphincter. The emesis is nonbilious as the obstruction is proximal to the bile duct. Infants have poor weight gain and are often dehydrated (eg, sunken fontanelle, decreased skin turgor, delayed capillary refill). The amount of milk consumed (particularly with bottle feedings) along with the mother's technique (mainly adequate burping) should be assessed to ensure there is no excessive air swallowing or overfeeding as an etiology.
The nurse plans care for a pediatric client who has just undergone a cleft palate repair. Which of the following interventions should the nurse include in the plan of care? Select all that apply. What should you look out for with a patient who had a cleft palate repair? 1. Frequent swallowing, Difficulty Breathing A cleft palate is a malformation of the roof (palate) of the mouth occurring from incomplete fusion of the palatine bones and maxilla during fetal development. Cleft palate causes an opening (cleft) in the mouth into the nasal cavity, which leads to difficulty in sucking and feeding.
1. Assist and encourage caregivers to hold and comfort the child 3. Position the child supine with an elevated head of bed after feedings 4.Remove elbow restraints per policy for skin and circulatory assessment Hard objects (eg, utensils, tongue depressors, pacifiers, straws) should not be placed into the mouth as they may damage the surgical site, which can lead to hemorrhage.
The school nurse is teaching a class of 10-year-old children about prevention of dental caries. Which recommendations would be part of the nurse's teaching plan? Select all that apply. Dental caries (ie, cavities) form when bacteria (eg, Streptococcus mutans) digest carbohydrates in the mouth, producing acids that break down tooth enamel and cause mineral loss. Oral hygiene and dietary intake are significant factors contributing to the development of caries.
1. Chewing sugar free gum 2. Including milk, yogurt and cheese in the diet 3. Minimizing intake of sweet, sticky foods 4. Rinsing the mouth with water after meals when brushing is not possible. Risk for dental caries can be reduced by avoiding highly cariogenic foods (eg, refined, simple sugars; sugary beverages; sweet, sticky foods), increasing intake of cariostatic foods (eg, dairy products, whole grains, fruits and vegetables), and maintaining oral hygiene (eg, brushing teeth, rinsing after meals). - Drinking tap water rather than bottled water (most tap water sources add fluoride to promote dental health, whereas most bottled water does not contain fluoride) - Finishing meals with a high-protein food
Several children seen at a local pediatric clinic are found to have slightly decreased hemoglobin levels. What dietary modification would most likely help increase hemoglobin levels in these clients? Iron deficiency is the leading cause of anemia worldwide. Most cases of iron deficiency anemia (IDA) result from inadequate intake of foods high in iron. In IDA, RBCs are small (ie, microcytic) with reduced hemoglobin content, appearing paler (ie, hypochromic) under a microscope.
1. Ensuring adequate intake of meat, fish, and poultry The richest dietary sources of iron include meat, fish, and poultry, which provide a form of iron that is easily absorbed by the body. Plant-based foods (eg, nuts, green leafy vegetables, whole grains) are not as iron rich and contain a less bioavailable form of iron than animal-based foods. Also, foods high in vitamin C (eg, tomatoes, potatoes, strawberries) may boost iron absorption when combined with iron-rich foods (Option 1).
The school nurse is caring for a 10-year-old client 10 minutes after a permanent tooth was knocked out during gym class. Which of the following actions should the nurse take?
1. Gently rinse the tooth with sterile saline, reinsert it into the gingival socket, and have the client hold it in place with a finger until stabilized urgently by a dentist Dental avulsion (ie, tooth separated from the mouth) of a permanent tooth is a dental emergency. The nurse should rinse the tooth with sterile saline, reinsert the tooth into the gingival socket, and hold it in place (eg, client holds it with a finger) until stabilized by a dentist (Option 1). Reimplantation 15 minutes to 1 hour after injury reestablishes blood supply, increasing the probability of tooth survival. If the tooth cannot be reinserted, it should be kept moist by submerging it in a commercially prepared solution, cold milk, sterile saline, or, as a last resort, saliva (eg, holding it under the tongue). Scrubbing the tooth can lead to root damage. The tooth should be gently rinsed with sterile saline and kept moist. Placing the tooth in water (a hypotonic solution) will lyse the blood cells remaining in the root, which could permanently kill the tooth and prevent any potential for successful reimplantation. Wrapping the tooth in sterile gauze will cause it to dry up. Nurse should arrange immediate transfer to dentist
The nurse is caring for a 2-year-old who is receiving a saline enema for treatment of intussusception. Reporting which client finding to the health care provider (HCP) is most important?
1. Passed a normal brown stool Most cases of intussusception are successfully treated without surgery using hydrostatic (saline) or pneumatic (air) enema. The nurse will monitor for passage of normal brown stool, indicating reduction of intussusception. If this occurs, the HCP should be notified immediately to modify the plan of care and stop all plans for surgery. Intense pain causes spasms of the pyloric muscle that lead to vomiting after each episode. Vomiting tends to resolve once the intussusception is reduced. - Pain in intussusception is typically intermittent. It occurs every 15-20 minutes, along with screaming and drawing up of the knees. Therefore, if a child stops crying, it may not be due to reduction of intussusception.
An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia? Gastrointestinal blood loss, which can occur if infants under age 1 year are fed cow's milk, is a potential cause of iron deficiency anemia. However, excessive milk intake is a more common cause, particularly in clients over age 1 year. Impaired or decreased iron transfer is a potential cause of iron deficiency anemia, particularly in preterm infants or infants born in multiples. However, iron stores received from the mother are typically depleted by age 5-6 months (2-3 months for preterm infants); after this point, iron must be acquired through dietary sources. Because this client is a toddler (age 1-3 years), impaired iron transfer is not a likely cause of the current anemia.
2. Excessive intake of milk One common cause in toddlers is excessive milk intake, over 24 oz/day. In addition to becoming overweight, toddlers who consume too much milk develop iron deficiency due to the likely exclusion of iron-rich foods in favor of milk, a poor source of available iron. Treatment of iron deficiency anemia includes oral iron supplementation and increased consumption of iron-rich foods (eg, leafy green vegetables, red meats, poultry, dried fruit, fortified cereal). It is also important to limit milk intake (16-24 oz/day) in toddlers to ensure a balanced diet.
The nurse is providing postoperative care for a newborn with Hirschsprung disease who underwent bowel resection with a temporary colostomy. Which of the following assessment findings are to be expected during the immediate postoperative period? Select all that apply. Hirschsprung disease is characterized by the absence of ganglion nerve cells in a portion of the colon, causing a lack of intestinal motility and bowel obstruction. Surgery is commonly performed to remove the affected portion of the colon. A temporary colostomy may be placed to redirect the client's stools through an abdominal wall stoma until the intestine heals and can be anastomosed.
2. Moderate blood-tinged mucus in the colostomy bag 4. Small amounts of blood on the stoma during bag changes 5.Surrounding skin is tender to palpation - Beefy red and slightly edematous stoma; a pink and moist stoma is NORMAL hereafter because it indicates adequate intestinal blood flow. - Blood-tinged mucus coming from the stoma due to irritation of the intestinal mucosa during surgery (Option 2) - A small amount of blood when handling the stoma during bag changes (Option 4) -Intact skin surrounding the stoma, without signs of breakdown or excoriation; the skin may be tender immediately after surgery due to manipulation (Option 5). A flattened or sunken stoma indicates prolapse and should be reported immediately. Paleness or graying of the stoma indicates decreased blood supply.
The newborn has undergone surgical repair of tracheoesophageal fistula with esophageal atresia. The nurse is preparing the family for discharge home. Which of the following parent statements indicate the teaching has been effective? Select all that apply.
2."I should ensure my newborn is in a semi-upright position during feedings." - to reduce the risk of gastroesophageal reflux (Option 2) 3."I will call the clinic if I notice an increase in drooling or regurgitation with eating." - which can indicate gastroesophageal reflux and/or esophageal stricture that may require esophageal dilations 5. "The gastrostomy tube may need to stay in place after we leave the hospital." - he gastrostomy tube may remain in place after discharge to provide supplemental feedings until the newborn can adequately ingest nutrients orally - and monitoring for signs of tracheomalacia (eg, barking cough).
During a routine assessment of a developmentally normal 18-month-old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention? Some strategies for dealing with a toddler during a stage of physiologic anorexia and pickiness include: - Set and enforce a schedule for all meals and snacks - Offer the child 2 or 3 choices of food items - Do not force the child to eat - Keep food portions small - Expose the child repeatedly to new foods on several separate occasions - Avoid TV and games during meals or snacks
3. Educate the parent about physiologic anorexia - occurs when the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood. During this phase, toddlers are increasingly picky about their food choices and schedules. Although to the parents it may appear that the child is not consuming enough calories, intake over several days actually meets nutritional and energy needs. Parasitic infection can cause malnutrition (eg, failure to thrive). There is no indication that the child is suffering from any malnutrition. Therefore, an evaluation for parasites or referral to a nutritionist is not necessary.
The nurse is assessing an infant with Hirschsprung disease. Which of the following findings would require immediate follow-up? Manifestations of HD include constipation, weight gain, gradually increasing abdominal distension, and bilious vomiting. Delayed meconium passage (ie, >48 hr) is an early indication of HD; therefore, it is an expected finding.
3. Fever and one episode of bloody diarrhea Hirschsprung-associated enterocolitis is a life-threatening complication of HD. The colon becomes significantly dilated with stool (ie, megacolon), causing edema, ischemia, and potential necrosis as the blood vessels surrounding the colon are stretched and circulation is impaired. Mucosal barrier impairment allows gut bacteria to migrate into sterile tissues, resulting in sepsis. Signs of enterocolitis (eg, fever; explosive, foul-smelling or bloody diarrhea) must be reported to the health care provider immediately (Option 3). Excessive, inconsolable crying and poor feeding = gastrointestinal distress and cramping abdominal pain associated with HD.
The nurse is admitting a 6-month-old client with suspected intussusception. Which of the following interventions should the nurse anticipate for this client? Select all that apply.
3. Initiate an infusion of IV fluids 4. Maintain the client on NPO status 5. Prepare the client for an air enema Erythropoiesis-stimulating agents (eg, epoetin alfa) = used to stimulate the production of RBCs --> chronic kidney disease and anemia. Laxatives (eg, polyethylene glycol) are not indicated for clients with bowel obstruction and inflammation (eg, intussusception) because of the risk for increased intestinal pressure and perforation.
The mother of a 6-year-old child with cystic fibrosis (CF) has received instruction on the use of pancreatic enzymes. Which statement made by the mother indicates a need for further teaching? 1. "I need to monitor the total amount of this medication that I give to my child every day." (6%) 2."I should give this medication with or just before my child has a meal or snack." (10%) 3."It is okay for my child to chew this medication." (61%) 4."It is okay to open the capsule and sprinkle the medicine on a tablespoon of applesauce." In CF, unusually thick mucus obstructs the pancreatic ducts, preventing pancreatic enzymes (amylase, trypsin, and lipase) from reaching the small intestine. The result is malabsorption of carbohydrates, fats, and proteins; the inability to absorb fat-soluble vitamins (A, D, E, and K) is of particular concern. Gastrointestinal signs and symptoms of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea.
3."It is okay for my child to chew this medication." (61%) - Capsules should be swallowed whole and not crushed or chewed; chewing the capsules could cause irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in fibrosing colonopathy (Option 1). Capsules should not be taken with milk as they can cause it to curdle.
Based on the newborn's findings, what condition does the nurse suspect? 1) Epiglottitis refers to inflammation of the epiglottis that may result in life-threatening airway obstruction. Symptoms include a high-grade fever and severe sore throat, followed by drooling and respiratory distress (eg, inspiratory stridor). ) Neonatal abstinence syndrome is a withdrawal syndrome affecting newborns exposed in utero to physiologically addictive substances (eg, opioids). Findings include irritability and inconsolability, a high-pitched/shrill cry, and neuromuscular irritability (eg, tremors, hypertonia Patent ductus arteriosus (PDA) is an acyanotic congenital defect that causes a "machine-like" murmur. When fetal circulation changes to pulmonary circulation at birth, the ductus arteriosus should close spontaneously. PDA commonly resolves within 48 hours and requires no intervention in full-term newborns.
4. Tracheoesophageal fistula Esophageal atresia and tracheoesophageal fistula (EA/TEF) are congenital malformations of the trachea and esophagus. Manifestations include coughing, vomiting, and cyanosis with feeds. A diagnostic tool for EA/TEF includes assessing for resistance above the stomach when inserting a nasogastric tube.
The newborn has received a gastrostomy tube and is scheduled for surgical repair of esophageal atresia and tracheoesophageal fistula. For each intervention, click to specify if the intervention is indicated or not indicated for the care of the newborn.
Indicated: Administer IV fluids, Monitor for episodes of apnea, Set up suction equipment at the bedside, Maintain the newborn's head in an elevated position (>/ 30 degrees) =Administering prophylactic IV antibiotics to reduce the risk of systemic infection from aspiration Not Indicated: Provide feedings through a gastrostomy tube, -Providing feedings through a gastrostomy tube is not indicated PRIOR to TEF repair surgery due to NPO status. The gastrostomy tube is used for decompression (ie, air removal) to help prevent regurgitation. In addition, a nasogastric tube is often inserted into the esophageal pouch and connected to continuous or intermittent suction until surgical repair.
