Week 7: Ricci Chapter 42 Prep U
The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "Babies with esophageal atresia produce an excessive amount of amniotic fluid." "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." "Enzymes in amniotic fluid can cause the development of esophageal atresia."
"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." Explanation: Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.
A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? "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." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."
"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Explanation: An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.
The nurse is assessing a toddler and palpates a sausage-shaped mass in the upper mid abdomen. When taking the toddler's history, what question would the nurse ask the parent first? "Has your toddler been having different colored stools?" "Can you describe any pain your toddler is having?" "How is your toddler's appetite?" "Has your toddler been around anyone who has been sick?"
"Has your toddler been having different colored stools?" Explanation: A sausage-shaped mass in the upper mid abdomen is a classic sign of intussusception. Intussusception occurs when the proximal segment of the bowel "telescopes" into a more distal segment of the bowel, thus the sausage-shaped mass. Another classic sign of intussusception is stools that appear like currant jelly. These are stools which are bloody and mixed with mucus. This should be the question the nurse asks first. Next, the nurse should ask about the pain. The pain with intussusception has a sudden onset and is intermittent and crampy. The appetite of the child generally is poor due to abdominal pressure and pain. Intussusception is not a contagious or infectious 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? "I have to be careful because I am prone to not absorbing nutrients." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "It's unusual for someone my age to get Crohn disease."
"I have to be careful because I am prone to not absorbing nutrients." Explanation: Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease affecting the intestine(s) in a continuous pattern.
The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? "I should position him on his abdomen with knees bent." "He will require 250 to 500 mL of enema solution." "I should wash my hands and then wear gloves." "He should retain the solution for 5 to 10 minutes."
"I should position him on his abdomen with knees bent." Explanation: A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.
The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will monitor her IV line to help maintain her fluid volume." "I will teach her mother to give her small drinks frequently." "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will weigh her every morning at the same time."
"I will make sure there is plenty of orange juice available. It's her favorite juice." Explanation: Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.
The nurse is performing discharge teaching for an adolescent diagnosed with peptic ulcer disease. Which statement(s) by the adolescent demonstrates learning has occurred? Select all that apply. "I will need to make sure to take all of the antibiotic prescribed." "I can use ibuprofen for pain." "My proton pump inhibitor should be taken when I feel discomfort." "I will be starting yoga soon to help with the stress." "I can eat whatever I want to as long as I take my medications."
"I will need to make sure to take all of the antibiotic prescribed." "I will be starting yoga soon to help with the stress." If Helicobacter pylori was detected as a cause of the peptic ulcer disease, the adolescent will be prescribed an antibiotic and should take all of the medication. Yoga will help in decreasing stress, which can exacerbate peptic ulcer disease. Proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of peptic ulcer disease or other gastrointestinal diseases, or chronic salicylate or prednisone use. The client should use acetaminophen for pain, not ibuprofen.
The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? "Have you tried using a toothbrush to get it off?" "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it." "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated."
"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Explanation: Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.
The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? "My child has such large bowl movements that it clogs the toilet." "My child only has a bowel movement about four times a week." "My child eats vegetables and fresh fruit, but does not like beans." "My child does not have liquid stool or leak liquid stools that I am aware of."
"My child has such large bowl movements that it clogs the toilet." Explanation: Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation.
A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter is eating more vegetables." "There is gluten hidden in unexpected foods." "There are many types of flour besides wheat." "My daughter can eat any kind of fruit."
"My daughter can eat any kind of fruit." Explanation: While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease? "The soup we eat at our house is all made from scratch." "She loves hot dogs, and we always cut hers up into small pieces." "I have learned to make my own bread with no gluten." "Even though milk and pudding are good for her, we don't give her those foods."
"She loves hot dogs, and we always cut hers up into small pieces." Explanation: Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hot dogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "Most children with celiac disease are diagnosed within the first year of life." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." "The entire family will need to eat a gluten-free diet."
"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.
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? "How many times a day does your child urinate?" "How long has your child been toilet trained?" "Tell me about the types of stools your child has been having." "What foods has your child eaten during the last few days?"
"Tell me about the types of stools your child has been having." Explanation: 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 adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statement(s) by the adolescent indicates that adequate learning has occurred? Select all that apply. "The famotidine may make me confused." "The omeprazole could give me a headache." "It sounds like the health care provider is reluctant to give me bisacodyl because of the side effects." "I will probably need a laxative because of the omeprazole." "I should try to lie down right after I eat."
"The famotidine may make me confused." "The omeprazole could give me a headache." "It sounds like the health care provider is reluctant to give me bisacodyl because of the side effects." Famotidine may cause confusion. Omeprazole can cause headaches. Bisacodyl is used to treat constipation. Omeprazole use more likely will result in diarrhea, not constipation. Children with gastroesophageal reflux disease (GERD) should not lie down after meals.
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? "The treatment for the disorder will be a surgical procedure." "Your child will be treated with oral iron preparations to correct the anemia." "We will give enemas until clear and then teach you how to do these at home." "Your child will receive counseling so the underlying concerns will be addressed."
"The treatment for the disorder will be a surgical procedure." Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.
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? "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "The health care provider will remove about half of the herniated contents during the procedure."
"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." Explanation: A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.
A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "We should not stop this medication abruptly." "She might lose some weight initially." "This drug helps to control the abdominal cramping." "We might notice some of the medication in her stool."
"We should not stop this medication abruptly." Explanation: Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.
The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "You will most likely have a blood test to check for certain antibodies." "You will most likely have an ultrasound evaluation." "You will most likely have viral studies." "You will most likely be tested for ammonia levels."
"You will most likely have a blood test to check for certain antibodies." Explanation: 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.
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.
The child has been diagnosed with severe dehydration. The health care provider has prescribed a bolus of 20 ml/kg of normal saline over a 2-hour period. The child weighs 63.5 lb (28.8 kg). At which ml/hour should the nurse set the child's intravenous administration pump? Record your answer using a whole number.
288 Explanation: Using the child's weight in kilograms, multiply by prescribed dose. 28.8 kg x 20 ml/kg = 576 ml. Divide by time administered. 576 ml ÷ 2 hr = 288 ml/hr
The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.
48 Explanation: Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift
The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? 7 to 14 days 5 to 7 days 3 to 5 days 1 to 3 days
7 to 14 days Explanation: The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.
The nurse is caring for a child who was dehydrated following gastric surgery but has since been rehydrated. The health care provider prescribes intravenous maintenance fluids for the child. Calculate the intravenous maintenance fluid rate per hour for this child, who weighs 40 kg. Record your answer using a whole number.
79 Explanation: The formula to determine maintenance fluid rate is: *100 ml/kg for first 10 kg *50 ml/kg for next 10 kg *20 ml/kg for remaining kg * Add together for total ml needed per 24-hour period. *Divide by 24 for ml/hour fluid requirement. Therefore, for a child weighing 40 kg the equation is: *100 X 10= 1000 *50 X 10= 500 *20 X 20= 400 *1000 + 500 + 400= 1900 *1900/24= 79.17= 79 ml/hr
The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? Ask the parents if they have any questions regarding the care of their child. Explain to the parents that surgical intervention will fix the defect in the baby's lip. Teach the mother the appropriate technique for breastfeeding an infant with cleft lip. Refer the family to a social worker or mental health practitioner.
Ask the parents if they have any questions regarding the care of their child. Explanation: The family's emotional response to the birth of a child with cleft lip, palate, or both may range from grief to anger to denial. The nurse should encourage the parents to express their feelings and provide the parents with opportunities and support for normal infant-parent interactions.
The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Ham and cheese sandwich, orange slices, chips, and whole milk Whole wheat pasta, meatballs, carrot sticks, apple, and water Baked salmon, potato slices, vanilla ice cream, and apple juice Meatloaf, green beans, peanut butter cookie, and fat-free milk
Baked salmon, potato slices, vanilla ice cream, and apple juice Explanation: Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.
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? Check for gastric residual before starting feeding. Position the client with the head of the bed at a 20° angle. Use a syringe plunger to administer the feeding. After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes.
Check for gastric residual before starting feeding. Explanation: 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.
A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? Crohn disease ulcerative colitis food poisoning Hirschsprung disease
Crohn disease Explanation: Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.
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 Forceful vomiting followed by the child being eager to eat again Severe constipation with occasional ribbon-like stools Bouts of diarrhea with failure to gain weight
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.
The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse? Explain that surgery will make this better in the future. Encourage the mother to provide care for her infant. Encourage the child's mother to hold her infant against her shoulder to provide closeness while not looking at the defect. Tell the mother that while this is difficult it will get easier.
Encourage the mother to provide care for her infant. Explanation: Providing care to the infant is the best means for the mother to begin bonding with her baby. Activities such as feeding, diapering and bathing will be helpful. Encouraging the mother to avoid looking at the cleft lip will not assist her in the process of accepting it. While surgery will be performed it will not take place for a few months. making it vital that she begin bonding with her infant. Telling the parent she will get used to it minimizes her concerns and is not the most therapeutic response by the nurse.
A parent brings the 2-week-old infant to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply. Feed the infant a formula thickened with rice cereal. Feed the infant while holding the infant in an upright position. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. If breastfeeding, switch to feeding the infant formula. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. Consult a pediatric surgeon regarding having a myotomy procedure performed.
Feed the infant a formula thickened with rice cereal. Feed the infant while holding the infant in an upright position. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. The traditional treatment of gastroesophageal reflux in the infant is to feed a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding the infant in an upright position and then keeping the infant upright by holding them and/or elevating the head of the crib 30 degrees for 30 to 45 minutes after feeding so gravity can help prevent reflux. There is no need for the parent to switch from breastfeeding to formula-feeding. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the infant in a more upright position during and following feeding; these procedures would not be appropriate at this point.
A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Appendicitis Pancreatitis Gastroenteritis Hirschsprung disease
Gastroenteritis Explanation: Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.
A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? High carbohydrate, high protein Low calorie, high carbohydrate High calorie, high fiber Low fiber, low calorie
High carbohydrate, high protein Explanation: The goal of nutritional intervention is to provide adequate nutrient intake to optimize normal growth and development—including pubertal development, which is frequently delayed—and to prevent and correct nutrient deficiencies. Adequate nutrition with a high-protein and high-carbohydrate diet may be recommended.
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? Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease Short bowel syndrome (SBS)
Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Preparing family for home care Promoting comfort Maintaining skin integrity Improving hydration
Improving hydration Explanation: Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.
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 partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.
In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.
A 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 Volvulus with malrotation Necrotizing enterocolitis Short-bowel/short-gut syndrome
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.
The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? Listening for bowel sounds Observing the abdominal skin Determining the infant's ability to suck on a pacifier Turning the infant every 4 hours
Listening for bowel sounds Explanation: Bowel sounds will allow the nurse to know how peristalsis is progressing after surgery. This will determine when the infant is able to receive nourishment other than through the intravenous route. Observing the perianal skin would be important because the perianal skin is at significant risk for breakdown because this will be the first time that stool has passed through the anal sphincter. The infant's ability to suck on the pacifier is important but is unrelated to the surgery. The infant should be turned at least every 2 hours.
A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? No intervention is needed, as the opening will most likely close spontaneously. Surgery at age 1 to 2 years will likely be needed to repair the condition. Wrapping an elastic band around the child's waist should correct the problem. Taping a silver dollar over the area will help reduce the hernia.
No intervention is needed, as the opening will most likely close spontaneously. Explanation: An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.
A nurse manages the interdisciplinary care for an infant born with an omphalocele. Which action should the nurse perform? Protect the exposed bowel by gently manipulating it back into the abdominal cavity. Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV methylprednisolone. Ensure the newborn is always lying on their back with proper support.
Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. Explanation: For an infant with omphalocele, the nurse will obtain IV access and give fluid resuscitation to correct any electrolyte abnormalities. The nurse will protect the bowel by wrapping the exposed viscera with warm saline-soaked sterile gauze and cover the defect with a sterile bag. The exposed bowel is not placed back into the abdominal cavity. The infant will be NPO; thus, oral prednisone or prednisolone would not be given. IV methylprednisolone is administered for irritable bowel syndrome, not omphalocele.
The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question? NPO nasogastric tube placed to suction serum amylase levels PO pain management
PO pain management Explanation: Maintain NPO status and nasogastric tube suction and patency. Administer intravenous fluids to keep the child hydrated and correct any alterations in fluid and electrolyte balance. Pain management is crucial in children with pancreatitis; due to NPO status, medications are typically prescribed intravenously. Serial monitoring of serum amylase levels will determine when oral feeding may be restarted.
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? Prepare the child for admission to the hospital. Assess the child's usual urinary voiding pattern. Encourage fluid intake. Administer antacids as ordered.
Prepare the child for admission to the hospital. Explanation: 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.
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Prepare the infant for surgery. Assist in insertion of a nasogastric (NG) tube. Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant.
Prepare the infant for surgery. Explanation: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception. A nasogastric (NG) tube is inserted for gastric decompression in an infant with intussusception.
The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue? Some patches are light in color and other patches are dark in color. The patches are thick, white plaques on the tongue. There are also plaques on the buccal mucosa. There are also white patches on the erupted teeth.
Some patches are light in color and other patches are dark in color. Explanation: A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Oral candidiasis (thrush) is characterized by thick, white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the infant may have by that age.
An adolescent has hepatitis B. What would be the most important nursing action? Conscientious collection of stool for ova and parasites Strict calculation of caloric and vitamin B intake Strict enforcement of standard precautions Close observation to detect cerebral hallucinations
Strict enforcement of standard precautions Explanation: Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions. Using standard precautions of gloves and good handwashing will help prevent spread of the disease. Ova and parasites are not present with hepatitis B. A good diet with adequate protein and vitamins will help the body heal, so these should not be restricted. The nurse observes for mental status changes. These can occur as a complication, but preventing spread of the disease is the nursing priority.
The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Take a stool culture Administer antibiotic therapy Administer IV potassium Feed the child a cracker
Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Pale and slightly dry mucosa Blood pressure of 80/42 mm Hg Tenting of skin Soft and flat fontanels (fontanelles)
Tenting of skin Explanation: Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.
An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? The adolescent will become fatigued easily. The adolescent will be very irritable and perhaps require sedation. Hypothermia is common. The adolescent's urine will be dark and infectious.
The adolescent will become fatigued easily. Explanation: Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.
The newborn was diagnosed with esophageal atresia and a nasogastric tube was inserted. Which findings are most consistent with this condition? Select all that apply. The newborn's mouth was very dry. The newborn coughed excessively during attempts to feed. The newborn's skin was very jaundiced. Coarse crackles were auscultated throughout all lung fields. X-ray revealed that the nasogastric tube was coiled in the upper esophagus.
The newborn coughed excessively during attempts to feed. Coarse crackles were auscultated throughout all lung fields. 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 child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply. Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation. Take the medication between meals to increase absorption.
Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation. Anti-inflammatory medications increase sensitivity to sunlight and may crystalize in the urine. These medications are irritating to the gastric lining and are taken with food to avoid irritation. These drugs decrease folic acid absorption; therefore, parents should anticipate a concurrent prescription for folic acid.
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? Refusal to eat Vomiting about 2 hours after feeding Chronic diarrhea Vomiting immediately after feeding
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 child is diagnosed with short bowel syndrome. What treatment(s) should the nurse expect to be included in the child's plan of care? Select all that apply. antibiotics vitamin supplements total parenteral nutrition laxatives immunosuppressants
antibiotics vitamin supplements total parenteral nutrition For the child with short bowel syndrome, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are typically prescribed. Laxatives and immunosuppressants are not used.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. applesauce bananas skim milk rye bread wheat bread
applesauce bananas skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.
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? esophageal atresia omphalocele gastroschisis hiatal hernia
esophageal atresia Explanation: 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.
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? esophageal atresia (EA) cleft palate pyloric stenosis hernia
esophageal atresia (EA) Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
The parents of a 5-week-old infant present to urgent care because the child is "throwing up forcefully with every feeding." What other assessment(s) will the nurse complete? Select all that apply. feeding technique family history of lactose and gluten intolerance vomiting description and pattern current weight and weight gain since birth mucous membranes and skin
feeding technique vomiting description and pattern current weight and weight gain since birth mucous membranes and skin This child is showing potential symptoms of pyloric stenosis, which presents as postfeed projectile vomiting. The nurse should assess the feeding technique to determine if it is caused by excessive air intake or a lack of burping. The projectile vomiting from pyloric stenosis can lead to inadequate weight gain and dehydration, so the weight gain, skin, and mucous membranes should be assessed. These symptoms are not related to gluten or lactose intolerance. Gluten intolerance is uncommon before the introduction of solid foods and includes poor growth, bulky stools, malnutrition, distended abdomen, and anemia. Lactose intolerance symptoms include abdominal pain, poor growth, diarrhea, and frothy stools.
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? clear lung sounds fever no joint swelling report of a headache
fever Explanation: Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection. The progression of the disease will be reported to the health care provider. A headache may accompany the fever and is a sign of generally not feeling well. It does not indicate progression of the disease, thus does not need to be reported. Clear lung sounds and no swollen joints are good signs, but they are not associated with Crohn disease.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? sausage-shaped mass in the upper mid abdomen perianal fissures and skin tags abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant
hard, moveable "olive-like mass" in the upper right quadrant Explanation: A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.
The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? diaphragmatic hernia umbilical hernia inguinal hernia hiatal hernia
inguinal hernia Explanation: An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.
A 9-month-old infant presents to the emergency department with vomiting and abdominal pain. While assessing the client, the nurse notes the client screaming intermittently and drawing up legs toward chest a palpable mass in upper right quadrant (above). What does the nurse anticipate in this child's stools? narrow, ribbon-like stools loose, watery stools jellylike, bloody stools foul-smelling, fatty stools
jellylike, bloody stools Explanation: This child is presenting with characteristic symptoms of intussusception, including abdominal distention and episodes of abdominal pain/cramping. During these episodes, the child draws legs up followed by vomiting. These occur approximately every 15 minutes, followed by breaks where the child appears normal. Intussusception usually results in jellylike (red currant jelly) mucousy red stools. Foul-smelling, fatty stools are typical of celiac disease. Narrow, ribbon-like stools are typical of Hirschsprung disease (aganglionic megacolon). Loose, watery stools are typical of diarrhea or may occur with irritable bowel disease.
A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer IV fluid replacement to the child. Which fluid(s) is suitable for use? Select all that apply. lactated Ringer's normal saline 5% dextrose in water 0.45% saline 10% dextrose in water
lactated Ringer's normal saline IV fluids can be used to treat dehydration. The fluids used are normal saline (also referred to as 0.9% saline) and Ringer's lactate solution. Dextrose is used to treat low blood sugar, not dehydration.
A parent brings the 10-year-old child in to the clinic. The nurse notes: icteric sclera and skin, headache, anorexia, vomiting, and temperature 101.8°F (38.8°C). The parent states the child has had the symptoms since returning to the US from India a few days ago. The nurse will anticipate preparing the child for which test? liver function tests abdominal ultrasound fecal ova and parasite test magnetic resonance imaging (MRI)
liver function tests Explanation: The nurse would anticipate preparing the child for liver function tests due to the suspicion of the child having hepatitis A. It is a communicable disease of the liver caused by the hepatitis A virus. It is transmitted person-to-person through the fecal-oral route or by consumption of contaminated food or water. The symptoms of hepatitis A include pain in the abdomen, joints, or muscles; jaundice; nausea; vomiting; diarrhea; fatigue; fever and anorexia. Traveling to an at-risk country also is an indicator for the nurse. Alanine transaminase (ALT) and aspartate transaminase (AST) are commonly used to diagnosis hepatitis A. An ultrasound, MRI, nor fecal test are not indicated for this client based on the presenting symptoms. Additional testing may be indicated if the liver testing is negative.
The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? mother age 42 with pregnancy maternal use of acetaminophen in third trimester preterm birth history of hypoxia at birth
mother age 42 with pregnancy Explanation: Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress. painless rectal bleeding. dehydration. ischemia.
painless rectal bleeding. Explanation: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.
A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect? pancreatitis appendicitis Crohn disease ulcerative colitis
pancreatitis Explanation: The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted. Appendicitis pain and tenderness would be localized to the right lower quadrant. Crohn disease is a chronic bowel disorder causing frequent, recurring diarrhea. Ulcerative colitis is a chronic bowel disease affecting the large intestine and the rectum.
A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has: severe dehydration. failure to thrive. malabsorption syndrome. risk for fluid volume deficit.
severe dehydration. Explanation: A loss of more than 10% of body weight in a day is a sign of severe dehydration. Failure to thrive and malabsorption syndrome are long-term conditions, not objectively defined by a 24-hour weight change. This child is no longer at risk for a fluid volume deficit but is showing signs of dehydration.
The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: steatorrhea. severe diarrhea. currant jelly stools. projectile stools.
steatorrhea. Explanation: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.
