Chapter 28: The Child with a Gastrointestinal Condition

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Questions and Answers

What deficiency disease causes bony deformities due to inadequate supply of vitamin D?

  • Scurvy
  • Rickets (correct)
  • Scurvy
  • Osteoporosis

Which substance should be avoided by parents of a child allergic to cow's milk?

  • Casein (correct)
  • Whey
  • Lactose
  • Gluten

What is the medically accepted definition of constipation based on bowel movements in a 2-week period?

  • Less than seven (correct)
  • Less than five
  • Less than twelve
  • Less than ten

Which surgical operation is used to repair hernias?

<p>Herniorrhaphy (B)</p> Signup and view all the answers

Which of the following is a symptom associated with rickets due to vitamin D deficiency?

<p>Bony deformities (B)</p> Signup and view all the answers

What is a common dietary source of casein that should be avoided in certain allergies?

<p>Cheese (D)</p> Signup and view all the answers

In children, which test may be conducted to assess for hernia complications?

<p>Ultrasound (C)</p> Signup and view all the answers

Which of the following conditions can be mistaken for constipation due to similar symptoms?

<p>Irritable Bowel Syndrome (C)</p> Signup and view all the answers

What is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux?

<p>Position the infant in the crib on his or her abdomen, with the head elevated. (C)</p> Signup and view all the answers

What symptom would be most commonly reported by parents of a child with pyloric stenosis?

<p>Projectile vomiting (D)</p> Signup and view all the answers

Which condition is most likely if a child is reported to be scratching the anal area and complaining of itching?

<p>Pinworms (C)</p> Signup and view all the answers

What potential side effect should a nurse inform the parents about when administering pyrvinium?

<p>Red stool (C)</p> Signup and view all the answers

What instruction should a nurse provide to prevent the spread and reinfection of pinworms?

<p>Keep children's nails short. (B)</p> Signup and view all the answers

Which food item should a nurse recommend for a 2-year-old child experiencing frequent constipation?

<p>Whole-grain cereal (C)</p> Signup and view all the answers

What characteristic of a child's stool would lead a nurse to suspect intussusception?

<p>Currant jelly (A)</p> Signup and view all the answers

What is the preferred treatment for a child diagnosed with intussusception?

<p>A barium enema (B)</p> Signup and view all the answers

What condition causes the development of Meckel's diverticulum?

<p>A pouch forms when the vitelline duct fails to disappear. (B)</p> Signup and view all the answers

In the event of severe isotonic dehydration in a child, what is the primary risk?

<p>Shock (D)</p> Signup and view all the answers

What should a nurse observe for following a child's ingestion of acetaminophen?

<p>Liver toxicity symptoms (B)</p> Signup and view all the answers

What constitutes the typical presentation of pinworm infection in children?

<p>Nighttime anal itching (A)</p> Signup and view all the answers

Which dietary change is most effective for treating childhood constipation?

<p>Adding high fiber foods (D)</p> Signup and view all the answers

What is a critical nursing consideration for managing intussusception in children?

<p>Monitoring for changes in stool characteristics. (D)</p> Signup and view all the answers

What is the expected urine output for a 2-month-old infant?

<p>400 to 500 mL in 24 hours (A)</p> Signup and view all the answers

Which of the following is NOT an appropriate intervention when feeding a child with pyloric stenosis?

<p>Feed the infant quickly to prevent vomiting (B)</p> Signup and view all the answers

Which symptom is a characteristic assessment finding for Hirschsprungs disease in a 1-month-old infant?

<p>Ribbon-like stools (D)</p> Signup and view all the answers

What indicates moderate dehydration in a child?

<p>Dry mucous membranes (B)</p> Signup and view all the answers

What sign would most likely be present in a child with suspected appendicitis?

<p>Rebound tenderness in the right lower quadrant (D)</p> Signup and view all the answers

Which of the following would be observed in a child with kwashiorkor?

<p>White streak in hair (A)</p> Signup and view all the answers

What does an elevated erythrocyte sedimentation rate (ESR) in an infant with gastroenteritis indicate?

<p>Inflammation (B)</p> Signup and view all the answers

Which type of beverages should be avoided for fluid replacement in a dehydrated child?

<p>Cola or other caffeinated drinks (A)</p> Signup and view all the answers

Which of the following symptoms might lead a nurse to suspect dehydration in a child?

<p>Lethargy (B)</p> Signup and view all the answers

Which is a common feeding strategy for infants with pyloric stenosis?

<p>Give a thickened formula (B)</p> Signup and view all the answers

What is NOT a symptom of moderate dehydration in a child?

<p>Increased urine output (C)</p> Signup and view all the answers

A decrease in which parameter indicates worsening dehydration in a child?

<p>Urinary output (D)</p> Signup and view all the answers

What is likely to be observed during a physical exam of a child with kwashiorkor?

<p>Pitting edema (B)</p> Signup and view all the answers

Which of the following interventions is crucial for preventing complications in appendicitis?

<p>Perform regular abdominal assessments (B)</p> Signup and view all the answers

What is the primary purpose of providing anticipatory guidance to parents about developmental milestones?

<p>To increase parents' knowledge of growth and development (C)</p> Signup and view all the answers

Which dietary practice could potentially lead to a vitamin C deficiency in children?

<p>Using fruits primarily from homemade preserves (B)</p> Signup and view all the answers

When administering oral nystatin suspension for thrush, what is the correct method?

<p>Swab medication on the oral mucosa with a sterile applicator (A)</p> Signup and view all the answers

Why do infants have a higher risk of fluid and electrolyte imbalances compared to adults?

<p>A larger proportion of their body water is extracellular. (A)</p> Signup and view all the answers

How should the nurse interpret laboratory results showing pH 7.32, PaCO2 40, and HCO3 21 in an infant?

<p>Metabolic acidosis (B)</p> Signup and view all the answers

After surgery for pyloric stenosis, what should the nurse do if an infant is hungry and crying?

<p>Allow 1 ounce of glucose water at frequent intervals (D)</p> Signup and view all the answers

How much oral fluid should be administered to an 18-pound child with diarrhea to replace fluid loss?

<p>81 mL (A)</p> Signup and view all the answers

Which statement by a parent indicates a need for more education on poison prevention?

<p>I keep syrup of ipecac handy. (B)</p> Signup and view all the answers

What is the importance of understanding developmental milestones for parents?

<p>To identify areas needing intervention (C)</p> Signup and view all the answers

Which of the following actions is appropriate when caring for an infant post-anesthesia?

<p>Providing clear fluids initially (C)</p> Signup and view all the answers

What is a major reason for teaching parents about anticipatory guidance in child development?

<p>To enhance their parenting skills (C)</p> Signup and view all the answers

What is a common misconception regarding fluid replacement in infants?

<p>They require the same fluid amounts as adults. (C)</p> Signup and view all the answers

Which of the following is essential when administering medication to a child suffering from thrush?

<p>Use sterile equipment for application. (A)</p> Signup and view all the answers

Why is syrup of ipecac no longer recommended for home use in poison prevention?

<p>It can cause excessive vomiting. (C)</p> Signup and view all the answers

What health risk is heightened due to a child's higher extracellular water percentage?

<p>Rapid dehydration in hot climates. (D)</p> Signup and view all the answers

What symptom in a newborn most likely indicates tracheoesophageal fistula?

<p>Choking on the first feeding (A)</p> Signup and view all the answers

What is the expected acid-base imbalance due to persistent vomiting in a child?

<p>Alkalosis (C)</p> Signup and view all the answers

Which finding indicates ineffectiveness of treatment for dehydration in an infant?

<p>Weight loss of 4 ounces (C)</p> Signup and view all the answers

Why can rapid respirations contribute to dehydration?

<p>They cause evaporation of fluid on the mucous membranes. (C)</p> Signup and view all the answers

Which condition is indicated by a child weighing 4 ounces less after hospitalization for gastroenteritis?

<p>Ineffective treatment (B)</p> Signup and view all the answers

What is the most likely consequence of loss of hydrochloric acid from vomiting?

<p>Metabolic alkalosis (C)</p> Signup and view all the answers

In cases of dehydration, which assessment finding is considered less critical?

<p>Skin elasticity (D)</p> Signup and view all the answers

What effect does persistent vomiting have on electrolyte levels?

<p>Decreases potassium levels (A)</p> Signup and view all the answers

What should the nurse anticipate administering after gastric lavage for acetaminophen poisoning?

<p>N-acetylcysteine (C)</p> Signup and view all the answers

What is the primary source of lead exposure in children?

<p>Deteriorating paint in older buildings (D)</p> Signup and view all the answers

What is the immediate course of action for a child who swallowed dishwashing detergent?

<p>Take the child to the emergency department (A)</p> Signup and view all the answers

Which statement by a mother might suggest a cause for her child's ascariasis?

<p>My child often eats carrots pulled from the garden. (D)</p> Signup and view all the answers

What type of stool appearance is expected in a child diagnosed with celiac disease?

<p>Bulky and frothy (B)</p> Signup and view all the answers

Which grain is safe for a child with celiac disease to consume?

<p>Rice (D)</p> Signup and view all the answers

What is the nurse's priority goal in the care of a 7-month-old infant with acute gastroenteritis?

<p>Prevent fluid and electrolyte imbalance (B)</p> Signup and view all the answers

Which dietary modification should a nurse suggest for a child with mild diarrhea?

<p>An oral rehydrating solution, like Pedialyte (B)</p> Signup and view all the answers

What observation might indicate nonorganic failure to thrive in a child?

<p>Child appears limp and unresponsive (C)</p> Signup and view all the answers

Which nursing intervention is most appropriate for mothers of infants diagnosed with nonorganic failure to thrive?

<p>Educating the mother on positive caregiving behaviors (D)</p> Signup and view all the answers

Which sign is commonly associated with ascariasis in children?

<p>Abdominal pain or discomfort (D)</p> Signup and view all the answers

What might indicate a successful dietary adjustment in a child with celiac disease?

<p>Improvement in energy levels (C)</p> Signup and view all the answers

Which electrolyte imbalance is most concerning in a child with gastroenteritis?

<p>Hyponatremia (A)</p> Signup and view all the answers

What key aspect should the nurse address when discussing lead poisoning prevention with parents?

<p>Regularly washing hands prevents lead ingestion (C)</p> Signup and view all the answers

Flashcards

Tracheoesophageal fistula in newborns

A birth defect where the esophagus and trachea are improperly connected, leading to vomiting and choking during feeding.

Vomiting and acid-base imbalance

Prolonged vomiting leads to alkalosis because of lost stomach acids, disrupting the body's acid-base balance.

Infants and dehydration

Weight loss is a critical sign of dehydration in infants; infants have a high percentage of water in their bodies.

Rapid respirations and dehydration

Rapid breathing increases insensible water loss through evaporation from mucous membranes, contributing to dehydration.

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Meconium passage delay

Failure to pass meconium (first stool) within 24 hours after birth can be a sign of an underlying issue, but not specifically a TEF.

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Infant dehydration signs

Significant indicators are dry mucous membranes, decreased skin turgor, and weight loss.

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Ineffective treatment of gastroenteritis

Weight loss in a 3-month-old hospitalized with gastroenteritis suggests ongoing or worsening dehydration and ineffective treatment.

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Acid-base balance related to vomiting

Persistent vomiting results in a loss of hydrochloric acid and sodium chloride from the stomach, leading to alkalosis.

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Infant Gastroesophageal Reflux Intervention

Position the infant in a prone position after feedings to avoid increased intra-abdominal pressure.

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Pyloric Stenosis Symptom

Projectile vomiting is the key symptom of pyloric stenosis.

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Anal Itching Cause

Pinworms are a common cause of anal itching and scratching in children.

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Pyrvinium Side Effect

Pyrvinium (Povan) can cause red stools.

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Pinworm Prevention

Keeping children's fingernails short helps prevent the spread of pinworms.

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Constipation Diet

Whole-grain foods are good for constipation as they aid in digestion.

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Intussusception Stool

Currant jelly stools (blood and mucus) are a sign of intussusception.

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Intussusception Treatment

A barium enema is the first treatment for intussusception, not surgery.

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Meckel's Diverticulum Cause

Meckel's diverticulum is caused by the vitelline duct failing to disappear.

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Severe Dehydration Risk

Severe isotonic dehydration puts a child at high risk for shock.

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Vitamin C deficiency cause

Homemade fruit preserves can cause vitamin C deficiency because heat destroys vitamin C.

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Nystatin administration

Use a sterile applicator to apply nystatin suspension directly to the oral mucosa.

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Infant fluid imbalance vulnerability

Infants have a higher percentage of extracellular water compared to adults, making them more prone to fluid and electrolyte imbalances.

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Metabolic acidosis pH

A pH lower than 7.35 indicates metabolic acidosis, aligning with a lower HCO3 (bicarbonate) level.

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Post-surgery infant feeding

After pyloric stenosis surgery, give infants small amounts of glucose water, gradually increasing to regular formula.

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Oral fluid replacement formula

Oral fluid replacement = 10 milliliters per kilogram of body weight.

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Poison prevention education

Parents should be educated on avoiding syrup of ipecac for poison ingestion; contact poison control, bringing the ingested substance, and going to the emergency department.

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Anticipatory guidance

Providing expected developmental milestones to parents.

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Gastric Lavage Follow-up

Following gastric lavage, the nurse anticipates administering N-acetylcysteine (Mucomyst), which is the antidote for acetaminophen.

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Lead Poisoning Source

Deteriorating paint in older buildings is the main source of lead poisoning exposure.

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Dishwashing Detergent Ingestion

For a child who swallows dish soap, immediately take the child to the emergency department and bring the detergent container.

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Ascariasis Cause

Ingesting roundworm eggs from contaminated soil is a cause of ascariasis.

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Celiac Disease Stools

Children with celiac disease typically have stools that are large, bulky, and frothy due to malabsorption.

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Celiac Disease Safe Grain

Rice is a safe grain for children with celiac disease since it's gluten-free.

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Acute Gastroenteritis Priority

Preventing fluid and electrolyte imbalance is the priority in treating acute gastroenteritis.

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Mild Diarrhea Diet

For mild diarrhea in children, soft foods like rice, bananas, toast, and applesauce, and oral rehydration solutions (like Pedialyte) are recommended.

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Nonorganic Failure To Thrive

A child with nonorganic failure to thrive may exhibit limpness, responsiveness to cuddling, and appear wary of caregivers.

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Failure To Thrive Intervention

With a non-organic failure to thrive child, consider intervention with the mother which avoid pointing out errors or negative characterizations of the child.

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What is rickets caused by?

Rickets is caused by a deficiency of vitamin D. This deficiency leads to bone deformities.

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What should parents avoid feeding a child allergic to cow's milk?

Parents should avoid feeding a child with cow's milk allergy foods containing casein, as it is a protein found in cow's milk.

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Define constipation.

Constipation is defined as having fewer than seven bowel movements in a two-week period.

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What type of surgery is used to repair hernias?

A herniorrhaphy is a surgical procedure to repair hernias. It is a relatively simple procedure and is well-tolerated by children.

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What is the connection between casein and cow's milk?

Casein is a protein found in cow's milk. It is a common allergen in children.

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How many bowel movements constitute constipation?

Fewer than seven bowel movements in a two-week period is medically defined as constipation.

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What is a herniorrhaphy?

A herniorrhaphy is a surgical procedure used to repair hernias. It is usually a simple procedure.

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What is the main cause of rickets?

Rickets is primarily caused by a deficiency of vitamin D. It leads to bone deformities in children.

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Urine Output of a 2-month-old

A healthy 2-month-old should produce 400-500 mL of urine per day.

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Pyloric Stenosis Feeding

Infants with pyloric stenosis need thickened formula, slow feeding, and burping to avoid vomiting.

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Hirschsprung's Disease Signs

Ribbon-like stools, fever, failure to thrive, vomiting, and decreased peristalsis are all signs of Hirschsprung's disease.

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Moderate Dehydration

Moderate dehydration involves 10% weight loss, dry mucous membranes, and normal anterior fontanel.

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Appendicitis Symptoms

Appendicitis presents with right lower quadrant pain, guarding, rebound tenderness, and pain on lifting the thigh.

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Kwashiorkor Symptoms

Kwashiorkor, a protein deficiency, causes a white streak in the hair, edematous abdomen, and slowed growth.

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Elevated ESR in Gastroenteritis

An elevated erythrocyte sedimentation rate (ESR) indicates inflammation, a characteristic of gastroenteritis.

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Fluid Replacement for Dehydration

Caffeinated beverages cause diuresis and worsen dehydration, so avoid them when rehydrating a child.

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Infant Dehydration

Dehydration can be serious in infants, as they have a high percentage of water in their bodies.

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Oral Fluid Replacement

The general rule for oral fluid replacement is 10 milliliters per kilogram of body weight.

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Study Notes

Newborn Findings Suggestive of Tracheoesophageal Fistula

  • Choking on first feeding is a key sign.

Acid-Base Imbalance from Persistent Vomiting

  • Persistent vomiting leads to alkalosis due to loss of stomach acid and sodium chloride.

Ineffective Gastroenteritis Treatment in a 3-Month-Old

  • Weight loss of 4 ounces in a 3-month-old hospitalized for gastroenteritis indicates ineffective treatment. This is significant because infant's weight is largely water.

Rapid Respirations and Dehydration

  • Rapid respirations increase insensible fluid loss due to evaporation from mucous membranes.

Gastroesophageal Reflux Intervention

  • Position the infant prone (on their abdomen) after feedings to avoid intraabdominal pressure.

Pyloric Stenosis Symptoms

  • Projectile vomiting is a hallmark symptom of pyloric stenosis.

Anal Itching Indication

  • Anal itching and scratching are suggestive of pinworms.

Pyrvinium (Povan) Side Effects

  • Pyrvinium stains clothing and turns stools red.

Preventing Pinworm Spread

  • Keeping children's fingernails short helps prevent pinworm spread.

Constipation Diet Modification

  • Increased high roughage foods like whole-grain breads and cereals are beneficial for constipation.

Intussusception Stool Description

  • Currant jelly stools (blood and mucus without feces) indicate intussusception, particularly 12 hours after obstruction onset.

Intussusception Treatment

  • Barium enema is the preferred treatment for intussusception, aiming to untwist the bowels. Surgery is a backup.

Meckels Diverticulum Cause

  • Meckels diverticulum results from the vitelline duct failing to disappear after birth, forming a pouch.

Risk with Severe Isotonic Dehydration

  • Shock is the most serious risk in severe isotonic dehydration.

Acetaminophen Ingestion Treatment

  • N-acetylcysteine (Mucomyst) follows gastric lavage for acetaminophen poisoning.

Lead Poisoning Prevention Source

  • Deteriorating paint in older buildings is the primary community source of lead.

Ingested Dishwashing Detergent Action

  • Immediately take the child to the nearest emergency department. Do not induce vomiting.

Ascariasis Possible Cause

  • Ingesting roundworm eggs from contaminated soil is a possible cause. Children who play or eat food near soil could be at higher risk.

Celiac Disease Stool Appearance

  • Celiac disease results in bulky, frothy stools due to malabsorption.

Celiac Disease Allowed Grain

  • Rice is a safe grain for children with celiac disease.

Acute Gastroenteritis Priority Goal

  • Preventing fluid and electrolyte imbalance is the top priority in acute gastroenteritis.

Mild Diarrhea Dietary Modification

  • An oral rehydrating solution like Pedialyte is recommended for mild diarrhea.

Nonorganic Failure to Thrive Assessment

  • Limpness (hypotonia) and unresponsiveness to cuddling are common in non-organic failure to thrive.

Nonorganic Failure to Thrive Parent Education

  • Educate parents on developmental milestones to build their understanding.

Vitamin C Deficiency Possible Cause

  • Homemade preserves (can destroy vitamin C through heat) can be a potential cause.

Thrush Medication Administration

  • Swabbing the affected oral mucosa with diluted oral medication is the recommended method.

Infant Vulnerability to Fluid Imbalance

  • Infants' proportionally larger percentage of extracellular body water makes them more susceptible to fluid imbalance.

Dehydration Metabolic Acidosis Interpretation

  • A pH below 7.35, with corresponding bicarbonate level, suggests metabolic acidosis in dehydration.

Postoperative Pyloric Stenosis Feeding

  • Glucose water is an initial feeding after pyloric stenosis surgery, with gradual increases in regular formula.

Oral Fluid Replacement for Diarrhea

  • Oral fluid replacement for dehydration is calculated as 10 mL per kilogram of body weight.

Poison Prevention Education Gap

  • A parent keeping syrup of ipecac handy signals a knowledge gap regarding poison prevention guidelines (avoid inducing vomiting without professional medical guidance. Immediately contact the poison control center and bring the substance ingested to the ED.)

Elevated Urine Output Reporting Criteria

  • A 2-month old with a 150mL urine output in 24 hours requires immediate physician reporting.

Pyloric Stenosis Feeding Interventions

  • Burping, slow feeding, and refeeding after vomiting are important interventions during feeding. Infant is not fed formula thinned with water, but thickened with cereal. Positioned on their right side after feeding.

Hirschsprung's Disease Suspicion Assessment

  • Ribbon-like stools, fever, failure to thrive, vomiting and diminished peristalsis are assessments suggesting Hirschsprung's disease.

Moderate Dehydration Assessment

  • Includes 10% weight loss, dry mucous membranes, and a normal anterior fontanel. It does not include increased urinary output.

Appendicitis Assessment Signs

  • Signs include localized right lower quadrant pain, guarding, rebound tenderness, and pain with thigh raising. C-reactive protein will be elevated in response to infection.

Kwashiorkor Assessment Findings

  • Edema of the abdomen, lack of growth, and a white streak in hair are associated with kwashiorkor.

Erythrocyte Sedimentation Rate (ESR) and Inflammation

  • Elevated ESR indicates an inflammatory response in gastroenteritis.

Dehydration Fluid Replacement and Caffeinated Drinks

  • Caffeinated drinks are inappropriate for fluid replacement due to their diuretic effect.

Rickets Deficiency

  • Inadequate vitamin D results in rickets, causing bony deformities.

Cows' Milk Allergy Avoidance

  • Avoid foods including casein, a protein component of cow's milk.

Constipation Medical Definition

  • Fewer than seven bowel movements in two weeks is a medical definition for constipation.

Hernia Repair Surgical Procedure

  • Herniorrhaphy is the surgical procedure used to repair hernias.

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