The child with a gastrointestinal disorders part #2

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Questions and Answers

What condition in a child should prompt a nurse to consider increased fluid requirements?

Congestive heart failure

Acute kidney injury

Pulmonary edema

Fever (correct)

Melena, the passage of black, tarry stools, indicates bleeding from which area of the gastrointestinal tract?

Lower gastrointestinal (GI) tract

Biliary system

Upper gastrointestinal (GI) tract (correct)

Rectal area

Which type of dehydration occurs when electrolyte and water deficits are present in approximately balanced proportions?

Severe dehydration

Isotonic dehydration (correct)

Hypotonic dehydration

Hypertonic dehydration

What is the response of the respiratory rate in a mechanically ventilated child with regard to fluid loss?

Increased respiratory rate increases insensible fluid loss Signup and view all the answers

What is a common misinterpretation of melena as a symptom?

Melena indicates bright red blood from the anal fissure Signup and view all the answers

Which condition is most likely to result in fluid overload in a pediatric patient?

Congestive heart failure Signup and view all the answers

In the context of isotonic dehydration, which of the following statements is correct?

It occurs when both water and electrolyte deficits are similar. Signup and view all the answers

Which of the following conditions does NOT typically increase fluid requirements in children?

Congestive heart failure Signup and view all the answers

What type of dehydration is characterized by water loss exceeding electrolyte loss?

Hypertonic Signup and view all the answers

What physical assessment finding in an infant indicates dehydration?

Poor skin turgor Signup and view all the answers

Which associated factor should the nurse inquire about in a toddler with acute diarrhea?

Antibiotic therapy Signup and view all the answers

Which viral pathogen is the most frequent cause of acute diarrhea in young children?

Rotavirus Signup and view all the answers

Which parasite is known to cause acute diarrhea?

Giardia lamblia Signup and view all the answers

Which lab results of a stool specimen indicate bacterial gastroenteritis?

Neutrophils and red blood cells Signup and view all the answers

What is the first therapeutic management step for a child with acute diarrhea and moderate dehydration?

Oral rehydration solution (ORS) Signup and view all the answers

Which statement by a parent indicates a correct understanding of dietary management for a child recovering from diarrhea?

I should serve my child a normal diet with easily digested foods for the next 48 hours. Signup and view all the answers

Which condition causes hypotonic dehydration?

Excess electrolyte loss Signup and view all the answers

What is a potential long-term effect of not identifying and managing celiac disease in children?

Chronic diarrhea Signup and view all the answers

In the case of acute diarrhea, what should be avoided according to current management recommendations?

Antidiarrheal medications Signup and view all the answers

Which pathogen is less commonly associated with acute diarrhea in children in the United States?

Shigella organisms Signup and view all the answers

What symptom is commonly seen alongside severe dehydration in children?

Lethargy Signup and view all the answers

What is the primary treatment for severe dehydration in children?

Intravenous (IV) fluids Signup and view all the answers

Which antidiarrheal medication should be avoided in children with acute diarrhea?

Loperamide (Imodium A-D) Signup and view all the answers

What is the most likely cause of constipation in a child taking antihistamines?

Antihistamines Signup and view all the answers

Which of the following foods is considered high in fiber for a child with chronic constipation?

Popcorn Signup and view all the answers

What is the primary surgical treatment for Hirschsprung disease?

Surgical removal of affected bowel section Signup and view all the answers

Which enema solution is considered best for children undergoing bowel preparation?

Normal saline Signup and view all the answers

How should a nurse prepare a 3-year-old child for a temporary colostomy?

By using visual aids to explain the procedure Signup and view all the answers

For a child with acute diarrhea, what is the recommended fluid intake method if IV fluids are not indicated?

Oral rehydration solution (ORS) Signup and view all the answers

Which symptom is NOT typical of Hirschsprung disease?

Frequent bowel movements Signup and view all the answers

Why are antidiarrheal medications generally not used in children?

They can worsen diarrhea or cause complications Signup and view all the answers

What type of diet should be implemented preoperatively for a child with Hirschsprung disease?

Low-fiber, high-caloric diet Signup and view all the answers

Which characteristic does NOT apply to oral rehydration solutions (ORS)?

High osmolality Signup and view all the answers

What is a common effect of using oil retention enemas in children?

Decreased bowel motility Signup and view all the answers

When assessing a child's recent medication history for constipation, which class should be considered the most suspect?

Antihistamines Signup and view all the answers

What is the most common congenital malformation of the gastrointestinal tract?

Meckel diverticulum Signup and view all the answers

Which statement accurately describes the inflammation present in Crohn disease?

It can involve any part of the GI tract. Signup and view all the answers

Which medication class is commonly used for treating moderate to severe inflammatory bowel disease?

Corticosteroids Signup and view all the answers

What is the main purpose of bismuth subsalicylate, clarithromycin, and metronidazole in peptic ulcer treatment?

To eradicate Helicobacter pylori. Signup and view all the answers

What is a characteristic feature of hepatitis A?

It is primarily transmitted through the fecal-oral route. Signup and view all the answers

Which vaccine is universally recommended for all newborns?

Hepatitis B vaccine Signup and view all the answers

What treatment offers the best chance of survival for a child with cirrhosis?

Liver transplantation Signup and view all the answers

What is the earliest clinical manifestation of biliary atresia that may be observed in an infant?

Jaundice Signup and view all the answers

Which of the following medications is NOT typically used in the treatment of inflammatory bowel disease?

Antidiarrheal medications Signup and view all the answers

Which aspect differentiates Crohn disease from ulcerative colitis?

Crohn disease can affect the entire GI tract. Signup and view all the answers

What characterizes the infection process of Helicobacter pylori?

It is commonly associated with peptic ulcers. Signup and view all the answers

Which layer of the bowel wall does ulcerative colitis primarily affect?

Mucosa and submucosa Signup and view all the answers

What is a primary mode of transmission for hepatitis A?

Fecal-oral route Signup and view all the answers

Which symptom is least likely to be associated with biliary atresia?

Severe abdominal pain Signup and view all the answers

What is the main risk associated with saliva overflow into the larynx during care?

Cyanosis Signup and view all the answers

What characterizes a strangulated hernia?

Impairment of blood supply Signup and view all the answers

What describes hypertrophic pyloric stenosis?

Thickening of pyloric muscle Signup and view all the answers

Which physical finding is most indicative of pyloric stenosis?

Visible peristalsis Signup and view all the answers

An infant with pyloric stenosis is likely to experience which of the following?

Weight loss Signup and view all the answers

What is a potential complication of excessive vomiting in an infant with pyloric stenosis?

Metabolic alkalosis Signup and view all the answers

What does intussusception involve?

Telescoping of bowel segments Signup and view all the answers

Which nursing action is appropriate if a child passes a normal stool while suspected of having intussusception?

Report the status to the practitioner Signup and view all the answers

What is the primary indicator for referring a child with celiac disease to a nutritionist?

Dietary education for family Signup and view all the answers

Which option does NOT represent a characteristic of a hiatal hernia?

Typically causes abdominal pain Signup and view all the answers

What distinguishes an incarcerated hernia from a strangulated hernia?

Easy reduction Signup and view all the answers

What is the main characteristic of an omphalocele?

Protrusion of viscera into the umbilical cord Signup and view all the answers

In which part of the abdomen do significant findings occur in pyloric stenosis?

Upper abdomen Signup and view all the answers

Which of the following symptoms is LEAST likely to be associated with pyloric stenosis?

Weight gain Signup and view all the answers

What is the primary purpose of dietary management in celiac disease?

To help the child adhere to dietary management Signup and view all the answers

What should be the nursing care priority for a patient with total parenteral nutrition (TPN)?

Teaching family signs of central venous catheter infection Signup and view all the answers

What is the initial therapeutic approach to the mother of a newborn with a cleft lip and palate?

Encouraging her to express her feelings. Signup and view all the answers

What is the appropriate action when a newborn with a gastroschisis pulls out their NG tube?

Replace the NG tube and continue low intermittent suction Signup and view all the answers

What is the most accurate noninvasive method to confirm eradication of H.pylori after treatment?

Stool sample test Signup and view all the answers

Which feeding approach helps meet the sucking needs of infants with cleft lip and palate before surgical repair?

Providing satisfaction of sucking needs. Signup and view all the answers

Why might a dairy-free diet be prescribed for a child with recurrent abdominal pain?

To rule out lactose intolerance Signup and view all the answers

What nursing intervention should be included for a mother intending to breastfeed an infant with a cleft palate?

Encouraging and helping her to breastfeed. Signup and view all the answers

What is an important aspect of postoperative care for an infant whose cleft lip was repaired?

Cleansing the suture line and using arm restraints. Signup and view all the answers

What dietary change is essential for managing celiac disease effectively?

Lifelong dietary avoidance of gluten Signup and view all the answers

What action should the nurse take during the first few days post-surgery for cleft lip?

Remove restraints periodically for cuddling. Signup and view all the answers

What key consideration must be accounted for when managing TPN for a child?

Minimizing risks related to catheter infection Signup and view all the answers

What should the response to parents be if H.pylori is detected in their child?

A stool sample can determine if it has been eradicated Signup and view all the answers

For a neonate suspected to have a tracheoesophageal fistula, which nursing care is essential?

Keeping the infant supine while elevating their head. Signup and view all the answers

Which statement regarding the emotional needs of parents with a child having cleft lip or palate is true?

Mother’s feelings must be addressed for proper attachment. Signup and view all the answers

What complication is associated with a central venous access device during TPN therapy?

Infection and occlusions Signup and view all the answers

What is a recommended strategy for feeding a baby with a cleft palate?

Using modified nipples to assist in breastfeeding. Signup and view all the answers

Why is it important to monitor bowel sounds after NG tube removal in a newborn?

To assess for signs of bowel function return Signup and view all the answers

What does effective postoperative care for an infant after cleft lip surgery require?

Gentle cleansing of the suture site after feeding. Signup and view all the answers

What misconception about celiac disease is false?

Celiac disease can have stress-related triggers Signup and view all the answers

What should the nurse monitor closely in a neonate with tracheoesophageal fistula?

Position maintenance, keeping the head elevated. Signup and view all the answers

What is a non-dietary approach to managing recurrent abdominal pain in children?

Providing reassurance Signup and view all the answers

During the healing process after a cleft lip repair, how should arm restraints be used?

They can be removed periodically to allow for mobility. Signup and view all the answers

What risk is not associated with placing the TPN and gastrostomy tubing under the diaper?

Puncture of the feeding tube Signup and view all the answers

In educating parents about their infant's cleft lip and palate, what should the nurse emphasize?

Early therapy is vital for improvement in outcomes. Signup and view all the answers

How can nurses help facilitate bonding between the mother and her infant with cleft lip and palate?

By allowing the mother to express concerns and feelings. Signup and view all the answers

What skills may be beneficial for a nurse caring for a neonate post-cleft lip repair?

Ability to provide psychosocial support to parents. Signup and view all the answers

What is the most appropriate nursing action for a school-age child with vomiting after a viral illness?

Brush teeth or rinse mouth after vomiting. Signup and view all the answers

Which method is most effective in minimizing gastroesophageal reflux in an infant?

Thicken the formula with rice cereal. Signup and view all the answers

What is the primary action of histamine-receptor antagonists like ranitidine in infants with gastroesophageal reflux?

Reduce gastric acid production. Signup and view all the answers

Which symptom is most indicative of acute appendicitis in a child?

Intense abdominal pain at McBurney point. Signup and view all the answers

In a child with appendicitis, which sign should the nurse monitor for potential perforation?

Sudden relief from pain. Signup and view all the answers

What is the best position to relieve discomfort for a child with suspected appendicitis?

Allow to assume a position of comfort. Signup and view all the answers

What characterizes Meckel diverticulum in children?

Intestinal bleeding may vary from mild to profuse. Signup and view all the answers

What dietary modification can help minimize reflux in an infant with gastroesophageal reflux?

Adding rice cereal to formula. Signup and view all the answers

Which symptom does NOT typically indicate acute appendicitis?

Abdominal pain relieved by eating. Signup and view all the answers

In the event of perforation during appendicitis, which condition might you expect?

Sudden relief of pain. Signup and view all the answers

Which practice is advised against when managing a child with possible appendicitis?

Applying heat to the abdomen. Signup and view all the answers

What does successful treatment of Meckel diverticulum often involve?

Surgical intervention for symptomatic cases. Signup and view all the answers

Which of the following actions should be taken for a child diagnosed with gastroesophageal reflux?

Frequent, small feedings. Signup and view all the answers

Study Notes

Pediatric Gastrointestinal Disorders - Study Notes

Fluid Requirements in Children: Fever in young children increases insensible fluid loss due to higher body surface area relative to fluid volume. Mechanical ventilation, congestive heart failure, and increased intracranial pressure (ICP) do not typically cause increased fluid requirements in the same way.
Melena and GI Bleeding: Black, tarry stools (melena) indicate bleeding from the upper gastrointestinal (GI) tract, not the lower GI tract, perianal area, or hemorrhoids.
Isotonic Dehydration: Isotonic dehydration is the most common type, characterized by balanced electrolyte and water deficits.
Hypertonic Dehydration: Hypertonic dehydration occurs when water loss exceeds electrolyte loss; it's a dangerous form and often caused by consuming fluids with high solute concentrations.
Dehydration Assessment: Dehydration in infants shows poor skin turgor, weight loss, lethargy, and tachycardia; capillary refill will be prolonged, not brisk.
Acute Diarrhea Causes: Antibiotic therapy is a common cause of acute diarrhea in children. Celiac disease, immunodeficiency, and protein malnutrition are associated with chronic diarrhea.
Viral Diarrhea Pathogen: Rotavirus is the most frequent viral cause of acute diarrhea in young children.
Parasitic Diarrhea: Giardia lamblia is a common parasite causing acute diarrhea.
Bacterial Gastroenteritis Diagnosis: Stool specimens showing neutrophils and red blood cells confirm bacterial gastroenteritis.
Acute Diarrhea Treatment (Moderate): Oral rehydration solution (ORS) is the first-line treatment for moderate dehydration. Other options like clear liquids, adsorbents, or antidiarrheal medications are not the initial therapy.
Post-Diarrhea Diet: A regular diet with easily digestible foods, not low-fiber, clear liquids, or carbonated drinks, is best for a child recovering from diarrhea.
Severe Dehydration Treatment: In cases of severe dehydration due to diarrhea and vomiting, intravenous (IV) fluids are the initial treatment, not ORS, clear liquids, or antidiarrheals.
Antidiarrheal Medications: Antidiarrheal medications like loperamide are generally not recommended for the treatment of acute infectious diarrhea. They may worsen dehydration by slowing motility.
Constipation Causes: Antihistamines can cause constipation in children. Diet, allergies, and emotional factors may also contribute.
High-Fiber Foods for Constipation: Popcorn is a useful source of high fiber for constipation.
Hirschsprung Disease Treatment: Surgical removal of the affected section of the bowel is the usual therapeutic management. Daily enemas and a temporary colostomy may be part of preoperative or postoperative management.
Hirschsprung Disease Enema Solutions: Normal saline solutions are ideal for administering enemas in children.
Hirschsprung Disease Psychological Considerations: Psychosocial preparation is important for children with Hirschsprung disease undergoing surgery.
Vomiting Management: Post-vomiting, rinsing the mouth is important and carbohydrate-containing fluids should be offered.
Gastroesophageal Reflux (GER): Thicken formula with rice cereal. Do not put the child in Trendelenburg position.
GER Medications: Histamine-receptor antagonists (like cimetidine or ranitidine) reduce gastric acid production.
Acute Appendicitis Symptoms: The most indicative symptom for acute appendicitis is localized abdominal pain, most intense at McBurney's point. Rebound tenderness and sudden pain relief may indicate perforation. Avoid applying heat or administering enemas.
Meckel Diverticulum: Meckel diverticulum is a common congenital GI malformation, often presenting with intestinal bleeding (ranging from mild to severe).
Crohn Disease vs. Ulcerative Colitis: Crohn disease involves any part of the GI tract, in discontinuous segments (skip lesions), and all layers of the bowel wall. Ulcerative colitis only involves the colon and rectum in continuous segments.
Crohn's and Ulcerative Colitis Treatment: Corticosteroids are a key treatment for moderate or severe inflammatory bowel disease.
Peptic Ulcer Disease Treatment: Medications like bismuth subsalicylate, clarithromycin, and metronidazole are used to eradicate H. pylori.
Hepatitis A: Hepatitis A is acute, not chronic; it's transmitted via the fecal-oral route.
Hepatitis B: Hepatitis B vaccination is now routine for newborns.
Cirrhosis Treatment: Liver transplantation is the most successful treatment for advanced cirrhosis.
Biliary Atresia: Jaundice is the earliest clinical sign of biliary atresia.
Cleft lip and Palate (Surgical Considerations): The initial approach with parents is to support expression of emotions while emphasizing the normalcy of their child. Post-operative care focuses on gentle suture line care and maintaining infants in supine or side-lying positions to prevent issues.
Tracheoesophageal Fistula: Maintaining a head-elevated position is important for newborns suspected of having a tracheoesophageal fistula, as oral feedings are initially avoided.
Hernia Types: Strangulated hernia is a type of hernia where the impaired blood supply in the herniated organ is a primary concern.
Pyloric Stenosis: Pyloric stenosis involves hypertrophy of the pyloric muscle, not dilation, hypotonicity, or reduction of tone.
Pyloric Stenosis Clinical Signs: Visible peristaltic waves and weight loss are important signs of pyloric stenosis. Excessive vomiting can lead to metabolic alkalosis.
Intussusception: Intussusception is the telescoping of one segment of bowel into another; if the child passes a brown stool, the practitioner should be notified immediately.
Celiac Disease Management: A nutritionist is crucial for guidance on a lifelong gluten-free diet for celiac disease.
Short Bowel Syndrome (Home Management): Teaching the family about recognizing central venous catheter infections is a critical part of home management for infants with short bowel syndrome undergoing TPN and gastrostomy feedings.
Gastroschisis Post-op Care: Immediate replacement of an accidentally removed NG tube and maintaining it is important for providing proper decompression and drainage. The prescribed low-wall intermittent suction should be resumed.
Peptic Ulcer Disease Diagnosis (H. pylori): Stool samples, not further endoscopies, are used to confirm eradication of H. pylori after treatment.
Recurrent Abdominal Pain (RAP) and Dairy-Free Diet: A dairy-free diet is typically implemented to rule out lactose intolerance.

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This quiz covers essential study notes on pediatric gastrointestinal disorders, focusing on fluid requirements, dehydration types, and GI bleeding. It provides insights into how conditions like fever and mechanical ventilation impact children's fluid balance. Prepare to assess key concepts in managing gastrointestinal health in young patients.