#7: pediatric dehydration/gastroenteritis Flashcards
When evaluating the extent of an infant‘s dehydration, the nurse should recognize that the symptoms of severe dehydration include:
A. tachycardia, decreased tears, 5% weight loss.
B. normal pulse and blood pressure, intense thirst.
C.. irritability, moderate thirst, normal eyes and fontanel.
D. tachycardia, parched mucous membranes, sunken eyes and fontanel.
D. tachycardia, parched mucous membranes, sunken eyes and fontanel.
Infants with severe dehydration have more than 10% weight loss. Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected. The infant would be extremely irritable (or lethargic), with sunken eyes and fontanel. These are the symptoms of severe dehydration.
Therapeutic management of the child with an inflammatory bowel disease (IBD) includes a diet that has which component?
A. Low protein
B. Low calorie
C. High fiber
D. Vitamin supplements
D. Vitamin supplements
A high-protein, high-calorie diet is needed to help correct nutrition deficits, A high-fibre diet is not recommended for IBD as the fibre may increase gastrointestinal symptoms. Even small amounts of bran have been associated with a worsening of the child’s condition. Multivitamins, iron, and folic acid supplementation are recommended.
A child has a nasogastric (NG) tube after surgery for acute appendicitis. The purpose of the NG tube is to:
A. allow transperitoneal drainage.
B. maintain an accurate record of output.
C. prevent the spread of infection.
D. prevent abdominal distention.
D. prevent abdominal distention.
The Penrose drain is used to permit transperitoneal drainage. NG drainage is only one part of the child’s output. The nurse would need to incorporate the NG drainage with other output. There is no relationship to the spread of infection. The NG tube is used to maintain gastric decompression until the return of intestinal activity.
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. What is the most appropriate nursing action?
A. Notify the physician.
B. Measure abdominal girth.
C. Auscultate for bowel sounds.
D. Take vital signs, including blood pressure.
A. Notify the physician.
Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated. Measuring abdominal girth, auscultating for bowel sounds, and taking vital signs may be indicated, but the physician still should be notified as to the change in status.
The nurse assesses the newborn immediately after birth. A tracheoesophageal fistula should be suspected if what condition is present?
A. Jaundice
B. Clubfeet
C. Absence of sucking
D. Excessive amount of frothy saliva in the mouth
D. Excessive amount of frothy saliva in the mouth
Jaundice is not usually associated with a tracheoesophageal fistula, nor are clubfeet.. The infant is able to suck, just not manage the secretions. Excessive salivation and drooling indicates tracheoesophageal fistulas. With a fistula the child has difficulty managing the secretions, causing choking, coughing, and cyanosis.
What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?
A. Liver transplantation may be needed eventually.
B. Death usually occurs by 6 months of age.
C. Prognosis for a full recovery is excellent.
D. Children with surgical correction live normal lives.
A. Liver transplantation may be needed eventually.
Most children with biliary atresia will ultimately require liver transplantation. If untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention but it is not a cure. Liver transplantation is usually required. Even with surgical intervention, many individuals progress to liver failure and require transplantation.
A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions for acute diarrhea. Instructions to the mother about breastfeeding should include to:
A. continue breastfeeding.
B. stop breastfeeding until breast milk is cultured.
C. stop breastfeeding until diarrhea is absent for 24 hours.
D. express breast milk and dilute with sterile water before feeding.
A. continue breastfeeding.
Breastfeeding should continue. Culturing the breast milk is not necessary. Breastfeeding can continue along with oral rehydration solution to replace the ongoing fluid loss caused by the diarrhea. Breast milk should not be diluted.
Incorrect
Which statement best describes Hirschsprung’s disease?
A. The colon has an aganglionic segment.
Hirschsprung’s disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine resulting from the lack of ganglion. It is associated with an inability to pass meconium within 24 to 48 hours of birth or feces if the child is older. There is a lack of peristalsis in the affected segment, which interferes with the evacuation of solid waste. The internal sphincter does not relax and as a result, stool is not evacuated.
B. There is passage of excessive amounts of meconium in the newborn.
C. It results in excessive peristaltic movements within the gastrointestinal tract.
D. It results in frequent evacuation of solids, liquid, and gas.
A. The colon has an aganglionic segment.
Hirschsprung’s disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine resulting from the lack of ganglion. It is associated with an inability to pass meconium within 24 to 48 hours of birth or feces if the child is older. There is a lack of peristalsis in the affected segment, which interferes with the evacuation of solid waste. The internal sphincter does not relax and as a result, stool is not evacuated.
A child is admitted to the hospital and diagnosed with ulcerative colitis. The nurse should evaluate the patient for which associated symptoms?
A. Rectal bleeding
B. Anal lesions
C. Diarrhea
D. joint pain
E. anorexia
A. Rectal bleeding
Rectal bleeding is common with ulcerative colitis. Anal lesions are rare in ulcerative colitis. Diarrhea is often severe with ulcerative colitis. Joint pain and anorexia can be mild to moderate with ulcerative colitis.
C. Diarrhea
Rectal bleeding is common with ulcerative colitis. Anal lesions are rare in ulcerative colitis. Diarrhea is often severe with ulcerative colitis. Joint pain and anorexia can be mild to moderate with ulcerative colitis.
D Joint pain
Rectal bleeding is common with ulcerative colitis. Anal lesions are rare in ulcerative colitis. Diarrhea is often severe with ulcerative colitis. Joint pain and anorexia can be mild to moderate with ulcerative colitis.
E.. Anorexia
Rectal bleeding is common with ulcerative colitis. Anal lesions are rare in ulcerative colitis. Diarrhea is often severe with ulcerative colitis. Joint pain and anorexia can be mild to moderate with ulcerative colitis.
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child‘s mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend:
A. bringing the child to the hospital for intravenous fluids.
B. alternating giving the child ORS and carbonated drinks.
C. continuing to give the child ORS frequently in small amounts.
D. maintaining the child on NPO for 8 hours and resuming ORS if vomiting has subsided.
C. continuing to give the child ORS frequently in small amounts.
A school-age child with mild dehydration can be rehydrated safely at home with oral solutions. Carbonated drinks should not be given to the child. They may have high carbohydrate content and contain caffeine, which is a diuretic. Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals. NPO status is not indicated.
What factor predisposes an infant to fluid imbalances?
A. Decreased surface area
B. Lower metabolic rate
C. Immature kidney functioning
D. Decreased daily exchange of extracellular fluid
C. Immature kidney functioning
The infant has a proportionately greater body surface area, which allows for greater insensible water loss. The infant has a higher metabolic rate. The infant’s kidneys are unable to concentrate or dilute urine, conserve or excrete sodium, or acidify urine. This results in an increased amount of extracellular fluid in the infant.
What diet would be appropriate for the child with celiac disease?
A. Salt-free
B. Phenylalanine-free
C. Low gluten
D. High calories, low protein, low fat
C. Low gluten
The diet does not have to be salt free. Low phenylalanine is indicated in phenylketonuria. Celiac disease is characterized by intolerance to gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated. Diet should be high in calories and protein and low in fat.
An infant with neurological impairment and delay is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medications are proton pump inhibitors?
A. Ranitidine (Zantac)
B. Omeprazole (Prilosec)
C. Pantoprazole (Protonix)
D. Glycopyrrolate (Robinul)
E. Bethanechol (Urecholine)
A. Omeprazole (Prilosec)
Omeprazole (Losec) and pantoprazole (Pantoloc) use a proton pump inhibitor that blocks the action of acid-producing cells. Ranitidine (Zantac) is a histamine-2 (H2) receptor blocker, not a proton pump inhibitor. Ranitidine (Zantac) inhibits the action of histamine at the H2 receptor site in the stomach that results in the inhibition of gastric acid secretion. Glycopyrrolate (Robinul) is an anticholinergic agent that is used to inhibit excessive salivation. Bethanechol (Urecholine) is a prokinetic drug and remains controversial in use.
Correct
B. Pantoprazole (Protonix)
Omeprazole (Losec) and pantoprazole (Pantoloc) use a proton pump inhibitor that blocks the action of acid-producing cells. Ranitidine (Zantac) is a histamine-2 (H2) receptor blocker, not a proton pump inhibitor. Ranitidine (Zantac) inhibits the action of histamine at the H2 receptor site in the stomach that results in the inhibition of gastric acid secretion. Glycopyrrolate (Robinul) is an anticholinergic agent that is used to inhibit excessive salivation. Bethanechol (Urecholine) is a prokinetic drug and remains controversial in use.
Management of the child or adolescent with a peptic ulcer often includes:
A. offering milk at frequent intervals.
B. administering proton pump inhibitors.
C. administering medication combination therapy.
D. coping with stress and adjusting to chronic illness.
B. administering proton pump inhibitors.
Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent adverse effects. Proton pump inhibitors are more effective than antacids. Triple medication therapy is used with the presence of H. pylori. Coping with stress is beneficial, but peptic ulcer disease is treatable.
The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What action should the nurse include?
A. Inform her that bedrest is important during the 4-week incubation period.
B. Tell her that the child should not return to school until 3 weeks after jaundice appears.
C. Give reassurance that hepatitis A cannot be transmitted to other family members.
D. Teach infection control measures to family members.
D. Teach infection control measures to family members.
The disease does not usually have an icteric phase and often is subclinical. The period of communicability is from the latter half of the incubation period to 1 week after onset of clinical illness. Hepatitis A is a contagious disease that is transmitted through the fecal–oral route. The nurse should teach infection control measures to the family, including safe food handling and good hand hygiene.
