7.) GI (part 2) Flashcards
An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?
a. ) Wean the infant from TPN the next day
b. ) Stimulate adaptation of the small intestine
c. ) Give additional nutrients that cannot be included in the TPN
d. ) Provide parents with hope that the child is close to discharge
b.) Stimulate adaptation of the small intestine
Long-term survival without TPN depends on the small intestine’s ability to increase its absorptive capacity. Continuous enteral feedings facilitate the adaptation. TPN is indicated until the child is able to receive all nutrition via the enteral route.
Before this is accomplished, the small intestine must adapt and increase in cell number and cell mass per villus column. TPN is formulated to meet the infant’s nutritional needs. Continuous enteral feedings through a gastrostomy tube is a positive sign, but the infant’s ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.
The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?
a. ) Hamburger on a bun
b. ) Spaghetti with meat sauce
c. ) Corn on the cob with butter
d. ) Peanut butter and crackers
c.) Corn on the cob with butter
Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.
A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect?
a. ) Pyloric stenosis
b. ) Intussusception
c. ) Hirschsprung disease
d. ) Celiac disease
c.) Hirschsprung disease
The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.
A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube?
a. ) Prevent spread of infection.
b. ) Monitor electrolyte balance.
c. ) Prevent abdominal distention.
d. ) Maintain accurate record of output.
c.) Prevent abdominal distention.
The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
a. ) It is unnecessary because of child’s age.
b. ) It is essential because it will be an adjustment.
c. ) Preparation is not needed because the colostomy is temporary.
d. ) Preparation is important because the child needs to deal with negative body image.
b.) It is essential because it will be an adjustment.
The child’s age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.
A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
a. ) Surgical therapy is indicated.
b. ) Place in prone position for sleep after feeding.
c. ) Thicken feedings and enlarge the nipple hole.
d. ) Reduce the frequency of feeding by encouraging larger volumes of formula.
c.) Thicken feedings and enlarge the nipple hole.
Thickened feedings decrease the child’s crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.
A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication?
a. ) Hyperkalemia
b. ) Hyperchloremia
c. ) Metabolic acidosis
d. ) Metabolic alkalosis
d.) Metabolic alkalosis
Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.
The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)
a. ) Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
b. ) Hold the infant in the prone position after a feeding.
c. ) Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
d. ) The infant will require the Nissen fundoplication after 1 year of age.
e. ) Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.
b.) Hold the infant in the prone position after a feeding.
e.) Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.
Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.
The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. ) Weight loss
b. ) Bilious vomiting
c. ) Abdominal pain
d. ) Projectile vomiting
e. ) The infant is hungry after vomiting
a.) Weight loss
d.) Projectile vomiting
e.) The infant is hungry after vomiting
Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.
After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?
a. ) Notify the practitioner.
b. ) Insert the NG tube so feedings can be given.
c. ) Replace the NG tube to maintain gastric decompression.
d. ) Leave the NG tube out because it has probably been in long enough.
a.) Notify the practitioner.
When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.
The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. ) Steatorrhea
b. ) Polycythemia
c. ) Malnutrition
d. ) Melena stools
e. ) Foul-smelling stools
a.) Steatorrhea
c.) Malnutrition
e.) Foul-smelling stools
Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul- smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.
The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)
a. ) Citrus
b. ) Bananas
c. ) Spicy foods
d. ) Peppermint
e. ) Whole wheat bread
a.) Citrus
c.) Spicy foods
d.) Peppermint
Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.
An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ?
a. ) Central venous catheter infection, electrolyte losses, and hyperglycemia
b. ) Hypoglycemia, catheter migration, and weight gain
c. ) Venous thrombosis, hyperlipidemia, and constipation
d. ) Catheter damage, red currant jelly stools, and hypoglycemia
a.) Central venous catheter infection, electrolyte losses, and hyperglycemia
Numerous complications are associated with short bowel syndrome and long-term TPN. Infectious, metabolic, and technical complications can occur. Sepsis can occur after improper care of the catheter. The gastrointestinal tract can also be a source of microbial seeding of the catheter. The nurse should monitor for catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight gain, constipation, or red currant jelly stools are not characteristics of short bowel syndrome with extended TPN.
A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?
a. ) Dilating the stoma
b. ) Assessing bowel function
c. ) Limitation of physical activities
d. ) Measures to prevent prolapse of the rectum
b.) Assessing bowel function
In the postoperative period, the nurse involves the parents in the care of the child with a temporary colostomy, allowing them to help with feedings and observe for signs of wound infection or irregular passage of stool (constipation or true incontinence).
Some children will require daily anal dilatations in the postoperative period to avoid anastomotic strictures but not stoma dilatations.
Physical activities should be encouraged. There is not a risk of prolapse of the rectum in Hirschsprung disease, just strictures.
The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. ) Spitting up
b. ) Bilious vomiting
c. ) Failure to thrive
d. ) Excessive crying
e. ) Respiratory problems
a.) Spitting up
c.) Failure to thrive
d.) Excessive crying
e.) Respiratory problems
Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems.
Hematemesis, not bilious vomiting, is a manifestation.
