Chapter 22: The Child with Gastrointestinal Dysfunction

Chapter 22: The Child with Gastrointestinal Dysfunction

Hockenberry: Wong's Essentials of Pediatric Nursing, 10th

Edition.

• Which condition in a child should alert a nurse for increased fluid requirements?
• Fever
• Mechanical ventilation
• Congestive heart failure
• Increased intracranial pressure (ICP) - ANSWER-Fever

ANS: A

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

• A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes

that melena, the passage of black, tarry stools, suggests bleeding from which area?

• Perianal or rectal area
• Hemorrhoids or anal fissures
• Upper gastrointestinal (GI) tract
• Lower GI tract - ANSWER-Upper gastrointestinal (GI) tract

Melena is denatured blood from the upper GI tract or bleeding from the right colon.Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

• Which type of dehydration is defined as "dehydration that occurs in conditions in

which electrolyte and water deficits are present in approximately balanced proportion"?

• Isotonic dehydration
• Hypotonic dehydration
• Hypertonic dehydration

d.All types of dehydration in infants and small childre - ANSWER-Isotonic dehydration

ANS: A

Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic dehydration.

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• A nurse is admitting an infant with dehydration caused from water loss in excess of

electrolyte loss. Which type of dehydration is this infant experiencing?

• Isotonic
• Isosmotic
• Hypotonic
• Hypertonic - ANSWER-Hypertonic

Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion and is another term for isomotic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

• An infant is brought to the emergency department with dehydration. Which physical

assessment finding does the nurse expect?

• Weight gain
• Bradycardia

c.Poor skin turgor

• Brisk capillary refill - ANSWER-Poor skin turgor

Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

• Parents call the clinic and report that their toddler has had acute diarrhea for 24

hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea?

• Celiac disease
• Antibiotic therapy
• Immunodeficiency
• Protein malnutrition - ANSWER-Antibiotic therapy

Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately.Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.

• Which pathogen is the viral pathogen that frequently causes acute diarrhea in young

children?

• Giardia organisms
• Shigella organisms
• Rotavirus

d.Salmonella organisms - ANSWER-ANS: C 2 / 3

Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

• Which is a parasite that causes acute diarrhea?
• Shigella organisms
• Salmonella organisms
• Giardia lamblia
• Escherichia coli - ANSWER-*Giardia lamblia*

• lamblia is a *parasite that represents 10% of non-dysenteric illness* in the United

States. Shigella, Salmonella, and E. coli are bacterial pathogens.

• A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen

confirm this diagnosis?

• Eosinophils
• Occult blood
• pH less than 6
• Neutrophils and red blood cells - ANSWER-Neutrophils and red blood cells

Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

Protein intolerance and parasitic infections are suspected in the presence of eosinophils.

Occult blood may indicate pathogens such as

• Shigella,
• Campylobacter, or
• hemorrhagic Escherichia coli strains.

A pH of less than 6 may indicate carbohydrate malabsorption or secondary lactase insufficiency.

• Which therapeutic management should the nurse prepare to initiate first for a child

with acute diarrhea and moderate dehydration?

• Clear liquids
• Adsorbents, such as kaolin and pectin
• Oral rehydration solution (ORS)
• Antidiarrheal medications such as paregoric - ANSWER-Oral rehydration solution

(ORS)

ANS: C

ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are

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