GI+Round+2

=**GI Rounds 2 **= media type="youtube" key="OZOCcoD5a5c" width="616" height="346"
 * Intussusception **

Most frequent cause of intestinal obstruction in children. One portion of the bowels telescopes into another Peaks 3-9 months, more common in boys Idiopathic, no clear cause 3months to 5 years Possible causes polyp, foreign body, viral infection

Pathophysiology Bowel telescopes into another, walls of the bowel press against each other cutting of blood and lymph flow, causing inflammation, edema, obstruction Causes blood and mucous in stool Obstruction Abdominal distention Vomiting Necrosis and perforation

Clinical manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Colic <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Intermittent abdominal pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Crying, drawing legs up to abdomen <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Vomiting <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Currant jelly stools

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Onset – <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Severe intermittent abdominal pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nonbilious vomiting, later bile stained <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Currant jelly stools <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Tender abdomen <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Sausage shaped mass right upper quadrant <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Listless, lethargic, shock

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Diagnosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Definitive test barium or air contrast enema <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Abdominal ultrasound reliable

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nonsurgical reduction using barium, air or water soluble contrast <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Air insuflation and water soluble contrast, safer with less perforation <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">90% success with air, 65-85 with contrast <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Prompt surgical intervention if unsuccessful or for perforation

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Nursing management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Caregivers need reassurance <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Demonstration of telescope or glove <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">NPO <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">NG suction <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">IV fluids <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Passage of normal stool can indicate resolution <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Reoccurrence possible

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Family Teaching: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Observe for S&S of recurrence

media type="youtube" key="B9C5BHTX-dA" width="616" height="346" =<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Case study: Intussusception =

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">//Julisa presents to the local clinic complaining of severe abdominal pain. She is 5 years old. She appears in obvious distress. Her pulse is slightly elevated as is her temperature at this time; her respirations are shallow. The nurse notices she is doubled over with her legs drawn up to her abdomen. Occasionally she will relax for a while. Mother states she has had infrequent vomiting which now just looks like bile and no bowel movements. She states she has done this all day but that the pain will occasionally will go away for a while. The doctor on call sends her to the ER.// =====

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">The child has quieted for the moment but states she is very thirsty. Mother states she will get her a coke on the way to the ER. Is this a good idea? Why or why not? =====

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">When the diagnosis is later made in the ER, the nurse pulls out a glove to demonstrate what has happened to the mother. Why? What does she do with it? =====

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">The mother of the child says she is confused. The doctor said Julisa would have to have surgery but then another doctor said a test might help. The mother wants to know what they are talking about, “Cause I just want the test that will help, not surgery, I just don’t want her to have to have surgery…” What tests is she talking about? What is the likelihood that it will help? =====

=== media type="youtube" key="MDl7iySivFg?version=3" height="361" width="589" align="center"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Congenital aganglionic megacolon <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Most common cause of distal bowel obstruction in the newborn <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">*A helpful mnemonic may be to think of a 'sprung' rubber band. It no longer has the elasticity to perform its job, similar to the distal bowel's lack of ganglion cells to help with peristalsis.
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Hirschsprung’s Disease (HD) **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Incidence/Etiology <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Males affected 3-4 xs more often than females <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Not hereditary but strong predisposition, family history in 10% <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Other associated conditions imperforate anus, urinary tract abnormalities, cardiac defects, seizure disorders, Downs

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pathophysiology: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Absence of parasympathetic ganglion cells in the colon <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Affected bowel unable to transmit peristaltic waves to move feces <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Thus bowel becomes enlarged and hypertrophied <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Distention and ischemia = enterocolitis

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Clinical manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Failure to pass meconium in first 24-48 hours after birth <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Abdominal distention <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Episodes of explosive passage of stools <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Inadequate weight gain <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ribbon like foul smelling stools <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Vomiting <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Palpable fecal mass <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Complication – enterocolitis (inflammation of small intestine and colon) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">May rapidly progress to perforation (major cause of death 30%)

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diagnosed in 15% at birth <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">60% third month <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">80% by one year <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">History chronic constipation <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Rectal exam absence of feces, internal sphincter tight <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Barium enema, definitive with rectal biopsy for absence of ganglionic cells

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Abnormal section of colon removed <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Pull through one step surgery most common <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Two stage abnormal colon removed, colostomy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Then normal colon anastomosed to rectum

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Nursing Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Preop <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">NPO <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">IV <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">NG suctioning <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Bowel cleaning <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Oral antibiotics, antibiotic enemas

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Postop <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">No rectal temperatures! axillary <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">NG <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Abdominal distention <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Incision site care <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Return of bowel sounds <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ostomy appliance fitting

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Explanation and teaching about colostomy, skin care, appliance application <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">S&S of complcations, enterocolitis, leaks, strictures= abdominal distention, irritability, constipation, vomiting, diarrhea

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 24.309999465942383px;">Case Study: Hirschsprungs Disease
==<span style="font-family: 'Times New Roman',Times,serif; font-size: 21.969999313354492px;">//At 36 hours old with no meconium stool, William is transferred to a more advanced hospital to assess his colon. After a barium enema and a rectal biopsy, William is diagnosed at 4 days old with Hirschsprung’s disease and is scheduled for surgery. Before he can have the pull through surgery, he contracts enterocolitis. Now emergency surgery is performed and a temporary colostomy is in place.// ==

====<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.015399932861328px;">What are some immediate nursing diagnoses, nursing interventions and nursing outcomes, which can be anticipated at this time? Preoperatively? Postoperatively? ====

====<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.015399932861328px;">The grandparents are visiting and the parents are exhausted. They have asked you to explain what Hirschsprung’s disease and enterocolitis is to the grandparents. What is your explanation? ====

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.015399932861328px;">The real William - A picture of the initial presentation at birth
media type="youtube" key="PFiJfkr5Dl0?version=3" height="525" width="642"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">This video is an example of the continued care and management needed after correction.

media type="youtube" key="v2ZpXxhuxQg?version=3" height="526" width="643"

=<span style="font-family: 'Times New Roman',Times,serif; font-size: 23.65999984741211px;">Liver: = <span style="color: #d22828; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Hepatitis A, B and C <span style="color: #d22828; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">media type="youtube" key="U-PE-5jTwzI" width="560" height="315"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis with a vowel comes from the bowel. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis A from food inflames liver but resolves. Vaccine. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis B from blood and bodily fluids. Vaccine <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis C from blood and bodily fluids. No vaccine <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis D can get if already have B <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatitis E from food usually seen in Asia, Africa and Mexico

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Symptoms: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fatigue, fever, nausea, vomiting, dark urine, jaundice, yellow eyes, joint pain, clay colored stools <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Can result in Liver damage, scarring or cirrhosis of the liver. lose function, muscle wasting because using protein from own body, fluid (ascites), mental confusion, bleeding.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Avoid: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">High fat diet <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Extra iron <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Alcohol <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Excess anti inflammatory agents, Tylenol.


 * <span style="color: #cc0a2d; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Biliary Atresia **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Biliary atresia is a chronic, progressive liver problem, evident shortly after birth. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Tubes in the liver, called bile ducts, normally allow a liquid produced by the liver called bile to drain into the intestines and kidneys. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Bile aids in digestion and carries waste products from the liver to the intestine and kidneys for excretion. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">In biliary atresia, bile ducts in the liver are blocked. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">When the bile is unable to leave the liver through the bile ducts, the liver becomes damaged and many vital body functions are affected.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">The cause of biliary atresia is unknown. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Biliary atresia does not seem to be linked to medications the mother took, or illnesses the mother had. Not a genetic link known for biliary atresia. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Biliary atresia is the most common cause of liver transplantation in children living in the U.S. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Biliary atresia occurs once in every 10,000 births and is more common in girls than in boys. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Asian populations and African-American newborns are more frequently affected than Caucasian newborns.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Biliary atresia causes liver damage and affects numerous processes that allow the body to function normally. Biliary atresia is a life-threatening disease and is fatal without treatment.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.59000015258789px;">Symptoms
<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">May appear healthy at birth. Symptoms develop between two weeks and two months of life, and include: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Jaundice <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dark urine <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Light colored stools <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Distended abdomen <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Weight loss

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Voluntary or involuntary passage of stool of near normal consistency. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Occurs once per month for 3 months. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Primary when 4 years of age and has not achieved fecal continence. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Secondary over 4 and occurs after period of continence. <span style="color: #dc1e1e; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Main causes: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Constipation but can be due to digestive tract difficulties such as Hirschsprungs, rectal prolaspe, anorectal lesions or hypothyroidism, hypokalemia, hypercalcemia, lead intoxification, myelomeningocele, cerebral palsy, MD or IBS. <span style="color: #dc1e1e; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Therapeutic Interventions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Dietary changes, lubricants, toilet ritual. Education.
 * <span style="color: #23b83e; font-family: 'Times New Roman',Times,serif; font-size: 23px;">Encopresis **

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">S&S Appendicitis Nursing diagnosis:

media type="youtube" key="4VVbOjBX5ew" width="588" height="439"

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Appendicitis: media type="youtube" key="r2zsbdPBhGY" width="560" height="315"

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Ulcerative Colitis: media type="youtube" key="JMApMBY0CfQ" width="560" height="315"

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Crohn's Disease <span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">media type="youtube" key="k0kRSF80PJ0" width="560" height="315"

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Celiac Disease: media type="youtube" key="gZeliSjhkpg" width="546" height="408"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Gluten free diet

<span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Parasites <span style="color: #e11919; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Pin Worms: media type="youtube" key="eplTQau7ZtY" width="504" height="377"

<span style="font-family: 'Times New Roman',Times,serif;">**Circle the correct response:**
====<span style="font-family: 'Times New Roman',Times,serif;">**T. F.** **1.** Infants and young children are less susceptible to dehydration than older children and adults, since infants have less fluid intake and output relative to size. ====

<span style="font-family: 'Times New Roman',Times,serif;">D. 1 gram = 10 milliliters of body fluid
====<span style="font-family: 'Times New Roman',Times,serif;">**6. This is one of the major causes for gastroenteritis among children under two years of age causing 70% to 80% of all infectious diarrheas in developed nations.** ====

<span style="font-family: 'Times New Roman',Times,serif;">D. Umbilical hernia
====**<span style="font-family: 'Times New Roman',Times,serif;">9. Probable diagnosis for a malnourished infant with an olive-like mass in the upper abdomen who exhibits nonbilious, projectile vomiting 30 to 60 minutes after each feeding is: **====

<span style="font-family: 'Times New Roman',Times,serif;">D. Hypertrophic pyloric stenosis
====**<span style="font-family: 'Times New Roman',Times,serif;">10. Abrupt, intermittent colicky pain, accompanied by vomiting, dehydration, fever, abdominal distention and later red, currant jelly stools are signs of what G.I. disorder? **====

<span style="font-family: 'Times New Roman',Times,serif;">**Complete the following 2 essay questions in the space provided being sure to include the prompted material:**
====**<span style="font-family: 'Times New Roman',Times,serif;">15. A 18 month old has been admitted to the unit with dehydration due to acute gastroenteritis. Name at less 3 nursing concerns/diagnosis’s with appropriate nursing interventions in the space provided. Be specific in your care. You may use a concept map to answer this question if desired. Continue on next page if needed. **====

====**<span style="font-family: 'Times New Roman',Times,serif;">16. A couple has just had their first baby. He was born with a cleft lip and palate. The parents are distraught. The infant is otherwise healthy and robust. The doctors have decided to schedule the infant for surgery for his lip but correction of the palate will wait. Is this the norm? What types of care will this family need? Write at least two nursing diagnosis’s with appropriate nursing interventions in the space provided. Focus on the immediate needs. **====

**<span style="font-family: 'Times New Roman',Times,serif;">Questions 17 and 18 relate to the case study below: **
====**<span style="font-family: 'Times New Roman',Times,serif;">Kennedy has been complaining of a stomachache for two days. She has a fever and has been vomiting. She guards her abdomen and complains each time her wheelchair bumps anything. She is pale, tachycardic and will not stand up straight when she gets to the room. Her mother states that she put a heating pad on her daughter’s stomach and she had stopped complaining for a while and now she is worse. **====

<span style="font-family: 'Times New Roman',Times,serif;">A. Surgery, IV management, antibiotics and observation until the child stabilizes, then the child can go home.
====<span style="font-family: 'Times New Roman',Times,serif;">B. Emergency surgery, IV therapy, antibiotic therapy for 7-10 days, possibly a penrose drain and nasogastric suctioning until GI activity returns. ====

<span style="font-family: 'Times New Roman',Times,serif;">**Multiple-choice questions with clinical practice framework:**
====**<span style="font-family: 'Times New Roman',Times,serif;">21. While caring for a child hospitalized with acute diarrhea you weigh the child without the diaper but need to assess the amount of fluid loss in the diaper so you weigh the diaper also knowing that: **====

<span style="font-family: 'Times New Roman',Times,serif;">D. Immediate small feeding on return from OR, monitor tolerance and I&Os.
====**<span style="font-family: 'Times New Roman',Times,serif;">25. The prognosis for children with short bowel syndrome has improved. The most important nursing considerations for these children involves: **====

<span style="font-family: 'Times New Roman',Times,serif;">D. Diet, activity and home care education.
<span style="font-family: 'Times New Roman',Times,serif;">Answers: <span style="font-family: 'Times New Roman',Times,serif;">1. F <span style="font-family: 'Times New Roman',Times,serif;">2. T <span style="font-family: 'Times New Roman',Times,serif;">3. B <span style="font-family: 'Times New Roman',Times,serif;">4. A <span style="font-family: 'Times New Roman',Times,serif;">5. C. <span style="font-family: 'Times New Roman',Times,serif;">6. D <span style="font-family: 'Times New Roman',Times,serif;">7. A. <span style="font-family: 'Times New Roman',Times,serif;">8. A. <span style="font-family: 'Times New Roman',Times,serif;">9. D. <span style="font-family: 'Times New Roman',Times,serif;">10. B. <span style="font-family: 'Times New Roman',Times,serif;">11. A, D, F <span style="font-family: 'Times New Roman',Times,serif;">12. A, C, D, E <span style="font-family: 'Times New Roman',Times,serif;">13. Isotonic, Hypotonic, Hypertonic <span style="font-family: 'Times New Roman',Times,serif;">14. Coughing, Choking, Cyanosis <span style="font-family: 'Times New Roman',Times,serif;">15. <span style="font-family: 'Times New Roman',Times,serif;">16. <span style="font-family: 'Times New Roman',Times,serif;">17. B. <span style="font-family: 'Times New Roman',Times,serif;">18. B. <span style="font-family: 'Times New Roman',Times,serif;">19. <span style="font-family: 'Times New Roman',Times,serif;">20. <span style="font-family: 'Times New Roman',Times,serif;">21. D. <span style="font-family: 'Times New Roman',Times,serif;">22. A. <span style="font-family: 'Times New Roman',Times,serif;">23. B. <span style="font-family: 'Times New Roman',Times,serif;">24. B. <span style="font-family: 'Times New Roman',Times,serif;">25. C.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Daigneau, C. V. (2005). The child with gastrointestinal dysfunction. In M. Hockenberry, D. Wilson & M. Winkelstein (Eds.), Wong's essentials of pediatric nursing (7th ed., pp. 839-889). St. Louis, Missouri: Elsevier Mosby.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Ellett, M. L. (2009). Chapter 24: The child with gastrointestinal dysfunction. In M. J. Hockenberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (8th ed., pp. 813-860). St. Louis, MO: Mosby Elsevier.

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