Chapter 41: Gastrointestinal Dysfunction

Acute Diarrhea (Gastroenteritis)

Brian is 4 years old, and his brother, Adam, is 5 months old. Both children are brought to the clinic by their
mother because of diarrhea and fever. Brian has also vomited twice. You assess the children and
determine that they are mildly dehydrated.
1.

Which of the following is the most appropriate method of rehydrating Brian?

A. Administer intravenous fluids.
B. Give an oral rehydration solution.
C. Give soft drinks that have been diluted and decarbonated.
D. Give small amounts of gelatin or clear liquids such as juice and water.
B
A. Intravenous fluids are only required when the child is unable to ingest sufficient amounts of fluid and
electrolytes to meet ongoing daily physiologic losses, replace previous deficits, and replace ongoing
abnormal losses; they are not usually required for mild dehydration.
B. Oral rehydration solutions are successful in treating the great majority of children with isotonic, hypotonic,
or hypertonic dehydration.
C. Soft drinks are usually high in carbohydrates, low in electrolytes, and high in osmolality; therefore they
are not effective solutions for rehydration. In addition, caffeinated sodas should be avoided because of the
diuretic effect of caffeine, which may lead to an increased loss of water and sodium.
D. Clear liquids such as fruit juices and gelatin are not used for rehydration because of their high
carbohydrate content, low electrolyte content, and high osmolality.

2.

The mother asks what to do about breast-feeding Adam. You should recommend:
A. Stop breast-feeding for 24 hours.
B. Stop breast-feeding until diarrhea stops.
C. Bottle-feed glucose/water, alternating it with breast-feeding.
D. Continue breast-feeding and give an oral rehydration solution to replace diarrheal losses
D
A. Breast-feeding should not be stopped because of its potential to reduce the severity and duration of the
illness.
B. Breast-feeding should not be stopped because of its potential to reduce the severity and duration of the
illness.
C. Oral rehydration solutions can be given in addition to breast-feeding to replace ongoing losses.
D. Human milk feeding during diarrheal illness results in possible reduced severity and duration of illness.

3. The mother asks about giving the children antidiarrheal medication. Your response should be
based on knowledge that these medications are:
A. Not recommended.
B. Recommended for children over age 6 months.
C. Recommended for children over age 1 year.
D. Recommended for children over age 4 years
Correct Answer
Antidiarrheal agents are not indicated in acute infectious diarrhea in infants and young children because of
the toxicity and adverse effects that may occur such as worsening of the diarrhea as a result of a decrease
of motility and ileus or a decrease in diarrhea, with continuing fluid losses and dehydration.

4.

The mother asks about giving Brian food after he is rehydrated. Which of the following is the most
appropriate recommendation?
A. Offer a regular diet.
B. Offer a regular diet except high-protein foods.
C. Give clear liquids for the next 24 hours.
D. Start the BRAT diet (bananas, rice, apples, and toast or tea
1. Early reintroduction of a regular diet is an important aspect of treatment of acute diarrhea in children to
prevent malnutrition.
2. Protein-containing foods are necessary to prevent malnutrition.
3. A regular diet is introduced as soon as possible to provide necessary nourishment for the child with acute
diarrhea.
4. A BRAT diet is avoided because it is low in energy and protein, too high in carbohydrates, and low in
electrolytes. A BRAT diet would not be used in this situation because the clinical situation does not warrant
it. A BRAT diet is used during periods of acute gastrointestinal symptoms of nausea/vomiting to minimize
gastric activity and provide sustenance for a limited period of time.

Appendicitis

Maria is a 10-year-old girl who is brought to the emergency department by her parents because of
generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 99.5
F. Bowel sounds are present. The diagnosis is possible appendicitis.

Questions
1. Several diagnostic tests are ordered. Appropriate nursing management in this preoperative period
includes which of the following?
A. Apply moist heat to the abdomen to relieve pain.
B. Administer an enema to ensure total bowel evacuation preoperatively.
C. Perform deep abdominal palpation to assess the level of pain.
D. Ensure that diagnostic tests are administered as soon as possible to prevent delay in
treatment
Correct Answer
D
A. The pain related to appendicitis is severe and should be treated by allowing the child to maintain a
comfortable position, by using a pillow to splint the abdomen, and by administering analgesics.
B. Laxatives or enemas should not be administered preoperatively. Such measures stimulate bowel motility
and increase the risk of perforation.
C. Deep abdominal palpation is not necessary to assess the level of pain; it causes excessive trauma to the
child with appendicitis.
D. Successful treatment of appendicitis is based on prompt recognition of the disorder; the primary nursing
objective is to assist in establishing a diagnosis.
2.

Which of the following clinical manifestations should lead you to suspect that Maria's appendix
has ruptured?
A. Fever
B. Localized pain
C. Increasing anorexia

D. Sudden relief from pain

D
A. A low-grade fever is present in appendicitis; only when the fever becomes greater than 39 C (102.2 F)
is perforation suspected.
B. Localized pain is present in appendicitis and is briefly relieved when the appendix ruptures.
C. Anorexia is present in appendicitis and is not a symptom of peritonitis caused by a ruptured appendix.
D. A sudden relief of pain occurs following rupture of the appendix. This symptom is brief, followed by an
increase in pain that is diffuse and accompanied by rigid guarding of the abdomen because of peritonitis.

3. Maria has an appendectomy. You anticipate that she will remain on low intermittent gastric
decompression until:
A. Pain decreases.
B. Nausea subsides.
C. Infection resolves.
D. Bowel motility returns
Correct Answer
D
A. Pain resulting from an appendectomy is treated with continuous analgesic administration, not low
intermittent gastric decompression. Therefore a decrease in pain is not related to the goal of gastric
decompression.
B. Gastric decompression is an intervention that helps prevent nausea; however, nausea will recur if the
suction is stopped before gastric motility returns.
C. Gastric decompression is not an intervention related to the prevention or treatment of infection. Therefore
a resolved infection is not an indication that the goal of gastric decompression has been achieved.
D. Gastric decompression evacuates excess stomach contents, which prevents abdominal distention,
nausea, and vomiting until bowel motility returns.

Cleft Lip and Palate

Questions
1. Juan is a newborn just delivered to Mr. and Mrs. Gonzales. He has a cleft lip and palate (CLP).
Which of the two defects is usually repaired first?
Correct Answer
Cleft lip
Surgical repair of cleft lip can be done during the first week of life when the infant is free of any oral,
respiratory, or systemic infection.

2. Juan is a newborn just delivered to Mr. and Mrs. Gonzales. He has a CLP. Protection of the
suture line for CL repair is provided by?
Correct Answer
Logan bow, tape, arm restraints
Nursing care during the postoperative period is directed toward protecting the operative site. The Logan
bow, a lip protective device that prevents trauma to the suture lines, is taped securely to the cheeks. Arm
restraints are applied immediately following surgery to prevent the infant from rubbing the suture line.

3.

Juan is a newborn just delivered to Mr. and Mrs. Gonzales. He has a CLP. When is CLP
repaired?
Usually between 12 and 18 months of age
The time of cleft palate repair is individualized according to the size, shape, and degree of deformity.
Most surgeons prefer to postpone the repair until 12 to 18 months of age to take advantage of palatal
changes that occur with normal growth.

4. Juan is a newborn just delivered to Mr. and Mrs. Gonzales. He has a CLP. What are associated
problems with CLP?
Correct Answer
Inadequate nutrition, otitis media, hearing loss, dental/orthodontic problems, and speech problems
Missing teeth and teeth that are malformed or malpositioned can interfere with feeding. Otitis media results
from improper drainage of the middle ear as a result of inefficient functioning of the eustachian tube.
Recurrent otitis media can lead to hearing impairment. Extensive orthodontics and prosthodontics are
usually necessary to correct problems of malpositioned teeth and maxillary arches. Defective speech can
result from insufficient palate functioning, faulty dentition, and hearing loss.

Dehydration and Diarrhea

Questions
1.

Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea
caused by bacteria. An early clinical sign of dehydration is usually:
A. Hypotension
B. Decreased urine output
C. Capillary refill time over 3 seconds
D. Tachycardia
D
A. Hypotension is a late sign of dehydration that occurs when fluid losses exceed the body's ability to
sustain blood volume and blood pressure.
B. Decreased urine output is a compensatory mechanism due to decreased blood flow through the kidneys
and is not an early sign of dehydration.
C. Capillary refill time over 3 seconds indicates a seriously compromised circulatory system and is an
indication of severe dehydration.
D. The earliest detectable sign of dehydration is usually tachycardia, the body's attempt to increase cardiac
output due to the low amount of blood volume.

2.

Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea
caused by bacteria. Mild dehydration is often treated at home by administering:
A. Diluted fruit juices
B. Oral rehydration fluids
C. Water
D. Warm milk
B
A. Fruit juices are not used as rehydrating solutions due to their high carbohydrate content, low electrolyte
content, and high osmolality.

B. Oral rehydration solutions are the fluids of choice for rehydration due to their glucose-mediated and
enhanced sodium absorption composition.
C. Water is not used as a rehydrating fluid due to its hypotonic nature and lack of electrolytes.
D. Cow's milk is not recommended because maldigestion of lactose can occur in children with infectious
diarrhea.
3.

Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea
caused by bacteria. Some of the most dreaded potential outcomes of hypertonic dehydration are
related to:
A. Neurologic disturbances
B. Hypovolemic shock
C. Impaired kidney function
D. Parenteral therapy complications
A
A. Cerebral changes in hypertonic dehydration are serious and may result in permanent damage, and are
therefore, the most dreaded potential outcomes.
B. Shock is more likely to occur in hypotonic or isotonic dehydration rather than hypertonic dehydration.
C. Renal compensation is impaired by reduced blood flow through the kidneys, which occurs in any form of
dehydration.
D. Parenteral therapy complications such as too-rapid initial fluid replacement can result in cerebral edema
in hypertonic dehydration. This, therefore, can be the cause of the dreaded outcome rather than the
outcome itself.

4.

Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea
caused by bacteria. Shannon's dehydration increases and she is hospitalized with parenteral fluid
therapy. Which replacement is not added until kidney function is reestablished?
A. Magnesium
B. Sodium chloride
C. Potassium
D. Sodium bicarbonate
C
A. Magnesium is usually decreased with prolonged vomiting or diarrhea and therefore, the risk of excess
magnesium is unusual.
B. 0.9% sodium chloride is the initial replacement fluid of choice in the management of dehydration.
C. Potassium is not administered until kidney functions are appropriate due to the risk of hyperkalemia,
which causes cardiac arrhythmias, respiratory failure, mental confusion, and numbness of extremities.
D. Sodium bicarbonate can be added to replacement fluids because acidosis is usually associated with
dehydration.