A 9m old male presents to the clinic with vomiting, sudden acute abd. pain and currant jelly stools.  Upon assessment the nurse palpates a sausage like mass in the RUQ.  What diagnosis will the nurse suspect?

Intussesception

• telescoping, prolapse, or invagination of one portion of the intestines into another.
• Assoc with gastiocenteritis, cystic fibrosis, celiac disease.

What is the preferred treatment and nursing responsibilities for intussecsception?

Non-surgical when possible!

(exception - shock or perforation)

Barium enema

• prepare child (for enema or surgery)
• Encourage parent to partcipate in care
• Assess for +BS and brown stool. 

A 6 week old infant presents to the ER with anorexia and a hx ofprojectile vomiting.  What disease will the nurse suspect?

1. When gathering a hx what additional S/S can be expected?

Pyloric Stenosis

Obstruction of the aoutlet from the stomach to the SI.  Muscle enlarges/spasms and nothing can get through.

1. Hungry after feedings, Vomits 20-30mins after eating, visible L to R peristalic waves. Olive size mass (epigastric area), dehydration, decr stool size & #.

What is the expected Therapeutic Managment for Pyloric Stenosis?

Pyloromyotomy

surgical longitudinal slit of the pyloric spinchter. 

A 10 year old presents with RLQ pain.  What would the nurse suspect? Additional Assessment data?

Appendicitis

Is there rebound pain?

Check McBurney Point

(midway btwn anterior iliac crest and imbilicus)

Additional S/S:

Fever         Vomitting      Tachycardia      Decr. or Abs BS      Diarrhea      Stooped posture        Rapid/shallow Breath     Pallor        Incr WBC (15k - 20k)

You, the nurse, receive an order to apply heat to the RLQ on a patient to relieve pain. The patient is  admitted to the hospital to r/o appendicitis. Is this an appropriate comfort measure?

No!!!  Apply Cold, not Heat!

Heat will increase the chances for the appendix to rupture. 

 Place child in semi-fowlers or on side for comfort.

What infection may be suspected when a mother reports sulfur-smelling belches from her 2 year old daughter?

Giardiasis

A Protozoan Infection

An abnormal elimination pattern characterized by repeated passage of feces in places not cultrally appropriate is known as ____________?

Encorpesis

Primary = Identified by 4yo --> Never fully toilet trained.

Secondary = Begins after affective toilet training.

What is the most common cause for abdominal surgery in childhood?

Appendicitis

Define the diagnosis criteria for Encopresis.

DX:

1. NOT related to physical problem
2. Atleast 1x month for 3 months   

What are some common causes of secondary encopresis?  Dangers?

Secondary Encropresis:

1. constipation (either genetic or due to not being allowed/afraid to use the bathroom.)
2. Voluntary Retention (may cause hard BM & anal fissure)

Management:

1. Reward/Reinforcement approp. toileting habits.
2. Est a toilet routine, Incr fiber & Fluids, Lubricants (mineral oil/suppositories), Behavior therapy, Digital removal of impaction, psycotherapy.