The nurse is caring for a boy with probable intussusception. He ...

[ec501234]

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool.
 
  Which nursing action is the most appropriate?
  a. Notify practitioner.
  b. Measure abdominal girth.
  c. Auscultate for bowel sounds.
  d. Take vital signs, including blood pressure.

Question 2

Which is an important nursing consideration in the care of a child with celiac disease?
 
  a. Refer to a nutritionist for detailed dietary instructions and education.
  b. Help child and family understand that diet restrictions are usually only temporary.
  c. Teach proper hand washing and standard precautions to prevent disease transmission.
  d. Suggest ways to cope more effectively with stress to minimize symptoms.

[honnalora]

Answer to Question 1

ANS: A
Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan. The first action would be to report the normal stool to the practitioner.

Answer to Question 2

ANS: A
The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.