A 4-month-old infant has gastroesophageal reflux disease (GERD) ...

[ts19998]

A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux?
 
  a. Place in Trendelenburg position after eating.
  b. Thicken formula with rice cereal.
  c. Give continuous nasogastric tube feedings.
  d. Give larger, less frequent feedings.

Question 2

Therapeutic management of most children with Hirschsprung's disease is primarily:
 
  a. Daily enemas.
  b. Low-fiber diet.
  c. Permanent colostomy.
  d. Surgical removal of affected section of bowel.

[softEldritch]

Answer to Question 1

ANS: B
Giving small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.

Answer to Question 2

ANS: D
Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary.

[ts19998]

Excellent

[cici]

TYSM