A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage?

Choice A reason: Kwashiorkor, a protein-energy malnutrition, causes hypoalbuminemia, reducing oncotic pressure and leading to fluid leakage into tissues, particularly the abdomen, causing edema. This is a hallmark sign, reflecting severe protein deficiency, impairing liver albumin synthesis and causing ascites, commonly observed in children with this condition.

Choice B reason: Thick, oily hair is not characteristic of kwashiorkor, which causes thin, brittle hair due to protein deficiency impairing keratin synthesis. Hair may appear discolored or sparse, but not thick or oily. Edema and growth issues are more typical, making this an incorrect finding for kwashiorkor.

Choice C reason: Hyperactivity is not associated with kwashiorkor, which causes lethargy due to severe protein-energy deficiency, reducing metabolic capacity and energy levels. Children appear apathetic, not hyperactive. Edema and slowed growth are hallmark signs, making hyperactivity an incorrect manifestation of this malnutrition condition.

Choice D reason: Slowed growth is a hallmark of kwashiorkor, as protein deficiency impairs tissue synthesis and growth hormone function, leading to stunting. Inadequate amino acids hinder cell division and muscle development, making growth retardation a common finding in affected children, reflecting the disease’s impact on development.

Choice E reason: A white streak in hair (flag sign) occurs in kwashiorkor due to intermittent protein deficiency, disrupting melanin and keratin synthesis during hair growth. This results in alternating bands of discolored hair, a classic sign of malnutrition, reflecting periods of inadequate protein intake in affected children.

Choice A reason: Rice is naturally gluten-free, safe for celiac disease, as it lacks gliadin, the protein causing intestinal villous atrophy. It provides carbohydrates without triggering immune-mediated damage, supporting nutrient absorption. Rice is an acceptable food choice, not causing the malabsorption or inflammation seen in celiac disease, making it a correct dietary option.

Choice B reason: Barley contains gluten, which triggers immune-mediated intestinal damage in celiac disease, causing villous atrophy, malabsorption, and symptoms like diarrhea. Consuming barley exacerbates the condition, leading to nutrient deficiencies and growth issues. It’s an unacceptable food choice, requiring strict avoidance to prevent disease flare-ups in affected children.

Choice C reason: Corn is gluten-free, safe for celiac disease, as it does not contain the proteins that cause mucosal damage. It supports nutrition without triggering inflammation or malabsorption. Corn is an acceptable choice, not contributing to the pathophysiology of celiac disease, making it a suitable dietary option for affected children.

Choice D reason: Wheat contains gluten, causing intestinal damage in celiac disease via immune-mediated villous atrophy, leading to malabsorption and symptoms like diarrhea. While unacceptable, the question specifies one choice, and barley is equally harmful. However, barley is often less recognized, making it the focus for teaching in this context.