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: The Somogyi phenomenon involves rebound hyperglycemia in the morning following nocturnal hypoglycemia, triggering counter-regulatory hormones (e.g., glucagon, cortisol), causing diaphoresis and headaches. Excess insulin at night lowers glucose, prompting a hyperglycemic rebound. This explains the child’s symptoms, requiring insulin dose adjustment to prevent nocturnal hypoglycemia.

Choice B reason: The Honeymoon effect is a temporary period of improved insulin production post-diagnosis in type 1 diabetes, not causing hyperglycemia, diaphoresis, or headaches. It reflects residual beta-cell function, not a morning rebound. The Somogyi phenomenon better explains the symptoms, making this an incorrect diagnosis.

Choice C reason: Ketoacidosis causes hyperglycemia, but with fruity breath, lethargy, and dehydration, not diaphoresis or headaches alone. It results from insulin deficiency, not nocturnal hypoglycemia rebound. The Somogyi phenomenon’s counter-regulatory response better matches the morning symptoms, making ketoacidosis an incorrect suspicion for this presentation.

Choice D reason: The Dawn phenomenon causes morning hyperglycemia due to growth hormone surges, not diaphoresis or headaches, which suggest a hypoglycemic event. It lacks the rebound mechanism of the Somogyi phenomenon, which explains the combination of symptoms, making this an incorrect suspicion for the child’s condition.

Choice A reason: Hirschsprung’s disease involves absent ganglion cells, causing functional obstruction, not a physical “kink” in the intestine. Surgery removes the aganglionic segment, not a structural bend. This statement is incorrect, as it misrepresents the disease’s pathophysiology and surgical goal, indicating a need for further parental education.

Choice B reason: Hirschsprung’s surgery often involves a temporary ostomy to bypass the aganglionic colon, allowing normal bowel function post-resection. The ostomy is typically reversed later. This statement reflects understanding that the ostomy is temporary, aligning with the surgical goal of restoring continuity, indicating correct parental comprehension.

Choice C reason: Normal bowel movements may not occur immediately post-surgery, as a temporary ostomy or recovery period is common in Hirschsprung’s disease. This statement is overly optimistic, suggesting a misunderstanding of the staged surgical process, which includes temporary measures before achieving normal function, requiring further clarification.

Choice D reason: Feeding tubes are not typically required in Hirschsprung’s surgery, which addresses colonic dysfunction, not feeding issues. This statement indicates a misunderstanding of the procedure’s purpose, which is to restore bowel function via resection or ostomy, not nutritional support, making it incorrect and irrelevant to the surgical goal.