A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base imbalance would the nurse expect to occur from this persistent vomiting?

Choice A reason: Feeding slowly in pyloric stenosis reduces gastric pressure, minimizing vomiting due to pyloric obstruction from hypertrophied muscle. Slow administration allows small amounts to pass the narrowed pylorus, decreasing reflux and aspiration risk. This intervention supports nutrition delivery, making it a critical nursing action for infants with this condition.

Choice B reason: Thinning formula with water is not recommended in pyloric stenosis, as it reduces caloric density, worsening malnutrition in infants already limited by vomiting. Standard or slightly thickened formula aids retention. Slow feeding and burping are prioritized to manage obstruction, making thinned formula an incorrect intervention for this condition.

Choice C reason: Burping before and during feeding in pyloric stenosis reduces gastric air, decreasing pressure on the obstructed pylorus and minimizing vomiting. This promotes formula retention, reducing aspiration risk. Frequent burping is a standard intervention, supporting effective feeding and nutrition in infants with this hypertrophic condition, making it appropriate.

Choice D reason: Positioning on the left side after feeding is not standard for pyloric stenosis, as right-side or upright positioning better reduces reflux by gravity. Left-side positioning may increase vomiting risk due to pyloric obstruction. Slow feeding and burping are prioritized, making this an incorrect intervention for managing feeding.

Choice E reason: Refeeding after vomiting in pyloric stenosis risks overfilling the stomach, exacerbating vomiting and aspiration due to pyloric obstruction. Small, frequent feedings are preferred to minimize gastric pressure. Slow feeding and burping reduce vomiting, making refeeding an inappropriate intervention, as it does not address the underlying obstruction.

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.