A child is ordered Digoxin 25 mcg IV twice a day.

The child weighs 13.2 lbs.

The pediatric dose is 25-50 mcg/kg/day.

Available is 0.1 mg/mL ampule.

What would be drawn up for a single dose?

Choice A rationale

Routinely administering Rho(D) immune globulin at 28 weeks of gestation is a standard prophylactic measure for Rh-negative pregnant clients. This timing provides protection against potential sensitization from fetal red blood cells that may cross the placenta during the third trimester, minimizing the risk of alloimmunization and hemolytic disease of the newborn.

Choice B rationale

A spontaneous abortion, regardless of gestational age, involves a potential mixing of maternal and fetal blood, especially if the fetus is Rh-positive. Administering Rho(D) immune globulin prevents the Rh-negative mother from developing antibodies to the Rh factor, thereby protecting future Rh-positive pregnancies from hemolytic disease.

Choice C rationale

Administering Rho(D) immune globulin within 72 hours following delivery of an Rh-positive infant is crucial for Rh-negative mothers. This prevents the mother from becoming sensitized to the Rh antigen after exposure to fetal red blood cells during birth. If sensitization occurs, subsequent Rh-positive pregnancies could be affected by hemolytic disease.

Choice D rationale

Amniocentesis, a procedure involving needle insertion into the uterus, carries a risk of fetomaternal hemorrhage and potential exposure of an Rh-negative mother to Rh-positive fetal blood. Administering Rho(D) immune globulin following this procedure is a prophylactic measure to prevent maternal sensitization and protect future Rh-positive pregnancies. .

Choice A rationale

Frequent enemas are sometimes used in the management of Hirschsprung's disease, but their primary purpose is to empty the bowel of accumulated stool, not to stimulate bowel movements. The disease is characterized by an absence of ganglion cells, which prevents normal peristalsis, making stimulation ineffective.

Choice B rationale

Avoiding medications that can cause constipation is crucial for children with Hirschsprung's disease. Since their colon lacks the necessary ganglion cells for normal peristalsis, any further slowing of bowel transit due to medication can exacerbate fecal impaction and increase the risk of enterocolitis.

Choice C rationale

Maintaining a high-fiber diet is generally contraindicated in Hirschsprung's disease. High-fiber diets increase stool bulk, which can worsen constipation and impaction in a colon that is unable to propel stool effectively due to the absence of ganglion cells in the affected segment.

Choice D rationale

There is no specific evidence or recommendation for strict adherence to a low-protein diet in the management of Hirschsprung's disease. Dietary interventions primarily focus on managing constipation and preventing enterocolitis, rather than protein restriction, which can impact growth and development.

Choice E rationale

Daily laxative use is generally not recommended as a primary long-term management strategy for Hirschsprung's disease. While laxatives might provide temporary relief, they do not address the underlying physiological defect and can lead to dependency or electrolyte imbalances. Surgical correction is the definitive treatment.

Choice F rationale

Surgical intervention is the definitive treatment for Hirschsprung's disease. This involves removing the aganglionic segment of the bowel, allowing for normal peristalsis to be restored. Without surgery, the child will continue to experience severe constipation, impaction, and potential life-threatening complications like enterocolitis.

Choice G rationale

While complications like enterocolitis in Hirschsprung's disease may necessitate emergency department visits, the goal of management is to minimize these occurrences through appropriate medical and surgical interventions. Frequent visits for routine bowel management indicate suboptimal long-term care, not a planned approach.