A child with severe gastroesophageal reflux disease (GERD) is scheduled for Nissen fundoplication. Postoperative nursing management should include (select all that apply):
Starting bolus feedings to stretch the stomach
Venting gastrostomy tube
Keeping child flat in bed to increase absorption of food
Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome
Correct Answer : B,D
Choice A reason: Starting bolus feedings to stretch the stomach is not recommended for a child with Nissen fundoplication as it can cause increased pressure on the surgical site and lead to complications such as bleeding, perforation, or slippage of the wrap.
Choice B reason: Venting gastrostomy tube is a correct answer as it allows for the release of gas and fluids from the stomach and prevents gastric distension and discomfort. A gastrostomy tube is often placed during Nissen fundoplication to facilitate feeding and venting.
Choice C reason: Keeping child flat in bed to increase absorption of food is not advised for a child with Nissen fundoplication as it can increase the risk of aspiration and pneumonia. The child should be positioned at a 30-degree angle or higher after feeding to prevent reflux.
Choice D reason: Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome is a correct answer as it is a potential complication of Nissen fundoplication. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, causing symptoms such as abdominal cramps, nausea, diarrhea, sweating, and dizziness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: An axillary temperature of 37.3° C is within the normal range for a 10 month old child and does not indicate a complication of intussusception or its treatment.
Choice B reason: Mild abdominal pain is expected after an emergency reduction for intussusception and can be managed with analgesics and comfort measures.
Choice C reason: A BP of 100/54 is normal for a 10 month old child and does not reflect hypovolemia or shock, which are possible complications of intussusception.
Choice D reason: Currant jelly stools are a sign of intestinal bleeding and ischemia, which are serious complications of intussusception that require immediate medical attention. Currant jelly stools are red, mucus-like, and mixed with blood. They indicate that the intussusception has not been resolved or has recurred.
Correct Answer is A
Explanation
Choice A reason: This statement is correct, as breastfeeding is the best source of nutrition and hydration for infants with diarrhea, as it provides antibodies, electrolytes, and fluids. The nurse should encourage the mother to continue breastfeeding per routine, or to offer expressed breast milk if the infant is too weak or fussy to nurse.
Choice B reason: This statement is incorrect, as Imodium is not recommended for infants with diarrhea, as it can cause serious side effects, such as ileus, toxic megacolon, or central nervous system depression. The nurse should advise the parents to avoid giving any anti-diarrheal medications to the infant, unless prescribed by the doctor.
Choice C reason: This statement is incorrect, as Kaopectate is not recommended for infants with diarrhea, as it contains bismuth subsalicylate, which can cause Reye syndrome, a rare but serious condition that affects the liver and brain. The nurse should advise the parents to avoid giving any anti-diarrheal medications to the infant, unless prescribed by the doctor.
Choice D reason: This statement is incorrect, as returning to daycare 24 hours after antibiotics have been started is not appropriate for infants with diarrhea secondary to rotavirus, as antibiotics are not effective against viral infections, and the infant may still be contagious and infect other children. The nurse should instruct the parents to keep the infant at home until the diarrhea has resolved, and to practice good hand hygiene and sanitation to prevent the spread of the infection.
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