A nurse is caring for a child diagnosed with Hirschsprung's disease.
Which of the following should the nurse include in the education of the child's parents? (Select All that Apply.)
The need for frequent enemas to stimulate bowel movements.
The importance of avoiding medications that can cause constipation.
The importance of maintaining a high-fiber diet.
Strict adherence to a low-protein diet.
The need for daily laxative use to promote bowel movements.
The need for surgical intervention to correct the condition.
The need for frequent visits to the emergency department for bowel management.
Correct Answer : B,F
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","F"]
Explanation
Choice A rationale
Post-kidney transplant, immunosuppressive medications are crucial to prevent rejection, which also compromises the immune system. Engaging in contact sports significantly increases the risk of direct trauma to the transplanted kidney, potentially causing injury or rupture, which could necessitate re-transplantation or lead to graft loss.
Choice E rationale
Grapefruit contains furanocoumarins, compounds that inhibit the cytochrome P450 3A4 (CYP3A4) enzyme system in the liver and intestines. Many immunosuppressants, like calcineurin inhibitors (e.g., cyclosporine, tacrolimus), are metabolized by CYP3A4. Inhibition of this enzyme can lead to increased drug concentrations and elevated risk of toxicity.
Choice F rationale
Fluid restriction post-kidney transplant may be necessary, particularly in the immediate postoperative period or if the patient experiences fluid overload or delayed graft function. Excessive fluid intake could contribute to hypertension or pulmonary edema, complicating recovery and potentially stressing the newly transplanted kidney.
Correct Answer is C
Explanation
Choice A rationale
Gonorrhea is a sexually transmitted infection caused by the bacterium *Neisseria gonorrhoeae*. This gram-negative diplococcus primarily infects mucous membranes of the reproductive tract, mouth, and rectum, leading to symptoms like discharge and dysuria. It is not caused by a protozoan.
Choice B rationale
Chlamydia is a sexually transmitted infection caused by the obligate intracellular bacterium *Chlamydia trachomatis*. This bacterium infects columnar epithelial cells, particularly in the genitourinary tract, often leading to asymptomatic infections or symptoms like urethritis and cervicitis. It is not a protozoal infection.
Choice C rationale
Trichomoniasis is a sexually transmitted infection caused by the anaerobic flagellated protozoan parasite *Trichomonas vaginalis*. This microorganism infects the urogenital tract, leading to vaginitis in females and urethritis in males, characterized by symptoms like itching, burning, and discharge.
Choice D rationale
Syphilis is a sexually transmitted infection caused by the spirochete bacterium *Treponema pallidum*. This bacterium can disseminate throughout the body, causing a multi-stage disease with diverse clinical manifestations affecting skin, mucous membranes, and internal organs. It is not caused by a protozoan.
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