A nurse is caring for a child who has Hirschsprung’s disease. Which of the following findings should the nurse expect? (Select all that apply)

Choice A reason: Diabetic ketoacidosis (DKA) presents with flushing, drowsiness, and dry skin due to severe hyperglycemia, ketosis, and dehydration from osmotic diuresis. In children, insulin deficiency increases glucose and ketone production, causing metabolic acidosis and lethargy. DKA is life-threatening, requiring urgent insulin and fluid therapy to correct metabolic imbalances and prevent coma.

Choice B reason: The Somogyi phenomenon involves rebound hyperglycemia after nocturnal hypoglycemia, typically causing morning symptoms like sweating or shakiness, not flushing or drowsiness. Dry skin and progressive worsening suggest sustained hyperglycemia, as in DKA, not a transient rebound, making this an incorrect diagnosis for the child’s acute presentation.

Choice C reason: Water intoxication results from excessive water intake, causing hyponatremia, seizures, or confusion, not flushing or dry skin. The child’s symptoms indicate hyperglycemia and dehydration, consistent with DKA, not water overload. This condition is unrelated to diabetes pathophysiology, making it an incorrect explanation for the clinical presentation.

Choice D reason: The Dawn phenomenon involves morning hyperglycemia due to nocturnal growth hormone surges, not flushing, drowsiness, or dry skin. These symptoms suggest severe metabolic decompensation, as in DKA, with dehydration and acidosis. The Dawn phenomenon is less acute and does not match the child’s progressive deterioration.

Choice A reason: Syrup of ipecac is obsolete for acetaminophen overdose, as it delays definitive treatment like N-acetylcysteine. Acetaminophen causes hepatotoxicity via toxic metabolites, requiring specific antidote administration. Ipecac risks aspiration and is ineffective post-gastric lavage, making it an inappropriate choice for managing this potentially life-threatening overdose.

Choice B reason: Vitamin K treats bleeding from anticoagulant overdose, not acetaminophen toxicity, which causes hepatotoxicity by depleting glutathione, leading to liver damage. Vitamin K does not address acetaminophen’s metabolic effects, making it irrelevant. N-acetylcysteine is needed to restore glutathione and detoxify metabolites, making this choice incorrect.

Choice C reason: N-acetylcysteine is the antidote for acetaminophen overdose, replenishing glutathione to detoxify the toxic metabolite NAPQI, preventing liver damage. Administered post-gastric lavage, it reduces hepatotoxicity risk, especially if given within 8 hours of ingestion, making it the expected treatment to protect the child’s liver function.

Choice D reason: Activated charcoal adsorbs toxins in the gut but is less effective post-gastric lavage, as the stomach is already cleared. Acetaminophen’s rapid absorption requires N-acetylcysteine to prevent hepatotoxicity. Charcoal may be used early but is secondary to the antidote, making it less critical in this scenario.