A nurse is caring for a school-age child who has appendicitis. For which of the following findings should the nurse monitor as a manifestation of a perforated appendix and report to the provider?

The nurse should describe hyperactive bowel sounds as sounds that are loud, high-pitched and increased in frequency and intensity. They are more frequent than normal bowel sounds, with a rapid succession of sounds occurring at a rate greater than 5 to 30 sounds per minute.

Hyperactive bowel sounds can be heard in conditions such as gastroenteritis, diarrhea, and early mechanical bowel obstruction. They indicate increased bowel motility and are often associated with increased peristalsis.

To differentiate hyperactive bowel sounds from normal or hypoactive bowel sounds, the nurse can explain that hypoactive bowel sounds are decreased or absent sounds that occur when the bowel motility is decreased, such as in conditions like paralytic ileus or after abdominal surgery. Normal bowel sounds are typically soft, low-pitched, and occur at a rate of 5 to 30 sounds per minute.

Reduced fat in the stools

Pancrelipase is an enzyme replacement therapy used in the treatment of cystic fibrosis, a condition that affects the exocrine glands, including the pancreas. Cystic fibrosis impairs the production and secretion of digestive enzymes, leading to malabsorption of nutrients, particularly fats.

Pancrelipase contains enzymes (lipase, amylase, and protease) that help in the digestion of fats, carbohydrates, and proteins, respectively. By administering pancrelipase, the nurse aims to improve the digestion and absorption of nutrients, especially fats. As a result, one of the therapeutic effects of pancrelipase in a child with cystic fibrosis is a reduction in fat in the stools, as the enzymes help break down dietary fats properly, preventing their excretion undigested.

Improved respiratory function in (option B) is not correct because while cystic fibrosis primarily affects the respiratory system, the administration of pancrelipase does not directly improve respiratory function. Other treatments and interventions are used to manage respiratory symptoms in cystic fibrosis.

Improved absorption of vitamins B and C in (option C) is not correct because Pancrelipase primarily aids in the digestion and absorption of fats, carbohydrates, and proteins. Although the absorption of vitamins can be indirectly affected by improved digestion, the main therapeutic effect of pancrelipase is related to fat digestion.

Decreased sodium excretion in (option D) is not correct because Pancrelipase does not have a direct effect on sodium excretion. Sodium balance is primarily regulated by the kidneys, and interventions targeting sodium excretion would involve dietary changes or medications targeting renal function.