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A nurse in an acute care facility is caring for a toddler.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.

A.

Pain rating

B.

Vomiting

C.

Stool

D.

Temperature

E.

Abdominal findings

Answer and Explanation

The Correct Answer is {"A":{"answers":"C"},"B":{"answers":"B,C"},"C":{"answers":"A,C"},"D":{"answers":"B"},"E":{"answers":"C"}}

  • Pain rating: Severe, intermittent abdominal pain where the child draws their knees to the chest and then returns to normal behavior is a classic symptom of intussusception. Neither Crohn’s disease nor appendicitis typically presents with this pattern, appendicitis pain is usually constant and worsening, while Crohn’s pain is chronic and non-episodic.
  • Vomiting:  Vomiting in intussusception is common and often non-bilious in early stages, aligning with the child's light-colored emesis. Vomiting also occurs in appendicitis, especially in the early stages. However, it is not a prominent or early symptom of Crohn’s disease unless obstruction is present.
  • Stool: The presence of blood and mucus in the stool ("currant jelly stool") is strongly associated with intussusception and may also occur in Crohn’s disease during flares due to colonic inflammation. Appendicitis does not typically cause bloody or mucoid stools, making this finding inconsistent with that diagnosis.
  • Temperature: A temperature of 37.4°C is within normal limits, appendicitis however may present with low grade fever. The absence of fever at this time limits its diagnostic value in this case.
  • Abdominal findings: A distended abdomen with hypoactive bowel sounds and a palpable sausage-shaped mass in the right upper quadrant is highly indicative of intussusception. These findings are not characteristic of appendicitis, which usually involves RLQ pain, or Crohn’s, which rarely presents with a discrete palpable mass.


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Related Questions

Correct Answer is []

Explanation

This client has multiple risk factors for pancreatitis, including type 2 diabetes mellitus, hyperlipidemia, and a history of cardiovascular disease. Although the vital signs are relatively stable, the presence of risk factors and a likely clinical presentation (e.g., abdominal symptoms assumed by context) are consistent with pancreatitis. In acute pancreatitis, the pancreas becomes inflamed and digestive enzymes may attack pancreatic tissue.

NPO status is essential to rest the gastrointestinal tract and reduce pancreatic stimulation. Opioids are typically required due to the severity of abdominal pain. Elevated glucose can result from impaired insulin production due to pancreatic inflammation. Jaundice may occur if the bile duct is obstructed due to pancreatic swelling or inflammation.

Correct Answer is D

Explanation

A. Explain long term consequences of the procedure to the child. This level of detail is not developmentally appropriate for a school-age child. It may increase anxiety without helping the child understand or cope with the immediate situation.
B. Remove the dressings while explaining the procedure to the child. While it is important to explain procedures, it should be done before starting to allow time for questions and emotional preparation. Explaining during may cause confusion or distraction.
C. Keep equipment out of the child's sight. Hiding equipment can actually increase fear and mistrust. School-age children benefit from open, age-appropriate communication and preparation about what to expect.
D. Allow the child to help remove the dressings. This is the most appropriate action. Allowing the child to participate in their care provides a sense of control, reduces anxiety, and helps build trust. It also aligns with the developmental need of school-age children to take on increasing responsibility and be involved in decision-making.

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