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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.

Temperature

B.

Vomiting

C.

Pain rating

D.

Abdominal findings

E.

Stool

Answer and Explanation

The Correct Answer is {"A":{"answers":"None"},"B":{"answers":"B,C"},"C":{"answers":"None"},"D":{"answers":"C"},"E":{"answers":"A,C"}}

  • Temperature: A temperature of 37.4°C is within normal limits and does not specifically support any of the three conditions. While low-grade fever may be seen in appendicitis or Crohn’s flares, the absence of fever at this time limits its diagnostic value in this case.
  • 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.
  • 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.
  • 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.
  • 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.


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Related Questions

Correct Answer is C

Explanation

A. Remind the client to eat scheduled meals daily: Clients nearing the end of life often have a decreased appetite and may be unable or unwilling to eat. Forcing meals can cause discomfort and is not a priority at this stage.

B. Place the client in a supine position: Lying flat can increase the risk of aspiration and respiratory discomfort. Positioning the client for comfort, often semi-Fowler’s or side-lying, is preferred.

C. Offer the client a blanket to keep warm: Clients near the end of life may experience chills or cool extremities due to decreased circulation. Providing a blanket helps maintain comfort and dignity, which is a primary goal of end-of-life care.

D. Speak in a loud tone when addressing the client: Speaking loudly is unnecessary unless the client has hearing impairment. Communication should remain calm, gentle, and respectful to provide reassurance and maintain comfort.

Correct Answer is A

Explanation

Rationale:

A. Adequate hydration: Maintaining proper fluid intake helps reduce blood viscosity and prevents sickling of red blood cells. Dehydration is a common trigger for sickle cell crises, so emphasizing hydration is crucial for prevention.

B. Increased iron intake: Most clients with sickle cell anemia do not require additional iron unless they have documented iron deficiency. Excess iron can accumulate and cause complications, especially in those receiving frequent transfusions.

C. Calorie restriction: Restricting calories is not recommended, as children with sickle cell anemia often have increased metabolic needs due to chronic hemolysis and may require adequate nutrition for growth and energy.

D. A low-protein diet: Protein is important for growth, tissue repair, and overall health. A low-protein diet is not indicated and could worsen nutritional status in children with sickle cell disease.

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