A nurse is contributing to the plan of care for a 5-week-old infant in the pediatric unit.

The infant has been vomiting since week 2 of life and it has been progressively worse over the past 2 weeks.

Parents report the vomiting is now forceful and projectile (“like a volcano erupting”) immediately after every feeding, but the infant is eager to eat and seems to be constantly hungry.

The infant has been receiving a cow’s milk-based, iron-fortified formula since birth. The pediatrician reports the infant has not gained weight in the past 2 weeks.

The last weight in the pediatrician’s office is 3.54kg (8 lb). No other significant medical or surgical history.

What condition is the client most likely experiencing and what actions should the nurse take to address that condition? What parameters should the nurse monitor to assess the client’s progress?

Choice A rationale
The goal of surgery for Hirschsprung disease is to remove the diseased section of the intestine and then pull the healthy portion of this organ down to the anus. This is typically achieved through a type of surgery called a pull-through procedure. In some cases, doctors recommend ostomy surgery of the bowel followed by a pull-through procedure. During ostomy surgery, surgeons create a stoma on a child’s abdomen and connect the stoma to the large or small intestine. After ostomy surgery, waste will leave the child’s body through the stoma. The stoma is usually temporary. In most cases, surgeons can later close the stoma and connect the healthy part of the intestine to the anus. Waste will move through the intestines, and stool will pass through the anus again. Therefore, the statement “I’m glad that the ostomy is only temporary” indicates understanding of the surgery’s goal.
Choice B rationale
The operation for Hirschsprung’s disease does not involve straightening out a kink in the intestine. Instead, it involves removing the part of the large intestine that is missing nerve cells and then connecting the healthy part of the large intestine to the anus.
Choice C rationale
The use of a feeding tube is not typically associated with the initial surgery for Hirschsprung’s disease. The surgery involves removing the diseased section of the intestine and then pulling the healthy portion of this organ down to the anus.
Choice D rationale
While the ultimate goal of the surgery is to enable normal bowel movements, it is important to note that about half of children may have ongoing problems after surgery. These problems may include constipation and, in some cases, other symptoms of intestinal obstruction, such as a swollen abdomen or vomiting.

Choice A rationale
It’s not advisable to follow the directions on the aspirin bottle for her age and weight. Aspirin is not recommended for use in children due to the risk of Reye’s syndrome, a rare but serious condition that can affect the liver and brain.
Choice B rationale
This is the correct response. Acetaminophen is a safer alternative to aspirin for managing fever in children.
Choice C rationale
While it’s generally a good idea to administer medication with food to prevent stomach upset, this advice does not address the specific risks associated with giving aspirin to a toddler.
Choice D rationale
Giving a toddler three baby aspirin every 4 hours is not recommended due to the risk of Reye’s syndrome.