Exhibits

For each potential provider prescription, click to specify if the prescription is expected or unexpected for the adolescent. There must be at least 1 selection in every row. There does not need to be a selection in every column.

A. Maintain the child in a supine position: The child should not be in a supine (lying flat) position during enteral feedings, as this increases the risk of aspiration. The child should be positioned upright or at least 30 to 45 degrees to reduce this risk.
B. Discard gastric residuals prior to each feeding: While it is important to check gastric residuals before each feeding to ensure proper gastric emptying, residuals should not automatically be discarded. Depending on the volume of residuals, the feeding may need to be delayed or adjusted rather than discarded.
C. Warm the feeding in the microwave oven for 15 seconds: Feeding should never be warmed in the microwave because it can cause uneven heating, which could lead to burns. Feedings should be warmed using a safe method, such as a warm water bath, to ensure even temperature.
D. Administer the feeding to the child at 10 mL/min: Administering the feeding at a slow and controlled rate, such as 10 mL/min, is recommended to prevent discomfort and reduce the risk of aspiration. This rate allows the digestive system to process the feeding properly.

Rationale for Correct Choices:

• Intussusception: The toddler's sudden onset of crying, drawing knees to the chest, and high-pitched cry are classic signs of intussusception. The "red jelly" stool (currant jelly stool) is also a hallmark symptom of this condition.
• Reinforce teaching with the guardian about hydrostatic reduction: Hydrostatic reduction is the treatment for intussusception, where a contrast material is used to reduce the telescoped bowel. It's an important intervention that should be discussed with the guardian.
• Palpate the toddler's abdomen for a mass in the upper quadrant: A palpable abdominal mass is a classic sign of intussusception, and the nurse should assess for this to help confirm the diagnosis.
• Abdominal pain: Monitoring abdominal pain is essential because it can be a significant indicator of worsening intussusception or any complications. The child is showing signs of severe pain, so it needs to be closely watched.
• Stool consistency: The "red jelly" stool is a key finding of intussusception, and the nurse should continue to monitor for this, as it is a clear indicator of bowel obstruction.

Rationale for Incorrect Choices:

• Prepare the toddler for an upper endoscopy with possible biopsy : An upper endoscopy with biopsy is used to assess gastrointestinal conditions like Celiac disease or gastroesophageal reflux. Intussusception is diagnosed through imaging techniques like ultrasound or a contrast enema, not an upper endoscopy.
• Request a prescription for a fat-soluble vitamin supplement: Vitamin supplements are more relevant to conditions like Celiac disease or other chronic malabsorption syndromes.
• Obtain a prescription for blood transglutaminase antibody testing: This test is relevant for diagnosing Celiac disease but is not needed for diagnosing intussusception, which requires imaging and clinical assessment for bowel obstruction.
• Gastroesophageal reflux: Gastroesophageal reflux does not typically present with the acute abdominal pain, "red jelly" stool, or the high-pitched crying observed in this toddler. It's more of a chronic condition associated with spitting up or regurgitation.
• Celiac disease: Celiac disease typically presents with gastrointestinal issues like diarrhea, abdominal distension, and failure to thrive, rather than acute symptoms like crying and "red jelly" stools.
• Gastroenteritis: While gastroenteritis may present with vomiting, diarrhea, and irritability, it does not explain the specific findings of a high-pitched cry, drawing knees to the chest, or the characteristic stool.
• Bone mineral densit: Bone mineral density is relevant to conditions like osteoporosis or rickets but is not related to intussusception. The focus here should be on monitoring gastrointestinal symptoms, particularly abdominal pain and stool consistency, not bone health.
• Sleep pattern: While sleep pattern can be affected by various conditions, it is not a primary concern in the management of intussusception. The toddler's acute symptoms (pain, vomiting, stool changes) should take precedence over monitoring sleep.
• Urine specific gravity: Urine specific gravity is typically monitored for dehydration or kidney function, but intussusception is not primarily associated with these issues.
• Request a prescription for blood transglutaminase antibody testing: This test is relevant for diagnosing Celiac disease but is not needed for diagnosing intussusception, which requires imaging and clinical assessment for bowel obstruction.