A nurse is caring for a 3-day-old newborn and suspects Hirschsprung disease. What finding best supports the nurse's concern?
The infant has passed several tar-like stools.
The infant has not gained weight and has stooled once.
The infant has not stooled.
The infant has passed hard, pellet-like stools.
The Correct Answer is C
Rationale:
A. Passing tar-like stools is normal for newborns within the first few days of life and does not indicate Hirschsprung disease.
B. Limited stooling and poor weight gain may suggest feeding issues but are not as indicative of Hirschsprung disease as the absence of stool.
C. The absence of stool (failure to pass meconium within 24-48 hours) is a classic sign of Hirschsprung disease, a condition where the absence of ganglion cells in the intestines leads to a blockage.
D. Passing hard, pellet-like stools may indicate constipation but is not specific to Hirschsprung disease, especially in a newborn.
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Correct Answer is A
Explanation
Rationale:
A. Acetaminophen can be used to manage mild discomfort after cardiac catheterization. It is a safe option for pain relief and is commonly recommended for children following the procedure.
B. Bed rest is typically recommended for a shorter duration, often 24 hours, not a full week. Extended bed rest is not usually required unless complications occur.
C. The diet should be advanced as tolerated, but there is no specific requirement to wait 24 hours; this will depend on the child’s recovery and tolerance.
D. Bathing recommendations often include avoiding submerging the site in water, so a tub bath may not be advised for the first few days to prevent infection. Sponge baths might be recommended instead.
Correct Answer is B
Explanation
Rationale:
A. Offering a pacifier is contraindicated after cleft lip and palate repair as it can disrupt the surgical site and interfere with healing.
B. Maintaining elbow restraints prevents the infant from touching or putting objects in their mouth, which could disrupt the surgical site and compromise healing.
C. The Trendelenburg position is not recommended as it can increase pressure on the surgical site and compromise breathing.
A
D. An ice collar may be used for pain relief in older children or adults but is not typically used in infants, and it may not be feasible in this population.