DISEASES OF THE DIGESTIVE organ

Problem No. 49

You are a district nurse in a children’s clinic. Conduct an active visit to the child of 3 months of age. On artificial feeding from 1.5 months. age, suffers from constipation. During the nursing examination, the nurse received the following data: There was no stool for two days. The child is restless, screams, presses his knees to his stomach, twists his legs. The skin is clean. The abdomen is moderately swollen, gases do not depart. Body temperature 36.7 degrees C, pulse 132 bpm, respiratory rate 44 per minute.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and draw up a nursing intervention plan with motivation.

Problem No. 50

You are a ward nurse in the neonatal pathology department. A one-month-old child was admitted for examination and treatment with a diagnosis of Pyloric stenosis? Pylorospasm?

Nursing examination obtained the following data: Breastfeeding. When sucking, periodically throws the breast. The real weight of the child is 3200. The child is restless. The skin is pale, clean, the subcutaneous fat layer is underdeveloped (thinned on the abdomen and thighs). Dystonia. The abdomen is slightly swollen, soft, painless on palpation, no visible peristalsis is observed. Stool 3 times a day, yellow, sour smell. Control feeding – 100 g. From the anamnesis: from the first pregnancy, which proceeded with preeclampsia of the first and second half. She was treated in the hospital for the threat of abortion in the second trimester. Childbirth in breech presentation, birth weight 3000.0, height 49 cm. Regurgitation began in the maternity hospital, was rare 1-2 times a day, then became more frequent and from 3 weeks of age was noted almost after each feeding, over the last week appeared vomiting “fountain”.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 51

You are a ward nurse in the pediatric gastroenterology department. A 9-year-old girl is hospitalized with a diagnosis of chronic gastroduodenitis.

During the nursing examination, the following data were obtained: the girl complains of pain in the abdomen of a cutting nature, the pains appear paroxysmal a few minutes after eating and last 30-40 minutes. Localization of pain – upper abdomen. Periodically, pain attacks are accompanied by nausea and vomiting.

From the anamnesis: The child from the 1st pregnancy, urgent delivery, proceeding without pathology. The girl is stubborn, capricious by nature. She studies well. For the last 3 years, he has been eating erratically, often in dry food, since. parents are working. In the family, there are frequent quarrels between the stepfather and the child. Suffering from abdominal pain for two years. First time in hospital.

Objectively: The girl is undernourished. Pale, blue shadows under the eyes. Pulse 88 bpm, respiratory rate 20 per minute, BP 100/60. The abdomen is soft on palpation, painful in the epigastric region. Stool with a tendency to constipation. Urination is not disturbed.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 52

You are a ward nurse in the pediatric gastroenterology department. A 13-year-old boy was admitted to the hospital with complaints of sharp pains in the epigastric region. Before admission to the hospital there was vomiting “coffee grounds”, after which the pain became dull, but there was weakness, palpitations, dizziness, tinnitus. Medical diagnosis: ‚ÄúPeptic ulcer of the stomach. stomach bleeding.”

On examination, the pallor of the skin is striking. BP 90/40 mm Hg PS 110 beats per minute, rhythmic, weak filling. On palpation – muscle tension in the epigastric region.

Tasks

  1. Identify needs that are not met.
  2. State the patient’s concerns.
  3. Set goals and plan nursing interventions with motivation.

Problem No. 53

You are a ward nurse in the pediatric gastroenterology department. There is an 8-year-old girl at your post with a diagnosis of biliary dyskinesia.

Nursing examination obtained the following data: complaints of dull aching pain in the right hypochondrium, nausea, belching, periodic vomiting. The pain is aggravated after eating fatty foods. The chair is unstable. The girl’s appetite is poor.

He considers himself ill for the last 2 years. Experiencing periodic pain in the right hypochondrium, nausea. The girl studies well, spends a lot of time preparing school lessons, walks a little. He worries when he gets a bad mark, he is afraid to upset his parents.

Objectively: The skin is pale, dryish to the touch. Undernourished girl. Tongue moist, densely lined with white at the root. Pulse 88 bpm, respiratory rate 22 per minute, BP 100/50. On palpation, the abdomen is soft, painful in the region of the right hypochondrium, when tapping along the costal arch on the right, pain occurs.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 54

You are a district nurse in a children’s clinic. A 4-year-old girl with a diagnosis of “Acute aphthous stomatitis” is undergoing outpatient treatment.

During the nursing examination, the following data were obtained: the girl is reluctant to make contact, restless, naughty, complains of pain in her mouth, refuses to eat, refuses to open her mouth. Sleeps badly Temperature 38 degrees C, … Lips are bright, swollen, increased salivation. On the mucous membrane of the cheeks, soft and hard palate, rashes in the form of erosions covered with a yellowish-gray coating. Mucous membranes bright, edematous. The submandibular lymph nodes are enlarged and painful. Respiratory rate 28 per minute, pulse 112 bpm.

From the anamnesis: the girl is ill on the 2nd day, the disease began with a rise in temperature to 37.8-38.9 degrees C, general weakness, sleep disturbance and refusal to eat.

Doctor prescribed:

– Irrigation of the oral cavity with a solution of furacillin 1: 5000 5-6 times a day.

– Before eating, rinse the mouth with a solution of novocaine 0.5% in warm water 1:1.

– Treatment of aft with trypsin solution 5-6 times a day.

– Antipyretics. (Paracetamol)

– Sparing diet.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 55

You are a district nurse in a children’s clinic. A mother with a 4-year-old child turned to the district pediatrician for an appointment. After examination by a doctor, a diagnosis of Enterobiasis was made.

During the nursing examination, the following data were obtained: complaints of itching in the anus, abdominal pain, loss of appetite, nausea, sleep disturbance, bedwetting. The girl, according to her mother, became capricious and irritable within two weeks.

Objectively: the girl is active, the skin is pale, the abdomen is soft, slightly painful on palpation around the navel, traces of scratching around the anus.

Medical appointments:

– Analysis of feces for enterobiasis.

– Pyrantel 10 mg/kg after taking the analysis once.

– .Recommendations for the treatment of all family members.

Tasks

  1. Find out what needs are being met.
  2. Formulate the problems of a sick child.
  3. Define goals and draw up a nursing intervention plan with motivation.

Problem No. 56

You are a kindergarten nurse. They began to notice that one of the children, a 6-year-old boy, complained of nausea, pain in the navel. The boy began to eat worse, lost weight, gets tired quickly, sleeps restlessly, sometimes he vomits. Objectively: the skin is pale, blue under the eyes, the subcutaneous fat layer is underdeveloped, sensitivity to palpation in the navel. Chair according to the boy without pathology. The pediatrician, having examined the child, made a presumptive diagnosis of Helminthiasis. During the examination in the analysis of feces, eggs of ascaris worms were found, the doctor prescribed treatment with decaris.

Tasks

  1. What is the final diagnosis?
  2. What changes are typical for a general blood test?
  3. Identify the patient’s problems.
  4. Define goals and create a nursing intervention plan with motivation.

Problem No. 57

You are a kindergarten nurse. When examining children after a daytime sleep in a 2-year-old girl, on the oral mucosa, several easily opening vesicles and erosions covered with a yellow-gray coating, surrounded by a bright red rim, were found. The child has increased salivation, the lips are swollen. The submandibular lymph nodes are enlarged and painful. The child refuses food, is naughty, does not play with children, body temperature is 38 degrees C.

Tasks

  1. What pathology did you suspect in the child.
  2. Identify what needs are being met.
  3. State the patient’s concerns.
  4. Define goals and create a nursing intervention plan with motivation.

Problem No. 58

You work as a ward nurse in the pediatric gastroenterology department. A 9-year-old girl is hospitalized with a diagnosis of gastric ulcer.

During a nursing examination, the following data were obtained: complaints of abdominal pain of a cutting nature, paroxysmal, decrease after eating, loss of appetite, belching, nausea, heartburn, constipation. The girl is touchy, according to her mother, capricious, she does not contact her neighbors in the ward. Objectively: the skin and mucous membranes are pale, the subcutaneous fat layer is not sufficiently expressed. On palpation, pain in the epigastric region.

Sick for about 2 years. Eats randomly, often dry. He has a negative attitude towards examination and treatment. He does not believe in his recovery.

Medical appointments:

– FGS.

– Diet N1.

– Bed mode.

– Medical therapy.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 59

You are a school nurse. After a physical education lesson, a 10-year-old boy came to you with complaints of pain in the right hypochondrium. The child is in the dispensary with a diagnosis of “Biliary dyskinesia in hypotonic form.”

During the nursing examination, the following data were obtained: complaints of constant aching pain in the right hypochondrium, which intensify after physical exertion, after eating fatty foods, weakness, fatigue, recurrent nausea, bitterness in the mouth. The child has been sick for two years. He does not follow the diet, he also often violates the motor regime. Objectively: the boy is active. The skin is pale, clean. Breathing through the nose is free, the respiratory rate is 18 per minute, the heart rate is 85 per minute. The abdomen is soft, painful in the right hypochondrium, the liver along the edge of the costal arch.

Tasks

  1. Find out what needs are being met.
  2. State the patient’s concerns.
  3. Define goals and create a nursing intervention plan with motivation.

Problem No. 60

You are a school nurse. A 10-year-old girl came to you for medical help with complaints of nausea, severe abdominal pain after general cleaning of the classroom. For 1.5 years, the girl has been in the dispensary for hypertensive type JVP.

During a nursing examination, the child is active, emotional, worries about his grades, and is sensitive to the comments of teachers. Appetite is reduced, does not like to have breakfast. Yesterday after dinner (potatoes with radish salad) there were pains in the abdomen, fell asleep after taking painkillers. Vomiting occurs periodically in the morning. The skin is clean, pale, shadows under the eyes. Food is somewhat reduced. Tongue wet, lined with white coating. Breathing through the nose is free, NPV – 18 per minute. Pulse – 90 beats per minute. The abdomen is soft on palpation, painful in the region of the right hypochondrium, when tapping along the right costal arch, there is a sharp pain. The chair is regular, once a day.

Tasks

1. What provoked a pain attack in the patient?

  1. What needs of the patient are not met?
  2. Identify actual and potential patient problems.
  3. Make a sound nursing intervention plan.

Problem No. 61

You are a district nurse in a children’s clinic. A mother came with a 4 year old child. Within a month, the mother notes that the child’s appetite has decreased, he began to sleep restlessly, periodically complains of pain in the abdomen, itching in the anus.

Nursing examination: The skin is pale, malnourished. Scratches in the anus. The abdomen is soft and painless on palpation. From the anamnesis: the child does not attend a children’s institution. The family has two more children, two cats live in the apartment.

Tasks

1. Find out what needs are being violated.

2. Identify the patient’s actual and potential problems.

3. Make a sound nursing intervention plan.

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