LPN Nursing · GI and Renal Disorders in Children · Practice question
A nurse is assisting with the care of an 11-month-old infant who was brought to the emergency department by their guardians. Click to highlight the findings below that require follow-up. To deselect a finding, click on the finding again.
Nurses' Notes
Day 1, 0800:
Guardians report infant has had frequent, sudden episodes of crying and has been pulling their knees to their chest over the past several hours. Infant vomits during these episodes. Guardians report a soft stool that contained blood and mucus 2 hr ago. Infant is eating solid foods and was recently switched from formula to whole cow's milk. Infant is currently receiving amoxicillin for otitis media following an upper respiratory infection.
Guardians report the infant is happy and plays in between these crying episodes.
Day 1, 1800:
Infant sleeping in crib.
Guardian states that the infant has been sleeping most of the time but with intermittent periods of extreme fussiness.
Guardian reports trying to feed the infant when awake but intake was refused. Moderate amount of urine and currant jelly-
like stool noted in diaper. Hypoactive bowel sounds. Infant cries when abdomen is palpated.
Vital Signs
Day 1, 0800:
Temperature 37.2° C (99° F) axillary
Heart rate 128/min (Apical)
Respiratory rate 26/min
Pulse oximetry 98%
Day 1, 1800:
Temperature 37.3° C (99.2° F) axillary
Heart rate 120/min (apical)
Respiratory rate 28/min
Pulse oximetry 97%
Diagnostic Results
Day 1, 0830:
Hemoglobin 8.1 g/dL (9.5 to 14 g/dL)
Hematocrit 26% (29% to 43%)
Progress Report
Day 1, 0900:
Abdomen tender to palpation. Sausage-shaped mass palpated in right upper quadrant.
Ultrasound confirms the presence of an intussusception.
Plan: Attempt reduction of intussusception by administration of gas enema in interventional radiology.
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Nurses' Notes Day 1, 0800: Guardians report infant has had frequent, sudden episodes of crying and has been pulling their knees to their chest over the past several hours. Infant vomits during these episodes. Guardians report a soft stool that contained blood and mucus 2 hr ago. Infant is eating solid foods and was recently switched from formula to whole cow's milk. Infant is currently receiving amoxicillin for otitis media following an upper respiratory infection. Guardians report the infant is happy and plays in between these crying episodes. Vital Signs Day 1, 0800: Temperature 37.2° C (99 ° F) axillary Heart rate 128/min (apical) Respiratory rate 26/min Pulse oximetry 98%
Answer & explanation
Correct:
The clinical presentation of this 11-month-old strongly suggests intussusception, a condition requiring urgent follow-up and intervention. The entire nurses' note segment is selectable and contains multiple findings that collectively describe a classic intussusception presentation: sudden, episodic crying with the infant drawing knees to the chest (indicating colicky abdominal pain), vomiting during episodes, and a stool containing blood and mucus — the hallmark 'currant jelly' stool of intussusception. The infant plays normally between episodes, which is also characteristic. These findings — the episodic severe colicky pain, bloody mucoid stool, vomiting, and age of presentation (6–18 months is peak incidence) — are all red flags that require immediate follow-up. The recent switch from formula to whole cow's milk could be noted as potentially relevant but is not a direct trigger of intussusception. The amoxicillin use for otitis media is worth noting since enlarged Peyer's patches from recent infection can serve as lead points for intussusception. Because the only selectable segment is the entire narrative paragraph (index 3), and all the clinically significant findings requiring follow-up are contained within that segment, the correct answer is to highlight segment index 3 in its entirety. No other segments are selectable.
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