Question

Which symptoms identified during the assessment of a 4-week-old male infant are consistent with the diagnosis of pyloric stenosis? A. Metabolic alkalosis B. Lack of interest in feeding C. Vomiting bile stained fluid. D. 2 ounce weight loss over last 3 days. E. Peristalsis observed over the abdomen.

Short answer

Symptoms consistent with pyloric stenosis in a 4-week-old infant include metabolic alkalosis (A), 2-ounce weight loss over the last 3 days (D), and peristalsis observed over the abdomen (E).

Step-by-step solution

Understand Pyloric Stenosis

Pyloric stenosis is a condition in infants that causes severe vomiting due to the narrowing of the pylorus, the opening from the stomach into the small intestine. Symptoms include projectile vomiting, which can lead to dehydration, and signs of metabolic alkalosis due to the loss of stomach acid.

Identify Symptoms of Pyloric Stenosis

Common symptoms of pyloric stenosis include projectile vomiting shortly after feeding, which may not be bile-stained because the obstruction prevents food from entering the small intestine where bile is introduced to the digested food. Additionally, one might see visible peristalsis as the stomach tries to push contents through the narrowed pylorus.

Assess Options

Option A (Metabolic alkalosis) occurs due to the loss of hydrochloric acid from the stomach with vomiting. Option B (Lack of interest in feeding) is not consistent; infants are typically hungry and want to feed due to loss of nutrients from vomiting. Option C (Vomiting bile stained fluid) would not be consistent with pyloric stenosis as bile is not typically present in the vomit. Option D (2-ounce weight loss) would be consistent with the failure to gain weight or weight loss due to vomiting. Option E (Peristalsis observed over the abdomen) is consistent as the stomach muscles may work harder to push contents through the narrowed pylorus.

Conclude the Appropriate Symptoms

Based on the understanding of pyloric stenosis and the associated symptoms, the correct answers include the options that describe symptoms consistent with the diagnosis of pyloric stenosis.

Key concepts

Metabolic Alkalosis

Metabolic alkalosis is a condition characterized by an elevated pH level in the blood, indicating a higher concentration of bicarbonate or a loss of acid. In infants with pyloric stenosis, this condition often arises from the frequent vomiting of stomach contents, which includes gastric acid. The loss of hydrochloric acid, normally present in vomit, can cause a significant shift in the body's acid-base balance.

It's crucial for caregivers and healthcare providers to recognize the signs of metabolic alkalosis in infants: irritability, muscle twitching, and, in severe cases, confusion or even seizures. These symptoms reflect the body's struggle to maintain normal neurological and muscular functions amidst altered blood chemistry. On the NCLEX-RN examination, nurses are expected to understand how to identify and manage metabolic alkalosis to ensure comprehensive pediatric care.

Infant Projectile Vomiting

Projectile vomiting in infants is a forceful expulsion of stomach contents that occurs suddenly and with great velocity, often without prior nausea. This is a hallmark sign of pyloric stenosis, a condition seen in young infants that can lead to complications if not promptly addressed.

Parents and healthcare professionals need to distinguish between normal spit-up and projectile vomiting. In pyloric stenosis, the vomiting typically occurs soon after feeding and is not bile-stained, as it has not mixed with bile from the intestine. This symptom represents a significant clue in diagnosis and should always prompt further investigation. The NCLEX-RN exam includes such pediatric scenarios to assess a nurse candidate's ability to discern critical symptoms and initiate appropriate action.

Peristalsis in Infants

Peristalsis is the involuntary contraction and relaxation of muscles in the gastrointestinal tract that propels food forward during digestion. In infants with pyloric stenosis, the muscles around the pylorus become hypertrophied, or thickened, causing a narrowing of the passageway from the stomach to the small intestine.

As a result, one may notice waves of peristalsis moving across an infant's abdomen as the stomach muscles work harder to push contents through the narrowed opening. This observation can be quite visible and is a critical diagnostic sign in assessing pyloric stenosis. Understanding the mechanics of peristalsis and its variations in pathological conditions is essential for NCLEX-RN candidates.

NCLEX-RN Examination Preparation

Preparing for the NCLEX-RN examination requires a thorough understanding of various disorders, including pediatric conditions like pyloric stenosis. Prospective nurses must be able to recognize signs and symptoms, such as metabolic alkalosis and projectile vomiting, and understand underlying physiological concepts like peristalsis.

Effective study strategies include reviewing case studies, practicing with scenario-based questions, and understanding the rationales behind each possible answer. Mastery of content, critical thinking, and time management are key components of NCLEX-RN examination preparation. Nursing candidates must demonstrate proficiency in recognizing and responding to pediatric emergencies to ensure they can provide safe and effective care as licensed professionals.