Question

A nine month old baby boy who swallowed quarter and got sent to the emergency department two days later. The parent did not noticed that the baby swallowed a coin until the baby started showing symptoms of vomiting and trying to cough something out his throat. The parent also reported that the baby was not been eating good but continues to disregard that there might be something wrong. The incident happened Sunday, the baby got sent to the hospital Tuesday.

All information provided must be properly cited. Do not copy and paste your answers.

MEDICAL DIAGNOSIS (1 point)

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DEFINITION/Description of medical diagnosis (2 points)

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DIAGNOSTIC TESTS expected to be ordered/findings you might anticipate (1 point)

(LIST NORMAL VALUES)

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SIGNS AND SYMPTOMS, Underline the S/S your patient exhibited (2 points)

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NURSING INTERVENTIONS to include teaching (2 points)

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PROCEDURES AND NURSING IMPLICATIONS (1 point)

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MEDICAL INTERVENTIONS/Orders (1 point)

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Answer 1

MEDICAL DIAGNOSIS

Foreign body ingestion

DEFINITION

A foreign body that is nonedible material outside the body is ingested into the mouth and through the gastrointestinal tract.

DIAGNOSTIC TESTS

• Barium swallow: This test is an x-ray of throat and esophagus. Barium helps esophagus and stomach show up better on x-rays. Nurse should administer the barium to the patient and observe for any side effects
• Computerized tomography scan: The dye is administered by mouth or in an IV before the pictures are taken.
• Endoscopy: This test uses a scope to see the inside of the digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures.
• Fluoroscopy: This is a special type of x-ray that shows movement of joints, organs, and parts of the body.
• Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of stomach and intestines (bowel).
• X-rays: X-rays of different parts of your body may be taken. These may include the neck, chest

SIGNS AND SYMPTOMS

• Dysphagia
• Nonspecific abdominal pain
• Stridor and wheezing
• Drooling
• Gagging, nausea/vomiting, neck/throat pain
• Atypical chest pain or noncardiac chest pain
• Choking
• Signs of upper gastrointestinal obstruction

NURSING INTERVENTIONS

• Nurse should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain.
• Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events.
• Provide emotional support to the child and parents

PROCEDURES AND NURSING IMPLCATIONS

A consent form is a legal document that explains the tests, treatments, or procedures. The nurses should obtain the informed consent before every procedures.

· Bougienage: Caregivers insert a thin tube into the esophagus to widen it. They then push the object into the stomach using another instrument. Bougienage is done if the object is smooth and blunt, and likely to be passed out the body. This may also be done if the object was swallowed within the past 24 hours.

· Endoscopy: Using a scope with a camera, caregivers look for the foreign body and remove it using different instruments. Objects may be grasped using forceps or caught using a net.

· Foley catheter: Caregivers insert a catheter (rubber tube) into the mouth or nose until it goes past the object. With fluoroscopy (a special type of x-ray) as a guide, the balloon at the end of the catheter is filled, and gently pulled out. This may be done if the object is smooth or blunt, such as a coin. A catheter may be used when the object was swallowed within the past 24 hours.

· Surgery: You may need surgery if many objects were swallowed, or if the swallowed object was large. This may also be done to look for an injury or problem caused by the foreign body. Caregivers may also repair or treat the injury or problem during surgery.

MEDICAL INTERVENTIONS

Management of most foreign body ingestions is conservative, using a ‘watch-and-wait’ approach.

Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients.

In most cases, items swallowed by children can be removed with an endoscopic procedure.

During this minimally-invasive procedure, a thin, flexible tube with a tiny camera and light attached at the end is carefully inserted in the child's mouth and into the gastrointestinal tract