Dustin who was diagnosed with Hirschsprung’s disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first?
A. Administer an antidiarrheal.
B. Notify the physician immediately.
C. Monitor the child every 30 minutes.
D. Nothing. (These findings are common in Hirschsprung’s disease.)
Correct Answer: B. Notify the physician immediately.
For the child with Hirschsprung’s disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung’s associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.
Option A: Generally, because of intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung’s disease. The diagnosis of Hirschsprung disease (HD) almost exclusively demands surgical intervention. Pediatric health care providers should possess a comprehensive understanding of the most popular surgical procedures to assist the bridging referral phase between the surgeon and the patient’s family.
Option C: The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. Parents should be aware of any suspicious symptoms suggestive of HD, including delay in the passage of meconium for more than 48 hours during the neonatal period. Moreover, non-specific symptoms, including constipation, abdominal distention, reflux, nausea, vomiting, and diarrhea, should also raise suspicion.
Option D: Hirschsprung’s disease typically presents with chronic constipation. Several points in the history and physical examination of HD as one of the differential diagnosis of neonatal bowel obstruction include (1) abnormal maternal amniotic fluid indexes including polyhydramnios, (2) vomiting and specifically bilious emesis, (3) obstipation, which might present with failure to pass meconium in the first 48 hours of life and (4) abdominal distention.