AIIMS Nagpur NO- 2020
Child Health Nursing (Pediatrics)
Easy
When palpating the abdomen of hypertrophic pyloric stenosis infant, the Nurse finds:
Appeared in: AIIMS Nagpur NO- 2020
Explanation
- Hypertrophic Pyloric Stenosis (HPS) involves the thickening of the pyloric muscle, which creates a physical obstruction at the gastric outlet.
- This thickened muscle is palpable as a distinct, firm, mobile, olive-shaped mass.
- The classic location for palpating this mass is in the right upper quadrant (RUQ) of the infant's abdomen, sometimes best felt when the infant's stomach is empty after vomiting.
Why Other Options Were Wrong
- Option B: The abdomen of an infant with HPS is typically non-tender. Marked tenderness is not a characteristic feature and may suggest other acute abdominal conditions like peritonitis.
- Option C: The obstruction in HPS is at the stomach outlet, which is proximal to the colon. Therefore, the stomach would be distended, but the colon would be empty and not distended.
- Option D: Peristaltic waves in HPS are a VISIBLE finding, not a palpable one. They are observed in the UPPER abdomen, moving from left to right, not in the lower abdomen.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Physical assessment findings in infantile hypertrophic pyloric stenosis to guide bedside assessment, documentation, and the next nursing action.
- A nurse's ability to identify the 'olive' mass during palpation is a critical assessment skill that can lead to a prompt diagnosis of HPS, preventing severe dehydration and electrolyte imbalance.
- Pre-operative nursing care is focused on correcting dehydration and hypochloremic metabolic alkalosis with IV fluids before the infant undergoes a pyloromyotomy (the surgical correction).
- Post-operatively, the nurse monitors for signs of infection, manages pain, and gradually reintroduces feedings, observing for any persistent vomiting.
How to Approach the Question
- First, identify the core condition in the question: 'hypertrophic pyloric stenosis'.
- Next, recall the classic clinical signs and symptoms associated with this condition. The main triad is non-bilious projectile vomiting, a palpable olive-shaped mass, and visible peristalsis.
- Analyze the action in the stem: 'palpating the abdomen'. This means you are looking for a finding that is felt by touch.
- Evaluate each option based on the classic signs and the action of palpation.
- Option A describes the classic palpable mass. Option D describes peristaltic waves, which are visible, not palpable, and in the wrong location. Options B and C are inconsistent with the pathophysiology of HPS.
- By matching the specific assessment technique (palpation) with the known pathophysiology, you can confidently select the correct finding.
Concept Tested & Keywords
- Concept Tested: Physical assessment findings in infantile hypertrophic pyloric stenosis
- Stem keywords: palpating, abdomen, hypertrophic pyloric stenosis, infant
- Lead-in keywords: finds
- Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
- Negative lead-in flag: false
Question ID
QGxy-yIs2MZWPb2Khm0cCq
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 58-60
Practise the full AIIMS Nagpur NO- 2020
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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