A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.)
a. Perineal and wound care
b. Necessity of firm stools to keep suture line clean
c. Bowel training beginning as soon as child returns home
d. Reporting any changes in stooling patterns to practitioner
e. Use of diet modification to prevent constipation
ANS: A, D, E
Wound care instruction is necessary in a child who is being discharged after surgery. The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided, since a firm stool will place strain on the suture line. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.
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