A nurse is caring for a 3-month-old male infant in an inpatient pediatric unit. Exhibits Which of the following actions should the nurse prioritize for the infant with suspected Hirschsprung’s disease?

Choice A rationale: Glycerin suppositories may stimulate rectal evacuation by osmotic action, but they are ineffective in Hirschsprung’s disease due to aganglionic rectal segments lacking neuromuscular coordination. The pathophysiology involves absence of enteric ganglion cells, leading to functional obstruction. Administering stimulants in this context may worsen discomfort or delay diagnostic clarity. Therapeutic focus should shift toward confirming diagnosis and planning definitive surgical management, not symptom suppression through inappropriate pharmacologic stimulation. Choice B rationale: Rectal biopsy is the gold standard for diagnosing Hirschsprung’s disease, which stems from failure of neural crest cell migration, leading to aganglionosis in the distal colon. Biopsy evaluates for absence of ganglion cells in the submucosal and myenteric plexuses. Confirmatory diagnosis enables planning for pull-through surgical procedures. Biopsy prioritization is critical when symptoms include delayed meconium passage, abdominal distention, explosive diarrhea, and a transition zone on imaging—all hallmark findings of Hirschsprung’s disease. Choice C rationale: Oral rehydration may seem appropriate in mild dehydration, but in Hirschsprung’s disease, fluid losses stem from poor absorption and structural bowel defects. Explosive watery stools reflect overflow diarrhea, not hyperosmolar loss. Moreover, oral intake may exacerbate abdominal distention. Parenteral fluid resuscitation may be more appropriate pending diagnostic confirmation and surgical consultation. Fluid correction must be guided by systemic signs and done cautiously to avoid worsening bowel symptoms. Choice D rationale: Antibiotics are not routinely indicated unless enterocolitis or sepsis is confirmed. Fever alone is nonspecific and may reflect systemic inflammation due to bowel obstruction. Hirschsprung’s-associated enterocolitis presents with toxic signs like vomiting, fever, bloody diarrhea, and lethargy, not just distention and watery stool. Initiating antibiotics prematurely may mask infection or delay focused diagnosis. A careful diagnostic approach, starting with biopsy, takes precedence to confirm structural bowel abnormality. MWISHO