A nurse is caring for a child diagnosed with Hirschsprung's disease. Which of the following should the nurse include in the education of the child's parents? (Select All that Apply.)

A. The need for frequent visits to the emergency department for bowel management. While Hirschsprung’s disease involves significant intestinal dysfunction, the goal of long-term management is to establish a predictable home routine. Parents are taught to monitor for enterocolitis, a life-threatening complication, which would necessitate emergency care. Routine bowel management is typically handled through specialized outpatient follow-up rather than recurrent emergency department utilization. B. The importance of maintaining a high-fiber diet. High-fiber intake can exacerbate abdominal distension and obstruction in a child with an aganglionic colon segment. The lack of peristalsis in the affected area means that bulkier stools are more difficult to propel, increasing the risk of impaction. Dietary management usually focuses on low-residue or specialized formulas to facilitate easier passage of stool before surgical correction. C. Strict adherence to a low-protein diet. Protein intake is essential for the growth and tissue repair of a pediatric patient, especially when preparing for surgical intervention. There is no physiological basis for restricting protein in Hirschsprung’s disease, as it does not affect the aganglionic nature of the bowel. Education should focus on high-calorie, nutritious options that do not contribute to intestinal bulk or obstruction. D. The need for surgical intervention to correct the condition. Hirschsprung’s disease is caused by the absence of ganglion cells in the distal colon, which can only be resolved by removing the aganglionic segment. Surgical procedures, such as a pull-through operation, are necessary to restore functional bowel motility and prevent chronic obstruction. Parents must understand the surgical timeline and the potential need for a temporary colostomy to allow the bowel to rest. E. The importance of avoiding medications that can cause constipation. Many common medications, such as certain analgesics or anticholinergics, decrease intestinal motility and can worsen the existing functional obstruction. In a child with impaired colonic transit, these drugs increase the risk of fecal impaction and toxic megacolon. Parents must be educated to screen all over-the-counter and prescribed medications for side effects that impact gastrointestinal motility. F. The need for frequent enemas to stimulate bowel movements. While enemas are used preoperatively to decompress the bowel, they are not a long-term alternative to surgical correction. Over-reliance on enemas can lead to electrolyte imbalances and potential mucosal injury in a pediatric patient. Education focuses on the temporary nature of these interventions as a bridge to definitive surgical treatment. G. The need for daily laxative use to promote bowel movements. Laxatives are generally ineffective in Hirschsprung’s disease because the primary issue is a lack of innervation, not slow transit in healthy tissue. Forcing stool into an aganglionic, non-relaxing segment can cause significant pain and increased intraluminal pressure. Management prioritizes surgical resection of the non-functional segment over pharmacological attempts to force bowel movements.