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Intussusception

Terms in this set (23)

Overview
Condition in which a portion of the bowel telescopes or invaginates into an adjacent bowel portion (see Understanding intussusception)
Possibly fatal if treatment is delayed more than 24 hours
Pediatric emergency
Overview-Pathophysiology
Bowel section invaginates and is propelled by peristalsis.
More bowel is pulled in, causing edema, obstruction, and pain.
Overview-Causes
Possibly linked to viral infections due to seasonal peaks
Overview-In infants
Unknown
Overview-In older children
Alterations in intestinal motility
Hemangioma
Lymphoid hyperplasia
Lymphosarcoma
Meckel's diverticulum
Polyps
Overview-In adults
Appendiceal stump
Benign or malignant tumors (65% of patients)
Gastroenterostomy with herniation
Meckel's diverticulum
Polyps
Adhesions, surgical scarring
Long-term diarrhea
Overview-Incidence
Intussusception is most common in infants under age 1 year.
It's the most common cause of intestinal obstruction in children between ages 6 months and 3 years.
It's slightly more common in males than in females.
Seasonal incidence peaks in late spring and early summer.
It's the most common abdominal emergency in childhood, especially in children younger than age 2 years.
Overview-Complications
Strangulation of the intestine
Gangrene of the bowel
Shock
Bowel perforation
Peritonitis
Pleural effusion
Sepsis
Death
Assessment-History
Intermittent attacks of colicky pain
Pain that causes the child to scream, draw his legs up to his abdomen, turn pale and diaphoretic and, possibly, grunt
Vomiting, initially stomach contents and, later, bile-stained or fecal material
Lethargy
Diarrhea; changes in bowel habits; bowel urgency
In adults, abdominal pain localized in the right lower quadrant that radiates to the back and increases with eating
Assessment-Physical Findings
Distended, tender abdomen
Guarding over the intussusception site
Palpable, sausage-shaped abdominal mass in the right upper quadrant or in the midepigastric area if transverse colon is involved
Bloody mucus found on rectal examination
Hyperactive bowel sounds initially, then possibly absent
"Currant jelly" stools, which contain a mixture of blood and mucus
Diagnostic Test Results-Laboratory
White blood cell count up to 15,000/μl indicates obstruction; greater than 15,000/μl, strangulation; and more than 20,000/μl, bowel infarction.
Diagnostic Test Results-Imaging
Abdominal ultrasound helps to diagnose intussusception.
Barium enema confirms colonic intussusception by showing the characteristic coiled spring sign; it also delineates the extent of intussusception (contraindicated if peritonitis or perforation is suspected).
Upright abdominal X-rays show a soft tissue mass and signs of complete or partial obstruction, with dilated loops of bowel.
Treatment-General
Hydrostatic or pneumatic reduction
Bowel decompression
Observation for spontaneous reduction (small bowel intussusceptions that are short)
Treatment-Diet
Nothing by mouth until bowel functions properly
Treatment-Activity
Bed rest until condition is resolved
As tolerated after reduction
Treatment-Medications
Analgesics
Antibiotics if the bowel is necrotic
I.V. fluid resuscitation
Treatment-Surgery
Segmental resection with reanastomosis (indicated for children with recurrent intussusception, those who show signs of shock or peritonitis, and those in whom symptoms are present for longer than 24 hours)
Treatment of choice in adults, usually segmental bowel resection
Nursing Considerations-Nursing Diagnoses
Acute pain
Anxiety
Deficient fluid volume
Fear
Risk for ineffective GI tissue perfusion
Risk for infection
Nursing Considerations-Expected Outcomes
express feelings of increased comfort
identify strategies to reduce anxiety
maintain normal fluid volume
discuss fears and concerns
exhibit signs of adequate GI perfusion
remain free from signs and symptoms of infection.
Nursing Considerations-Nursing Interventions
Offer reassurance and emotional support to the patient and, if the patient is a child, to his parents.
Provide comfort measures as appropriate. Encourage the patient and family to verbalize feelings and concerns, and offer emotional support.
Give prescribed I.V. fluids; ensure patent I.V. access.
Insert a nasogastric (NG) tube for decompression; provide NG tube and insertion site care.
Inspect the abdomen for distention, measure abdominal girth, and auscultate bowel sounds.
Maintain the patient in semi-Fowler's position.
Prepare the patient and family for possible reduction or surgery.
Encourage coughing and deep breathing and incentive spirometry.
Maintain nothing-by-mouth status; anticipate starting oral fluids once bowel function returns.
Nursing Considerations-Monitoring
Vital signs
Intake and output
Hydration status, including fluid balance
NG tube function and drainage
Bowel sounds, stools, and abdominal distention
Postoperative status
Incision site (after surgery)
Signs and symptoms of recurrence in the first 36 to 48 hours after reduction
Nursing Considerations-Associated Nursing Procedures
Assessment techniques
Fecal occult blood tests, pediatric
IV bag preparation
IV bolus injection
IV catheter insertion
IV pump use
IV volume-control set preparation
Intake and output assessment
Neurologic assessment, pediatric
Pain assessment, pediatric
Pain management
Postoperative care
Preoperative care, pediatric
Preparing a patient for abdominal surgery, OR
Pulse assessment, pediatric
Respiration assessment
Seizure management, pediatric
Surgical wound with drain dressing application, pediatric
Temperature assessment
Venipuncture, pediatric
Patient Teaching-General
disorder, diagnosis, and treatment, including possible hydrostatic reduction or surgery
rationales for treatment measures, such as NG decompression and I.V. fluid and medication administration
preoperative and postoperative care measures, including monitoring, and the need for coughing and deep breathing, frequent position changes, and early ambulation
surgical site care as indicated
signs and symptoms of infection
importance of parental participation in their child's care to minimize the stress of hospitalization (flexible visiting hours)
schedule for recommended follow-up, usually 1 to 2 weeks after discharge
possibility of recurrence and the fact that most recurrences occur in the first 24 hours after reduction
signs and symptoms of recurrence.
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