Transcript Intussusception PREPYRED BY/ NAWAL AL SULAMI What is intussusception? Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6 years of age.

Intussusception
PREPYRED BY/
NAWAL AL SULAMI
What is
intussusception?
Intussusception is the most
common cause of intestinal
obstruction in children
between 3 months and 6
years of age. It occurs when
a portion of the bowel
"telescopes" into itself,
causing intestinal
obstruction.
The condition can progress
from intestinal
obstruction to necrosis
(tissue death) of a
segment of the intestine.
Initially, blood flow
through the intestine is
decreased, causing
swelling and
inflammation. The
swelling can lead to
perforation (tearing) and
generalized abdominal
infection. Shock and
dehydration can occur
very rapidly
The cause may be
idiopathic
(unknown but
following a viral
infection); lead
point (change in
the mucosa from
another condition
such as cystic
fibrosis, or
hematoma); or
post operative
Assessment:
1-Paroxysmal abdominal pain; legs drawn up
2-Blood in stool, or later “currant jelly” stools
containing sloughed mucosa, blood, and mucus
3- vomiting
4-Increasing absence of stools.
5-Abdominal distention, bowel sound diminished,
absent or high pitch.
6-Sausage like mass palpable in abdomen
(Dance’s sign).
7-Unusual looking anus; may look like rectal
prolapse.
8-Dehydration and fever
9-Shock like state with rapid pulse, pallor, and
marked sweating
Diagnostic Evaluation:
X-ray of abdomen may show
absence of gas or mass in right
upper quadrant.
Barium enema is done if there
is no appearance of peritonitis;
shows a concave filling defect
(will help reduce the
invagination).
Ultrasonogram may be done to
locate area of telescoped
bowel.
How is intussusception
treated?
Two approaches are
used in treating
intussusception -nonoperative reduction
and surgery
Nonoperative reduction
After the diagnosis is confirmed,
intussusception is generally
reduced (resolved) by gentle
pressure exerted within the
intestine, using barium or air
enemas. Also, if your child is
ill with an abdominal infection
or has other complications,
your physician may choose
not to attempt to reduce the
intussusception with the
enema.
Both barium and air enemas
have a low risk (less than 2%)
of complications, which could
include tearing the intestine.
Surgery
For children who are too ill to have this
diagnostic procedure, who may have
significant infection in the abdomen, or in
whom intussusception does not resolve with
the enema, surgery is necessary. If the child
has several episodes of intussusception, a
surgical procedure may be performed in an
attempt to determine the cause of the
recurrent intussusception.
With the child under general anesthesia, the
surgeon makes an incision in the abdomen,
locates the intussusception, and pushes and
manipulates the bowel in order to return it to
its normal position. If the bowel is severely
damaged as a result of the intussusception,
additional procedures may be required
Nursing Intervention:
Monitor I.V. fluids and intake and output to guide in fluid
balance.
Be alert for respiratory distress due to abdominal distention.
Monitor vital signs, urine output, pain, distention, and
general behavior preoperatively and postoperatively.
Observe infant’s behavior as indicator of pain; may be
irritable and very sensitive to handling or lethargic or
unresponsive. Handle the infant gently.
Explain cause of pain to parents, and reassure them about
purpose of diagnostic tests and treatments.
Administer analgesic as prescribed
Maintain NPO status as ordered.
Insert nasogastric tube if ordered to decompress stomach.
Continually reasses condition because increased pain and
bloody stools may indicate perforation.
After reduction by hydrostatic enema, monitor vital signs
and general condition – especially abdominal
tenderness, bowel sounds, lethargy, and tolerance to
fluids – to watch recurrence.
Encourage follow up care.
nursing DIAGNOSIS
Imbalanced nutrtion less
than body reqirment R/t
inability to ingest and digest
food
RISK FOR deficient fluid
volume R/t excessive losses
through normal routes
GOLE
Provide
adequate
nutrition.
Prevent
dehydration.
Prevent
constption
intervention
Provide NG tube attached to suction.
Administer IV fluides to decompress
bowel and maintain hydrtion status.
Administer parenetral fluids and
electrolytes as prescribe.
Monitor vital signs frequently for
changes in BP and pulse(indicate
dehydration or fluid volume overload.
Record intake and out put.
measure Wight daily.
Assess for presence of bowel sounds
to evaluate return of bowel function.
Evaluate for abdominal distention
,vomiting, ,which may indicative
obstruction.
Monitor stool for frequency ,amount,
and consistency.
Administer laxative as ordered; to
promote comfort with elimination.
Encourage diet with adequate fiber and
fluids
outcome
Infant with
adequate
weight
gain.
vital signs
stable,
fluid and
electrolytes
in balance.
Passing
.
stool
Acute pain
R/t surgical
incision.
Risk for
infection R/t
surgical
procedure
Assess pain (location, level, and
characteristics)
Relive
pain.
Place the childe in a comfortable
preventing position for resting and breathing.
Provide wound care.
Infection
Administer prescribed pain
medication [analgesia]
Report increase in severity of pain
(inadequate dosage of the drugs)
Assess wound dressing for
any increased drainage
(report decrease in drainage).
Administer antibiotics as
prescribed.
Monitor vital signs
may incidence to signs
infection (fever).
No signs
of
infection
or
No fever
THANK YOU
THANK YOU
Nawal Alsulami
Any question