INTUSSUSCEPTION

Content
1.Discuss the main concept intussusception in the following areas:
▪ Etiology/risk factors
▪ Clinical manifestations
▪ Diagnostic
▪ Management
▪ Possible complications.
2.Pathophysiology
3.Describe the importance of diagnostic and laboratory test in the given scenario.
4.Nursing care plan (2-Priority Nursing Diagnosis- Actual and Potential)
5.Drug study following the given format
CASE SCENARIO
A nine-month-old baby Elmo, who was formerly healthy, with a 36-hour history of
vomiting after every feed and one episode of blood-tinge per rectum. This was
diagnosed as gastroenteritis in primary care and oral rehydration of 50 to 100 ml
after each BM therapy was advised. Prior to this, he had a recent diarrheal illness.
The initial observations in the ED revealed a Temp of 37.7 °C; PR of 130 bpm; RR
36cpm, Oxygen saturation 98% and central capillary refill time of two seconds. PE
revealed that he is not well hydrated. He was uncomfortable when the doctor
gently pressed on his abdomen and noted a sausage shape mass on palpation.
The parents report that Elmo will just suddenly cry inconsolably with drawing up
of the knees to the chest usually lasting for 10 minutes then eventually will stop
on his own. He was admitted in pedia ward, when after 6 hours after admission he
had vomited a yellow fluid, and passed blood-tinged per rectum and this time
Elmo continuously cried with drawing up of the knees to the chest and also look
very tired.
CASE SCENARIO

He was started on intravenous fluids of Lactate Ringers 100 ml/kg over 4 hours then
80 cc/hr for the next 8 hours and was given an Aeknil 75 mg through IV. Blood
investigations showed a C-reactive protein level of 48mg/L but were otherwise
within normal limits. A test for electrolytes performed with the results potassium
(K)-2.8 mEq/L, Sodium (Na) 129mEq/L. Abdominal X-ray showed evidence of bowel
obstruction. Although, the doctor knows that the clinical history with the
characteristic stools and physical findings are usually sufficiently typical for the
diagnosis, abdominal ultrasound scan was ordered, and Intussusception was
confirmed. Ultrasound-guided Hydrostatic (saline) enema was scheduled. Continue
IV fluids, insert NGT now, and Cefazolin 250 mg IV 1 hour prior to surgery.
ETIOLOGY

The exact cause of intussusception is unknown. In

most cases, it is preceded by a virus that produces
swelling of the lining of the intestine, which then
slips into the intestine below. In some children, it
is caused by a condition that the child is born
with, such as a polyp or diverticulum.
 CLINICAL MANIFESTATIONS
Children

The first sign of intussusception in an

otherwise healthy infant may be sudden,
loud crying caused by abdominal pain.
Infants who have abdominal pain may pull
their knees to their chests when they cry.

The pain of intussusception comes and

goes, usually every 15 to 20 minutes at first.
These painful episodes last longer and
happen more often as time passes.
Diagnostic
Ultrasound or other abdominal imaging. An ultrasound, X-ray or computerized tomography
(CT) scan may reveal intestinal obstruction caused by intussusception. Imaging will typically
show a "bull's-eye," representing the intestine coiled within the intestine. Abdominal
imaging also can show if the intestine has been torn (perforated).
 CRP Test
A c-reactive protein test measures the level of c-
reactive protein (CRP) in your blood. CRP is a
protein made by your liver. It's sent into your
bloodstream in response to inflammation.
Inflammation is your body's way of protecting
your tissues if you've been injured or have an
infection. It can cause pain, redness, and swelling
in the injured or affected area. Some autoimmune
disorders and chronic diseases can also cause
inflammation.
Normal Range:
3.0 mg/L or below
Based on the given scenario, blood
investigations showed a C-reactive protein level of
48 mg/L but were otherwise within normal limits.
 POTENTIAL
Risk for Infection related to alteration of normal peristalsis

NANDA 15TH ED P499-505

 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Risk for Infection Short Term Independent Independent Goal met,
The parents report related to alteration After 2-3 hours of Monitor vital signs. To evaluate fluid
that their child will of normal peristalsis nursing interventions, status and Short Term
just suddenly cry The child will: cardiopulmonary After 2-3 hours of
inconsolably with Manifest response to activity. nursing interventions,
drawing up of the improved Observe changes in The child was able to:
knees to the chest peristalsis as mental status, skin These could be signs Manifest
usually lasting for 10 evidenced by warmth and color, of developing improved
minutes then increased heart, and respiratory infection that need peristalsis as
eventually will stop on hydration. rate. prompt interventions. evidenced by
his own. The parents will: increased
Verbalize Observe changes in These could indicate hydration.
Objective understanding of color and/or odor of onset of infection. The parents was able
36-hour history of the individual vomit, drainage (e.g., to:
vomiting after causative/risk wound drains or Verbalize
every feed and factors. invasive tubes), and understanding of
one episode of Understand the excretions (e.g., urine the individual
blood-tinge per importance of & stool). causative/risk
rectum. preventing factors.
Child was infection Monitor nutritional Infants with Understand the
uncomfortable appropriately. status and weight. inadequate nutrition importance of
when the doctor may be anergic or preventing
gently pressed on unable to muster a infection
his abdomen and cellular immune appropriately.
noted a sausage
{Cont..} {Cont..} {Cont..} {Cont..} {Cont..}
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

response to
shaped mass on Long Term: Long Term:
pathogens, making
palpation. After 1-2 days of After 1-2 days of
them susceptible to
Vomited a yellow nursing interventions, nursing interventions,
infection.
fluid, and passed The child will: The child was able to:
blood-tinged per Maintain normal Maintain normal
Encourage increased Increased fluid intake
rectum 6 hours peristalsis as peristalsis as
fluid intake. helps replace fluid
after admission. evidenced by good evidenced by good
loss.
Continuously cried nutrition with nutrition with
Monitor the color of
with drawing up of hydration and no hydration and no
the child’s urine and Changes in urine and
the knees to the signs of signs of
stool. Measure and stool color may
chest and looked abdominal pain. abdominal pain.
record I&O. indicate infection that
very tired.
requires immediate
Abdominal x-ray
interventions as
showed evidence
Practice and possible.
of bowel
emphasize constant
obstruction.
and proper hand This is the first-line
hygiene by all defense against
caregivers between healthcare-associated
therapies and clients. infections (HAIs).

Inform parents with

the purpose of each Provides information
treatment about treatments for
management. better understanding.
{Cont..} {Cont..}
DRUG STUDY
 MECHANISM OF INDICATION AND CONTRAINDICATIO NURSING
DRUG SIDE EFFECT
ACTION RATIONALE N CONSIDERATION

Paracetamol Pyrexia of unknown Possible Headache Check if the

produces analgesia origin and for Contraindications: Insomnia patient is
Generic Name: by raising the symptomatic relief of (difficulty in
Patients with taking any
Paracetamol threshold of the fever and pain
nephropathy. sleeping) other
pain center in the associated with
Constipation medication
Brand Name: brain and by common childhood
Aeknil disorders such as
Itching that contains
obstructing Stomach pain
intussusception and paracetamol.
impulses at the
other conditions Nausea Check for any
pain-mediating
Classification: where the patient is Vomiting signs of allergy
chemoreceptors
Analgesics unable to take oral reactions.
(Non-Opioid) & medications but
Antipyretics The drug produces where paracetamol
antipyresis by an can be administered
Frequency and action on the with advantage.
Dosage: hypothalamus; heat
75mg, q4 hrs. dissipation is RATIONALE:
increased as a For prevention of
Route: result of febrile convulsion,
IV vasodilation and headache, cold,
increased sinusitis, muscle
peripheral blood pain, and toothache.
flow.
and that's all,

Thank You!