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(Intussuseption and Hirschprung's Disease)
Submitted By: Aristheo C. Magallanes BSN II BLK 4 Submitted To: Ms. Khristian Jeabie Delirio
you're at increased risk to develop it again. Color Doppler sonography determines whether reducible. and mucus. Barium enema is done if there is no appearance of peritonitis. A prior history of intussusception. may be comfortable between episodes. Abnormal intestinal formation at birth. child is inconsolable. blood. Intussusception affects boys more often than girls. lead point (change in the mucosa from another condition such as cystic fibrosis. Ultrasonogram may be done to locate area of telescoped bowel. Increasing absence of stools. Occurs primarily in infants (boys more often than girls) but can also occur in adults and older children. with the majority of cases occurring in children younger than 1 year. Sex. Usually results in a blockage of the intestine. Blood in stool. Medical Management: X-ray of abdomen may show absence of gas or mass in right upper quadrant. bowel sound diminished. . Once you've had intussusception. or hematoma). therefore. Sausage like mass palpable in abdomen (Dance’s sign). or post operative. It's the most common cause of bowel obstruction in children between the ages of 3 months and 6 years. Vomiting. Causes / Precipitating factors: The cause may be idiopathic (unknown but following a viral infection). also is a risk factor for intussusception. Abdominal distention.Intussuseption Definition: The invagination or telescoping of one segment of the intestine within another. Assessment / Clinical manifestation: Paroxysmal abdominal pain. absent or high pitch. pallor. Malrotation. legs drawn up. Surgical Management: Intussusception can be surgically reduced. and marked sweating. Age. Meckel’s diverticulum. enema reduction should be avoided. Absence of blood flow indicates ischemia and. or later “currant jelly” stools containing sloughed mucosa. Unusual looking anus. resection may be necessary if bowel is nonviable. Children are much more likely to develop intussusception than adults are. a condition present at birth (congenital) in which the intestine doesn't develop correctly. Dehydration and fever Shock like state with rapid pulse. shows a concave filling defect (will help reduce the invagination). may look like rectal prolapse.
pain. and reassure them about purpose of diagnostic tests and treatments. Explain cause of pain to parents. Provide anticipatory guidance for developmental age of child. urine output. . Monitor vital signs. monitor vital signs and general condition – especially abdominal tenderness. Be alert for respiratory distress due to abdominal distention. Administer analgesic as prescribed. lethargy. After reduction by hydrostatic enema. bowel sounds. Continually reasses condition because increased pain and bloody stools may indicate perforation. Encourage follow up care. and tolerance to fluids – to watch recurrence. Insert nasogastric tube if ordered to decompress stomach.V. distention. fluids and intake and output to guide in fluid balance. Handle the infant gently. Maintain NPO status as ordered. and general behavior preoperatively and postoperatively. may be irritable and very sensitive to handling or lethargic or unresponsive. Observe infant’s behavior as indicator of pain.Nursing intervention: Monitor I.
Assessment / Clinical manifestation: Symptoms that may be present in newborns and infants include: Difficulty with bowel movements Failure to pass meconium shortly after birth Failure to pass a first stool within 24 .48 hours after birth Infrequent but explosive stools Jaundice Poor feeding Poor weight gain Vomiting Watery diarrhea (in the newborn) Symptoms in older children: Constipation that gradually gets worse Fecal impaction Malnutrition Slow growth Swollen belly Medical Management: Rectal examination demonstrate absence of fecal material in the long segment disease. in short segment disease. Nerves in between the muscle layers trigger the contractions. when ingested. Radiopaque markers.Hirschprung's Disease Definition: Also known as Congenital Aganglionic Megacolon. . Hirschsprung's disease causes about 25% of all newborn intestinal blockages. such as Down syndrome. X-rays shows severe gaseous distention of the bowel. the nerves are missing from a part of the bowel. with absence of gas in the rectum. causing the bowel and abdomen to become swollen. It is the congenital absence of or arrested development of parasympathetic ganglion cells in the intestinal wall. Barium enema shows narrowed intestine proximal to anus and dilated intestine proximal to narrow segment. Intestinal contents build up behind the blockage. Causes / Precipitating factors: Muscle contractions in the gut help digested materials move through the intestine. Hirschsprung's disease is sometimes associated with other inherited or congenital conditions. This causes a blockage. rectal impaction may be present and. usually in the distal colon. It occurs five times more often in males than in females. In Hirschsprung's disease. Areas without such nerves cannot push material through. it may cause a rush of stool as the obstruction is temporary relieved. when the finger is removed. This is called peristalsis. Children with short segment disease retain the markers in the rectum for long periods. measure intestinal transit time.
Administer fluids to maintain hydration and replace lost electrolytes. Definitive surgery is done to remove the non-functioning bowel segment with various pull-through procedures (abdominoperineal. If abdominal distention is not relieved by enemas. Change position of infant frequently to increase circulation and allow for aeration of all lung areas. and rest the normal bowel. Report any wound redness. Use careful handwashing technique. Low residue diet will aid in keeping the stool soft. and confirm diagnosis. Prevent perianal and anal excoriation by thorough cleaning and use of ointments after the infant soils (postoperative stools can number 7 to 10 per day). consult doctor for a nasogastric (NG) tube. Reassure parents that colostomy will not cause delay in the child’s normal development. Prevent wound contamination from diaper. Anorectal manometry may be done to record the reflex response to anal sphincter. For older child. Maintain position of comfort with head elevated. Allow the infant to cry for a short period to prevent atelectasis. Encourage parents to hold and rock the infant. Support the parents when teaching them to care for their child’s colostomy. Offer pacifier for infant to suck if on parenteral fluids. or dehiscence immediately. or rectorectal). Begin oral feedings as ordered. evisceration. a colostomy or ileostomy is performed to decompress intestine. music. Offer soothing stimulation (eg. and rectal tube insertion fails to give relief. In older child. Suction oral secretions frequently to prevent infection of the tracheobronchial tree and lungs. Administer parenteral nutrition if feeding causes additional discomfort because of distention and nausea. Nursing intervention: Preoperative Assist in emptying the bowel by giving repeated enemas and colonic irrigations. requires cooperation of the child. Ultrasonogram may be done to demonstrate dilated colon. provide demonstration and written and verbal instruction to family for saline enema administration and use of stool softeners. Maintain patency of NG tube immediately postoperatively. Provide frequent oral hygiene while on NPO status. encourage frequent coughing and deep breathing to maintain respiratory status. Involve the entire family in teaching colostomy care to enhance acceptance of body change of the child. discomfort is significant. endorectal. divert fecal stream. Postoperative Change wound dressing using sterile technique. touch. Surgical Management: Initially. Offer small frequent feedings. . swelling or drainage. play therapy). Rectal biopsy may be done to demonstrate absent or reduced number of ganglion nerve cells. Maintain NPO status until bowel sounds return and the bowel is ready for feedings as determined by the physician.
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