PEDIATRIC

NURSING

PREPARED BY: GEMMA L. TANEDO R.N., MAN

THEORIST/THEORY

▪ ERIK ERIKSON’s - Psychosocial Development Theory

▪ SIGMUND FREUD’s – Psychosexual Development Theory

▪ JEAN PIAGET’s – Cognitive Development Theory

▪ LAWRENCE KOHLBERG’s – Moral Development Theory

COMMON HEALTH PROBLEMS:

 INFANCY

 TODDLERS

 PRESCHOOLER

 SCHOOL AGED CHILDREN

 ADOLESCENT
PEDIATRIC NURSING DISORDERS

 Gastrointestinal
 Psychosocial
▪ Integumentary
▪ Neurologic ( acquired and congenital)
▪ Blood disorders
▪ Endocrine
▪ Reproductive
▪ Renal
▪ Pulmonary
▪ Musculoskeletal
▪ Cardio
 Common Health Problems that Develop during
Infancy

 INTUSSUSCEPTION

 A condition characterized by the

telescoping of one portion of the
bowel into another portion.
 The condition results in obstruction
and interference of the intestinal
contents
Common Health Problems that Develop during
Infancy
 Most cases of childhood intussusceptions are of the
ileocolic type and idiopathic in nature.

 Hypersensitivity of infant’s digestive tract.

 Its peak age of incidence is 3–18months .(recent study 2021 Pub-med

Central of National Library of Medicine)

 More common in males ( male –to-female ratio) 3:1

 Presentation
3-18 months

Pale, lethargic and unwell

Vomiting (bile –stained)
Severe, colicky abd. pain
RUQ mass “sausage shaped”

Intestinal obstructions

“currant jelly stools”

Common Health Problems that Develop during
Infancy
•Complications:
Common Health Problems that Develop during
Infancy
Management
History taking, clinical signs
 Ultrasound
 CT Scan
 Barium Enema ( colon X-ray) solution to create pressure
within the intestine and "un-telescope.
 Air or liquid enema is still the mainstay first-line option in the
management of intussusception
 Surgical Correction if medical management is unsuccessful
and complications occurs.
 Monitor for the passage of normal, brown, stool which
indicates that the intussusception has reduced itself
 Management
A B
Management
Common Health Problems that Develop during
Infancy
Common Health Problems that Develop during
Infancy
 NURSING MANAGEMENT

 Monitor VS, electrolyte levels, urine and stool, IV fluids, Abx.

 Provide psychological support to the infant (cuddling,
pacifier, consistent care, and parents (explain the nature of
infant’s condition, allow parents to express feelings, anxiety
and concern.)
 Observe for passage of stools or barium after hydrostatic
reduction.
 Provide postoperative care.( Monitor return of bowel sounds
and stools)
 Observe for signs of recurrent obstructions.
 Acute pain related to bowel
invagination.
 Deficient fluid volume related
to vomiting, nausea, fever, and
diaphoresis.
 Ineffective breathing pattern
related to abdominal distention
and rigidity
Practice Questions:
1. Intussusception is telescoping of one portion of the
intestine into an adjacent segment, causing intestinal
obstruction and sometimes intestinal ischemia. Which
of the following is the most common cause of this
condition?
• A. Cystic fibrosis
• B. Idiopathic etiology
• C. Intestinal polyps
• D. Rotavirus vaccine
2. Which of the following is the most common
initial sign of intussusception?
• A. Intermittent colicky abdominal pain
• B. Lethargy
• C. Palpable abdominal mass
• D. Passage of currant-jelly stool
3. An 18-month-old boy is brought to the office by his father
because he has had episodes of abdominal pain and vomiting
during the past 8 hours. The father says that the child
appears relatively well between episodes. After physical
examination, intussusception is suspected. Which of the
following studies is the most appropriate next step to confirm
this diagnosis?
• A. Barium enema
• B. CT scan of the abdomen
• C. Colonoscopy
• D. Ultrasonography of the abdomen
4. The nurse is preparing to care for a child with a
diagnosis of intussusception. The nurse reviews the
child’s record and expects to note which signs of this
d/o documented?
A.Watery diarrhea
B.Ribbon-like stool
C.Profuse projectile vomiting
D.Bright red blood and mucus in the stool
5. Intussusception is most common in which of
the following age groups?
A. Children aged 3-18 months
B. Children aged 1-2 years
C. Children > 3 years
D. Adults aged 18-25 years
6. Which of the following are considered the hallmark
physical findings in intussusception?
A. Occult blood in the stools and peritonitis.
B. Right hypochondrium sausage-shaped mass and
emptiness in the right lower quadrant.
C. Frank hematochezia and currant jelly stools
D. Abdominal distention, fever, and leukocytosis
7. Describe the vomitus of a child with intussusception______

8. In addition to experiencing severe abdominal pain, tell what

position the infant will assume ________

9. The major complication of intussusception is ___________ of

the bowel.

10. Name two ways to correct intussusception______

Explanation/ Rationale
1. Answer: B: Idiopathic etiology. Most cases of intussusception are idiopathic.
Choice A: Cystic fibrosis is a risk factor. Choice C: A lead point, such as
intestinal polyps, can trigger intussusception in about 25% of cases. Choice D:
An older rotavirus vaccine was thought to increase the risk of
intussusception, but the newer vaccine does not include this risk.

2. Answer: A: Intermittent colicky abdominal pain. Initial symptoms of

intussusception include colicky abdominal pain that recurs every 15 to 20
minutes. Choice B: Later, as intestinal ischemia develops, pain becomes
steady, and the patient becomes lethargic. Choice C: A palpable abdominal
mass is sometimes present upon examination. Choice D: Passage of currant-
jelly stool is a late finding, and physicians should not wait for this occurrence
to suspect intussusception.
3. Answer: D: Ultrasonography of the abdomen. Ultrasonography is the preferred means of
confirming this diagnosis because it is easily done, relatively inexpensive, and safe. Choice A:
Barium enema used to be the preferred diagnostic test, but there is a risk that the barium
can enter the peritoneum if the patient has perforation and cause peritonitis. Choice B: CT
scan is not the preferred method of diagnosis, although sometimes asymptomatic
intussusception can be noted incidentally on CT scan. Choice C: Colonoscopy is not indicated
or appropriate.

4.Answer: D : currant jelly-like stool bright red and mucus are passed through the rectum.

5. Answer A : Most commonly, intussusception occurs in infants aged 3-18 months.

Intussusception is the most common cause of intestinal obstruction in patients aged 5
months to 3 years. Intussusception can account for as many as 25% of abdominal surgical
emergencies in children younger than 5 years, exceeding the incidence of appendicitis.
Although extremely rare, intussusception has been reported in the neonatal period.
6. Answer B. The hallmark physical findings in intussusception are a right
hypochondrium sausage-shaped mass and emptiness in the right lower quadrant
(Dance sign). This mass is hard to detect and is best palpated between spasms of
colic, when the infant is quiet. Abdominal distention frequently is found if
obstruction is complete. If intestinal gangrene and infarction have occurred,
peritonitis can be suggested on the basis of rigidity and involuntary guarding. Early
in the disease process, occult blood in the stools is the first sign of impaired mucosal
blood supply. Later on, frank hematochezia and the classic currant jelly stools appear.
Fever and leukocytosis are late signs and can indicate transmural gangrene and
infarction. Patients with intussusception often have no classic signs and symptoms,
which can lead to an unfortunate delay in diagnosis and disastrous consequences.
7.Bile stained
8. Pull legs up to chest/abdomen
9. Necrosis
10 Barium enema (the barium pushes the bowel straight), or surgical repair.