C - Imperforate Anus, Hernia, Appendicitis, Intussusception

Question 1

Whats intussusception? (3)

Answer 1

Folding/invagination of 1 part of intestine into another -> obstruction & BVs are squeezed -> ischemia: decreased blood flow -> infarction: tissue death

Question 2

Signs & symptoms of intussusception? (6)

Answer 2

1. severe paroxysmal: sudden intense, colicky: episodal pain -> scream & pull feet to stomach
2. bilious vomiting
3. late sign: blood & mucus in stools
4. lethargy
5. tender distended abdomen: palpable sausage shape
6. severe pain -> respiratory distress & apnea: breathing temporarily stops

Question 3

Nursing management for intussusception pre-op (3) & post-op (2)?

Answer 3

PRE-OP
1. insert NGT into abdomen for decompression
2. Nil by mouth with IV fluids
3. Electrolyte correction

POST-OP
1. ensure adequate nutrition & give clear fluids
2. monitor NGT tube drainage, bowel elimination, abdominal distention & bowel sounds, surgical site - infection, swelling drainage, vital signs - signs of infection

Question 4

Whats appendicitis?

Answer 4

obstruction in the appendix -> mucosal secretions and bacteria that normally live in the appendix build up inside -> inflammation

Question 5

Signs & symptoms of appendicitis? (2)

Answer 5

1. Mild fever & pain in umbilical region that travels to lower right quadrant of abdomen
2. vomit, nausea, loss of appetite

Question 6

Pre-op management for appendicitis? (2)

Answer 6

1. NIL by mouth immediately + IV fluids
2. Pain management
   - after diagnosis is cnfmd -> prevents masking of symptoms before diagnosis
   - sit in a semi-fowler’s position with pillows under knees to reduce tension on the abdominal wall

Question 7

Whats hernia?

Answer 7

• bowel protruding through abnormal opening in abdominal wall
• usually reducible with finger

Question 8

Whats imperforate anus?

Answer 8

• birth defect where anus has no opening

Question 9

Treatment for imperforate anus?

Answer 9

1. Perineal anoplasty
   - reconstruct the perineum: area betw genitals & anus
2. Colostomy
   - surgery to create opening for large intestine through the abdomen
3. Anal dilation
   - x2 daily for 1 wk
   - gradually upsize dilator