Chapter 24: Intussusception (Children) Flashcards
Intussusception
condition that occurs when one portion of the intestine that invaginates or telescopes into another portion, most commonly at the ileocecal valve
When does Intussusception occur?
usually in the first 2 years of life
- can be susceptible until early school age
- more common in males
Predisposing factors to the development
- polyps
- Meckel’s diverticulum
- Henoch-Schonlein purpura
- constipation
- lymphomas
- lipomas
- parasites
- rotavirus
- adenovirus
- presence of foreign bodies
- may occur as a complication of cystic fibrosis
Signs and Symptoms
- acute abdominal pain caused by the spasm of the telescoping bowel
- pain frequently mimics the pain experienced by “colicky” infants
- may pull their legs up toward the abdomen
- pain relieved once the abdomen relaxes
- vomiting may or may not be present and it may or may not be projectile
- fever
- dehydration
- abdominal distention
- lethargy
- grunting noises b/c of pain
Abdominal Pain in Children
- can be referred from an extra-abdominal source such as pneumonia, a UTI, or testicular torsion or can be associated with a systemic disease
- can be found in GI conditions such as streptococcal pharyngitis, lower lobe pneumonia, sickle cell disease, cystic fibrosis
- experience usually limited
- may be unable to accurately describe or pinpoint location or sensation
Classic Symptomatic Triad for Intussusception
- paroxysmal, episodic abdominal pain with vomiting q 5 to 30 minutes
- screaming and drawing up of legs with periods of calm, sleeping, or lethargy between episodes
- stool, possible diarrheal in nature, with blood
Diagnosis
based on history of the characteristic symptoms and the physical findings during examination
- “sausage-shaped” mass in the upper right quadrant during palpation
- abdomen is distended and tender on palpation
- bowel sounds may be increased or decreased
Diagnostic Tools
-ultrasound confirms diagnosis
Prevention
may not be prevented
-good prenatal care provides optimal fetal development in utero
Nursing Care
- provide information about the condition and reassurance to parents
- monitor infant for signs of perforation, peritonitis (inflammation of the abdominal cavity), or shock in addition to evidence of increased pain
- monitor and records child’s stools; spontaneous passing of a stool may = a resolution of the obstruction
- postoperative care
Signs of perforation and peritonitis
-has acute pain, beginning over the perforated area and spreading over the abdomen
-abdomen may become rigid, and may experience nausea and vomiting, tachycardia, fevers, chills, sweats, confusion, and decreased urinary output
-moderate or mild abdominal pain that worsens with movement
-fever, change in bowel habit, and malaise
-has nausea, loss of appetite, and fever or hypothermia
>nurse notes abdomen is distended with decreased bowel sounds
Medical Care
a barium or air enema is used for treatment and diagnose
-in radiological reduction, the barium (contrast media) or air allows visualization of the telescoped bowel
-the pressure applied by the enema may cause the telescoped bowel to return to its normal position thus relieving the obstruction
>if treatment through radiological reduction, the child is observed for passage of stool and barium or contrast material; nurse monitors vital signs and ongoing assessment of overall condition
Surgical Care
if radiological reduction is ineffective or if peritonitis, perforation, or shock is evident
-placing child NPO before surgery
-inserting a NG tube
-initiating IV fluid therapy
>the surgery either repairs the bowel or removes any portion that has been permanently damaged
Education/ Discharge
- care of the incision; observation of signs of infection
- parents taught about feedings, dehydration, and appropriate pain management strategies
