Chapter 24: Intussusception (Children)

Question 1

Intussusception

Answer 1

condition that occurs when one portion of the intestine that invaginates or telescopes into another portion, most commonly at the ileocecal valve

Question 2

When does Intussusception occur?

Answer 2

usually in the first 2 years of life

• can be susceptible until early school age
• more common in males

Question 3

Predisposing factors to the development

Answer 3

• 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

Question 4

Signs and Symptoms

Answer 4

• 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

Question 5

Abdominal Pain in Children

Answer 5

• 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

Question 6

Classic Symptomatic Triad for Intussusception

Answer 6

• 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

Question 7

Diagnosis

Answer 7

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

Question 8

Diagnostic Tools

Answer 8

-ultrasound confirms diagnosis

Question 9

Prevention

Answer 9

may not be prevented

-good prenatal care provides optimal fetal development in utero

Question 10

Nursing Care

Answer 10

• 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

Question 11

Signs of perforation and peritonitis

Answer 11

-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

Question 12

Medical Care

Answer 12

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

Question 13

Surgical Care

Answer 13

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

Question 14

Education/ Discharge

Answer 14

• care of the incision; observation of signs of infection

- parents taught about feedings, dehydration, and appropriate pain management strategies