Intussusception
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Outline
Overview
- Portion of the intestine telescopes into another portion
Nursing Points
General
- Most common cause of intestinal obstruction for kids < 3 yrs
Assessment
- Red currant, jelly-like stool
- Abdominal pain
- Cyclical
- Pulling legs to chest
- Nausea
- Vomiting of gastric contents
- Green bile = obstruction
- Sausage-shaped mass in the abdomen
- Signs of perforation (peritonitis)
- Fever
- N/V
- Abdominal distension
- Respiratory distress
- Altered LOC
- ↑ HR
Therapeutic Management
- Repair
- Radiologist guided
- Air enema or Hydrostatic enema
- 65-75% successful
- Surgical repair
- Radiologist guided
- Pre-op care
- Assess for passage of brown stool (indicates intussusception has reduced)
- NPO
- IV antibiotics & Fluids
- Post-operative care
- Monitor bowel function
- Assess for signs of infection
- Advance diet as tolerated
Nursing Concepts
- Elimination
- Gastrointestinal/Liver Metabolism
- Infection Control
Patient Education
- Signs and symptoms to report to provider
- Post-op procedures if surgical repair is indicated
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References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited
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Transcript
Hi, Everyone. This is going to be a pretty quick lesson to go over the diagnosis of intussusception.
Intussusception is when the bowel telescopes into itself. You can see in the photo here what that actually looks like. Now, this is a problem because the bowel can become obstructed And this can cause all kinds of complications like perforation, peritonitis, sepsis and necrosis of the bowel. Kids who have intussusception need emergency medical care and surgical intervention to prevent these complications, so it’s super important not to miss the signs and symptoms that we’ll talk about next.
So what are we looking for with the diagnosis intussusception? The first thing that probably stands out the most is blood in the stool that is described as bright red or red currant jelly stool. Parents will often find this in the diaper and may even bring it into the emergency room with them. One really important thing to note for assessment of this patient is that we have to keep assessing their bowel movements while waiting on surgery because if the child passes a normal brown stool then it’s likely that the intussusception has reduced itself and there may be no need for surgery!
The next thing to note for your assessment is a specific type of abdominal pain. The pain kids feel with intussusception is cyclical. This means it comes and goes. The kids going to have really intense moments of pain where they are drawing their knees to their chest and may be screaming. Then it stops and they seem to have relief for a bit.
They may also experience nausea and vomiting. and just remember if you notice bright green vomit this means that they could have an intestinal obstruction.
If you palpate the abdomen you’re probably going to feel a sausage shaped mass wherever the telescoping has occurred.
And remember the real concern is that an obstruction could happen that would leads to a perforation and then peritonitis and then to shock. So it’s really important to be aware of signs of peritonitis and these are: a sudden spike in temperature, nausea and vomiting, abdominal distension, ridgid guarding of the abdomen because it hurts so much, a change in vital signs (like increased respiratory rate or increased heart rate) and then you can also see an altered level of consciousness as the patient’s condition deteriorates.
So sometimes, the process of diagnosing intussusception can actually cure it. What I mean by this is that if we suspect a kid has intussusception we can send them down to the radiology department and they’ll do either a water, air or barium enema. This will allow them to look at the bowel and at the same time it can actually reduce the telescoping and fix the problem.
If that doesn’t work then the child will need to go to surgery to have the bowel fixed.
Nursing care following the surgery is going to be really similar to the nursing care you would provide to any patient that has had abdominals surgery. So primarily, you’ll need to monitor bowel function and provide wound care to the incision site.
Your priority nursing concepts for a pediatric patient with intussusception are gastrointestinal and liver metabolism, elimination and infection control.
Ok so the main things you need to know for this lesson about intussusception are: First that intussusception means that the bowel has telescoped into itself. The standout symptom to be aware of is that the stool may have blood in it that is described as being like red currant jelly. Our primary concern with intussusception is that it can lead to a bowel obstruction and ultimately to peritonitis and shock, so we’ve got to be on the lookout for symptoms of those problems, like green bilious vomiting, a sudden fever and abdominal distension. The first attempt at treating this is going to be through a water or an air enema and if this doesn’t work the kids going need to go to surgery. Post-op care is going to look a lot like any other post-op care you would provide for an abdominal surgery, so we are focusing on monitoring bowel function, looking for signs of infection and providing wound care.
That’s it for our lesson on Intussusception. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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