INTUSSUSCEPTION

INTRODUCTION
Intussusceptions is the invagination or telescoping of a portion of the

intestine in to an adjacent, more distal section f the intestine, which creates

mechanical obstruction. Intussusceptions is one of the most common causes of

intestine obstruction in infancy. Tt can at any time in life but most commonly

occurs children younger than age 3, with the greatest incidence between age 5

and 10 months.
 OBJECTIVES OF THE STUDY

1. To assess the health status of the child with intussusceptions.

2. To assess the nursing needs of the child with intussusceptions.
3. To prioritize the actual and potential nursing problems.
4. To provide effective nursing care to the child with intussusceptions.
5. To promote the health of the child with intussusceptions.
6. To evaluate the prognosis of the child.
7. To prevent complication of the disease.
8. To have a sound knowledge on intussusceptions.
9. To alleviate fear and anxiety of parents and family members.
10 To study the disease in practical.

PROFILE OF THE PATIENT

Name : Baby Sangeetha

Chronological age : 8/12 months

Developmental age : Infant

Sex : Female child

I.P. No : 069413

Occupation : Agricultural Labour

Income : Rs.800/- per month

Ward & Unit : Ward 235 I pediatric unit

Address : D/o. Senthil Kumar

Vellaiyampatti, Periyakulam,

Balamedu, Madurai.

Date of Admission : 15.09.2010 at 6.15am

Rd at 6.30 am

Date of Surgery : 15.09.2010

Diagnosis : Intussusception.

Nature of Surgery : Emergency Laparotomy and reduction done.

Informant : Mother

Reliability : Reliable

Source of Data : Records

PATIENT’S HISTORY

REASON FOR HOSPITALIZATION

 Passing red current jelly stools : 2 days

 Vomiting and abdominal distension : 2 days
 Fever and abdominal distension : 1 day
PRESENT HISTORY:
Child was patently normal up to 14.09.2010 on 15.09.2010 morning the

child passed mucous mixed stools but no blood stain. On the same day evening

the child passed blood and mucous mixed stools. Child has vigorous cry and

taken to a private pediatrician. Child has treated by the pediatrician and some

what better. On the next day (16.09.2010) child again passed blood and mucous

mixed current jelly stools, abdominal distension and vomiting. Child was taken

to the same pediatrician but due to non-availability of the private pediatrician.

Child was taken to Theni Medical College Hospital. There the child was put on

Ryle’s tube and greenish colour fluid aspirated. Given some medications and

referred here for further management.

PAST HISTORY:
There is no past history of same episode. No relevant past history of any
other illness and hospitalization

Family History:
 It is a nuclear family and no history of consanguineous marriage. All the

family members are health in this family except this child. No history of any

surgical, medical, communicable diseases and hereditary disorder in the family.

Family Composition

Name of the
Age & Educational Health
family Relationship Occupation
Sex status status
members
Senthil 33 yrs Head of Agricultur 7th std Healthy
Kumar male family e
Amsalakshmi 27 yrs Wife House wife 8th std Healthy
female
Vinoth 3½ yrs Son - - Healthy
Male
Sangeetha 8/12 Daughter - - Unhealthy
months (Patient)
female

PEDIGREE DIAGRAM

57 years
60 years
 27 years 28 Yrs
33 years

8/12 Months KEY NOTES

3 1/2Yrs

Male

Female

Death

Patient

SOCIO – ECONOMIC HISTORY:

Housing : Own terraced house

Type of family : Joint family

No of rooms : 2, one kitchen and one common hall.

No of doors : One

No of windows : Two

Water facilities : Adequate safe water from panchayat over

head tank. Distributed through street taps.

Latrine facilities : Open air defecation,

No sanitary latrine available

Drainage : No proper drainage facilities

Transport facilities : Available nearby 1km surroundings

Relationship with neighbors : Good

Storage of food : Closed aluminum vessels.

BIRTH HISTORY
Antenatal history:
Booked and in a private hospital and immunized with 2 doses of
Inj.Tetanus Toxoid. Taken iron and folic acid tablets regularly during
pregnancy. No infection, illness and irradiation of mother in the antenatal
period. No gestational diabetes and pregnancy induced hypertension in the
antenatal period. No complications occur in the antenatal period.

Intranatal history :
Full term, normal delivery and no premature rupture of membranes. No
prolonged labour and no drugs administrated during delivery. No birth injuries,
birth asphyxia during delivery. Baby cried well immediately after delivery. No
cyanosis and no delayed respiration after birth.

Postnatal history:
Baby cried well immediately after delivery. No birth asphyxia and
respirations are good. No resuscitation done. No postnatal sepsis or
complications.

Neonatal history:
Birth weight : 3.250 kg
APGAR N 8/10
No resuscitation done after delivery. No cord sepsis. No neonatal
infections occur. Bath given in the third day and breast feed after 1 hour of
delivery. No convulsions occur in the newborn period. Passed urine and
meconeum. No congenital anomalies and all the orifices are present. No
neonatal jaundice.

DEVELOPMENTAL HISTORY :
Gross motor:
Social smile : 2 months
Head control : 3 months
Turns over head : 5 months
 Sits with support : 6 months
Sits alone : 7 months
Crawls : 7 months

Fine motor:
Holds a rattle : 5 months
Holds an object : 7 months

Language
Mono syllabus : 7 months

DEVELOPMENTAL THEORIES :
Psychosocial : Sense of trust Vs Mistrust
(Dependence on care giver)
Psycho sexual : Oral stage (Pleasure on sneaking)
Congestive development : Sensory motor (Stimuli are recognized
Absorbed and incorporated into action)
Moral development : Pre-conventional morality stage 0
(Unable to understand good or bad)
Spiritual development : Undifferentiated feeling of trust,
Warmth and security from the foundation
For the later development of faith.

IMMUNIZATION HISTORY:
Immunized up to age. Last immunization done was February 2010 for
OPV in PPI programme. As per schedule, BCG, DPT 3 doses, OPV 3 doses,
Hepatitis B 3 doses given. The immunization cord is not available with the
child. BCG scan present.
DIETARY HISTORY:
Child started breast feeding after 1 hour of delivery. Exclusive breast
feeding give for 3 months only after 3 months bottle feeding given. Weaning
started at the end of 6th month with rice, dhal and potato. Now the child is taking
food along with bottle feeding.

ALLEGIC HISTORY:
No history of allergy to any drugs or dietary items.

CONTACT HISTORY:
No history of contact with communicable diseases like open TB cases.

NUTRITIONAL REQUIREMENTS:
Calories : 120 kcal / kg/ day
Proteins : 2.5 to 3.0 gm/ kg/ day
Fat : 4 – 5 gms/ kg/ day
Iron : 10 mg / day
Calcium : 400 mg /day
Fluids : 120 ml / kg / day

PHYSICAL EXAMINATION
General appearance : Moderate body built. Cried continuously
Level of consciousness : Conscious and active
Skin color : Normal black mixed complexion
Turgor : Normal
Warmth : Hot on touch
Head :
Head size : Normal
Fontanelle : Anterior fontanelle not closed. No bulging.
Posterior fontanelle closed.
Sutures : Not widened.
Hair : Black colored, equally distributed.

EYES :
Conjunctiva : Pink
Sclera : White
Cornea : Normal
Discharges : No discharges
Cataract : No cataract
Vision : Able to see objects
Pupils : Normal, Equally reaching to light.
Ears : Normal position, Pinna flexible
Able to hear voices and sounds.
Nose : No nasal discharges. No nasal flaring.
No nasal bleeding.
Mouth and throat : Lips dry. Tongue dry. No cleft lip or palate.
No dentition, No coated tongue
No oral thrush, Excessive cry
Lips pink in colour, No throat congestion.
Neck : Normal ranges of motion, No neck rigidity,
Neck control present,
No nodal enlargement

CHEST:
 Inspection :
Normal shape and size,
No chest in drawing
No refractory movements
Palpation :
No masses felt,
No auxiliary lymph node
Normal breast, No tactile fremitus
Percussion:
Normal resonance present
No fluid collection
Auscultation :
Normal breath sounds heard,
Normal heart sound heard
No murmurs

ABDOMEN:
Inspection shape: Distended, No visible peristalsis

Palpation:
Soft mass felt in the right upper quadrant
No hepatospleenomegaly
 Percussion:
No free fluid
Auscultation:
Bowel sounds heard

SPINE:

Normal curvature. No congenital neurological defects.

EXTREMITIES:

Normal range of motion. Baby maintain flexible legs over the abdomen.

No deformities. No extra digital

GENITOURINARY :

Normal external genitalia. Passed high colored urine

RECTUM :

Blood stained motion seen on rectal examination

NEUROLOGICAL :

No neurological deficits.

No convulsions. For all the reflexes are present except sucking,

swallowing, gagging, sneezing or coughing blinking and plantar grasp.

VITAL SIGNS:

Temperature : 101oF

Pulse : 132/mt. Regular volume and tension fair.

Respiration : 38/mt

Blood pressure : 84/62 mm of Hg.

 ANTHROPOMETRIC MEASUREMENTS

S.No Measurements Actual Expected Excess/ deficit

1. Length 65cm 68cm (-) 3 cm
2 Weight 7.5kg 8.5 kg (-) 1kg
3 Head circumference 44 cm 43-45 cm Normal
4 Chest circumference 43 cm 41-43 cm Normal

Calculation of Malnutrition:

Weight for age = Actual weight / Expected weight x 100

= 7.5/ 8.5 x 100

= 88%

According to Gomez classification,

75-90% of weight for age denotes first degree malnutrition. Since the

child has 88% weight for age the child is in first degree malnutrition.

INTUSSUSCEPTION

DEFINITION

Intussusception is a disorder characterized by telescoping of one of the

portions of the intestine into a more distal portion, leading to impairment of the

blood supply and necrosis of the involved segment. It is the most frequent cause

of intestinal obstruction during the first 2 years of life.

 - Suraj Gupte

Intussusception is a condition in which a segment of the bowel telescope

is inserted into the portion of bowel immediately distal to it.

- Assuma Beevi

Intussusception is found as invagination or telescoping of intestinal wall

into it or slipping of one part of intestine into another part just below it and most

common site is ileocecal region.

- Parul Dutta

Intussusception is one of the most frequent cause of intestinal obstruction.

Which occurs when a proximal segment of the bowel telescopes into a more

distal segment, pulling the mesentry with it.

- Wong’s

INCIDENCE:

Intussusception occurs in children between the ages of 3 months and 3

years. The peak occurrence is between the ages of 4 months and 9 months. It is

more common in males than in females

TYPES OF FORMS OF INTUSSUSCEPTIONS:

There are 3 forms in intussusceptions

1). Heocecal or ileocolic form

 There is the most common form of intussusceptions. Where the ileum

invaginates into the cecum and colon.

2. Ileoileal form:

In this form one part of the ileum invaginates into another section of the

ileum.

3. Colocolic form:

In this, one part of colon invaginates into another area of the colon.

ETIOLOGY:
The most common form of intussusceptions (more than 90%) is

idiopathic which is most likely a result of hypertrophy of intestinal lymphoid

tissue secondary to viral infection. ‘

A pathologic lead point may be found in only 2-8% of the cases,

especially after 2 years of age.

 Probably results from hyperactive peristalsis in the proximal portion of

the bowel with inactive peristalsis in the distal segment.

PRE-DISPOSING FACTORS:
The predisposing factors are
1. Henoch – schoenlein purpura

2. Meckel’s diverticulum

3. Parasites

4. Constipation

5. Inspissated fecal matter

6. Cystic fibrosis

7. Foreign body

8. Lymphoma and

9. Rotavirus or adenovirus infection

PATHOPHYSIOLOGY
Hyperactive peristalsis in the proximal portion of bowel

Telescoping into distal portion and pulling the mesentry with it

Mesentry compressed and angled

 Lymphatic and venous obstruction in the mesentry

Oedema obstruction and pressure with in the area increased

Pressure in the area of intussusceptions equals arterial pressure

Arterial blood flow stops, ischemia and pouring of mucous into the intestine.

Venous engorgement, leaking of blood and mucous into the intestinal lumen

Formation of classic current jelly stools

Ischemia increases leads to necrosis

Perforation, peritonitis and shock occurs

If untreated death occurs.

CLINICAL FEATURES:
S.No Clinical feature as per books Present or absent

in my patients
1 Sudden severe colicky abdominal pain which Present

makes the child vigorous cry

2 Child screams and draws the knees on to the Present

chest
3 Vomiting and abdominal distension Present
4 Passage of red current jelly stools Present
5 Palpable sausage shaped mass in right upper Present

quadrant
6 Cervix like mass and blood on the examing Present

finger on rectal examination

7 Fever and prostration Present
8 Signs of shock and peritonitis Absent

DIAGNOSTIC EVALUATION:

1. Plain X-ray Abdomen may reveal absence of bowel gas in the right lower

quadrant and dilated loops of small bowel

2. Ultrasound will show a target sign in upper abdomen or in left iliac fossa

due to presence of intussusceptions within the bowel

3. Barium enema : may show the intussusceptions as an inverted cap or a

claw sign may be seen. There is an obstruction to the retrograde

progression of barium into ascending colon and cecum. In the area of

intussusceptions, there may be a ceiling spring appearance to the column

of barium.
 4. A rectal examination : may reveals mucous, blood, stained finger.

MANAGEMENT CONSERVATIVE HYDROSTATIC

REDUCTION:

In most case the initial treatment of choice is conservative hydrostatic

reduction gives good results provided that there is no evidence of strangulation,

perforation or severe toxicity. It is performed by insertion of an unlubricated

balloon catheter into the rectum. The balloon is then inflated and pulled down

against the levator ani muscles. Thereafter, buttocks are strapped together. From

a height of 90cm, barium is allowed to flow into the rectum.

Now barium is replaced by water soluble contrast and air pressure to

reduce intussusceptions. The force exerted by barium flow is enough to correct

the invagination into original position as pushing an inverted finger o ut of a

glove.

TOTAL REDUCTION IS JUDGED FROM:

 Free flow of barium into the cecum and reflex into the terminal ileum.

 Disappearance of the lump.

 Passage of flatus and or stools per rectum

 Improvement in the patient’s general condition

 This procedure is contraindicated in patients with clinical signs of

perforation or shock.

SURGICAL MANAGEMENT:

Surgical reduction is indicate in patients who are unfit for hydrostatic

reduction or who fail to respond to hydrostatic reduction after 2 attempts.

Surgical correction involves manually reducing invagination and resecting

necrotic intestine, if indicated.

PROGNOSIS:
 Non-operative reduction is successful in approximately 15% of cases.

Left unreduced. Intussusception is invariably fatal. Spontaneous reduction with

recurrent episodes is known in older children.

SURGERY DONE TO MY PATIENT

Emergency Laparotomy and reduction done.

NURSING MANAGEMENT

As soon as a possible diagnosis of intussusceptions is made, the nurse

prepares the parents for the immediate need for hospitalization, the nonsurgical

hydrostatic reduction and the possibility of surgery.

Even though non-surgical interventions may be successful, the usual

preoperative procedures. Such as with holding of fluids by mouth, routine

laboratory testing, signed parental consent, and preanesthetic sedation are

performed. For the child with signs of electrolyte imbalance, hemorrhage, or

peritonitis, additional preparation such as replacement fluids, whole blood or

plasma, and nasogastric suctioning may be needed. Before surgery the nurse

monitor all stools, dehydration, abdominal distention and breathing difficulties.

Monitor pulse rate respiratory rate and temperature.

Post operative care of the child following reduction of intussusceptions is

just as like any general surgery.

TIME PLAN

DATE TIME PLAN OF WORK

15.09.201 7.30 To 12.00 My patient was pediatric surgery ward.
0 noon When I entered the ward I greet the staff and
my patient, parents and introduced him about
me. Asked the patient about himself.
Carbolisation and bed making done.
Physical assessment done.
16.09.201 7.30 to 12.00 I greeted the patient monitored vital signs
0 noon Temperature : 98.6
 DATE TIME PLAN OF WORK
Pulse : 112/m
Respiration : 44/mt
Blood pressure : 90/70 mm Hg
Assessment was done.
Assessed Gastro intestinal system
Assessed the patient’s activity level and ability
to do the work.
17.09.201 7.30 To 12.00 I greeted the patient
0 noon Monitored vital signs
Temperature : 98.6
Pulse : 130/mt
Respiration : 42/mt
Blood pressure : 90/70 mmHg
Parent complained of Crying
Provided comfortable bed and position
Baby bath given

DATE TIME PLAN OF WORK

18.09.201 7.30 To 12.00 I went to visit my patient
0 noon Provided comfortable bed monitored vital signs
I.V fluids given as prescribed
Physical assessment was done.
19.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
Maintained intake output chart
 DATE TIME PLAN OF WORK
Weighted the Baby
20.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
Maintained intake output chart
Weighted the Baby
21.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
Maintained intake output chart
Weighted the Baby

DATE TIME PLAN OF WORK

22.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
Maintained intake output chart
Weighted the Baby
23.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
 DATE TIME PLAN OF WORK
Maintained intake output chart
Weighted the Baby
24.09.201 7.30 To 12.00 I visited my patient
0 noon Provided comfortable bed monitored vital signs
I.V. fluids given as prescribed
Physical assessment was done.
Maintained intake output chart
Weighted the Baby

THEORY APPLICATION

Conservation of Energy

 Monitored vital signs, post operatively.

Temperature - 101oF

Pulse - 132/mt.

Respiration - 38/mt

Blood pressure - 84/62 mm of Hg

  Taking adequate rest and sleep
 Taking adequate nutrient after 24 hours of surgery
Conservation of structural integrity

 Aseptic dressing done once a day.

 Administered antibiotic for preventing infection.
 No redness, no pain, no gaping
 Wound is normal.
Conservation of personal Integrity

 Parent and family members are frequently visiting/seeing the child.

 Mother always with the child
 Child is expressing his feeling with mother, father, family members and
staff nurses.

Conservation of social integrity

 Family members are taking care of the child.

 Parents are willing to bring the child for regular checkup.
 Elder sisters having more interest to play with the child.

Conservation of structural integrity

Very important aspect in

i. Preventing infection
ii. Daily dressing
iii. Administering antibiotic
 iv. Pain killer
v. Discharge explanation to the parents regarding wound.
vi. Suture removal
Regular follow-up and medication

NURSING DIAGNOSIS
PRE-OPERATIVE
1. Pain related to obstruction of the intensive and impaction of fecal matter
secondary to intussusceptions.
2. Hyperthermia related to infection secondary to obstruction and stagnation
of intestinal contents.
3. Ineffective breathing pattern related to abdominal distention secondary to
reduced G.I. motility.
4. Risk for fluid volume deficient related to vomiting secondary to absence
of bowel movements.
5. Constipation related to decreased intestinal motility secondary to
intussusceptions.
 6. Anxiety of parents related to sudden obstructive symptoms,
hospitalization and surgical treatment secondary to intussusceptions.

POST – OPERATIVE:
1. Pain related to surgical procedure secondary to intussusceptions
2. Hyperthermia related to infection secondary to obstruction of intestinal
contents.
3. Risk for fluid volume deficient related to nil oral and loss of fluid in the
preoperative period, fever secondary to absence of bowel movements.
4. Impaired skin integrity related to surgical incision secondary to
intussusceptions.
5. Knowledge deficient regarding the disease condition and the outcome of
surgery.
6. Interrupted family process related to illness and hospitalization secondary
to disease condition and surgical procedure.

HEALTH EDUCATION
Health education given to the mother in the following aspects.
1). Disease condition
Since the child underwent surgical intervention care should be given in
the operated area. Watch and notify any changes in color and consistency of
surgical wound.

2). Hygiene
Child should be given bath daily two times it is summer season. Child
should be dressed with clean dress.

3). Nutrition :
 Child should be given high protein diet along with breast milk. A model
menu was prepared and given to the mother. She is advised to give small
frequent feeds.

4). Safety and security :

Since the child is able to crawl and walk with support hazardous things
like kerosene, drugs, stove, match boxes and hot food items should be kept
away from the child.

IMMUNIZATION
Mother is educated to immunize the child in time without fail. She is
advised to immunize the child with measles vaccine at 10 th month. She is also
advised to give optional vaccines also to the child like MMR, typhoid in the
prescribed age.

LOVE AND AFFECTION

As the infant needs more love and affection, mother is advised about
mother and baby bonding.

FOLLOW UP
Motehr is advised to give the drugs prescribed by the surgeon regularly.
She is also advised to attend the pediatric surgical outpatient department in the
prescribed days without fail.
 NET REFERENCE / JOURNAL REFERENCE – 1
Journal :

The new England Journal of Medicine Volume 344:564:572: February

22, 2001. No:8.

Topic :

Intussusception among infants given an oral rotavirus vaccine.

Abstract :

Intussusception is a form of intestinal obstruct in which a segment of the

bowel prolapses into a more distal segment. The investigator began on May 27,
1999, after 9 cases of infants who had intussusceptions after receiving the

tetravalent human reassortant rota virus vaccine (RRV – TV) were reported to

the vaccine adverse event reporting system.

Method :

Case – control study

Conclusion :

The strong association between vaccination with RRV – TV and

intussusceptions among otherwise healthy infants supports the existence of a

causal relation. Rota virus vaccines with an improved safety profile are urgently

needed.

JOURNAL REFERENCE – 2
Journal details:
American Journal of Epidemiology, Volume 163, No-6, 15 March 2006.

Topic :
Oral polio vaccine and intussusceptions

Abstract:

The authors investigated the possibility of an association between oral

polio vaccine (OPV) and intussusceptions by linking Scottish vaccination and

hospitalization data sets and performing self-controlled case series analysis.

The issue was important because rotavirus vaccine, another live oral virus

vaccine, was with drawn from the market in 1999 after studies showed a strong

association with intussusceptions.

Conclusion :
The authors conclude that overall, there is no evidence for an association

between OPV and intussusceptions, even when each dose is considered

separately.

CONCLUSION

Intussusception is one of the most frequent cause of intestinal obstruction

in between the ages of 3 months and 3 years. Most common type is ileocecal

value intussusceptions. Non-operative reduction 5 successful in 75% of cases.

Surgery is required for patients with unsuccessful contrast enema. The nurse

should preserve the parent child relationship by encouraging rooming in

because hospitalization may be the child’s first separation from the parents. Post

operative nursing care includes observing vital signs, intact sutures and
dressings return of bowel sounds, maintaining fluid and electrolyte balance,

minimizing the risk of infection and proper education to the parents.

CHILD HEALTH NURSING

CARE STUDY: ON
 Submitted to
Mrs. R. JEYASUNDARI, M.Sc.,(N)
M.Phil.,M.A.
Tutor in nursing
Mrs. N. MAHESWARI, M.Sc. (N), M.A.
Tutor in nursing
College of Nursing,
Madurai Medical College,

Submitted By
M.ANBALAGAN
M.Sc.,(N) I year,
College of Nursing,
Madurai Medical College,

MADURAI MEDICAL COLLEGE-

MADURAI
NAME : M.ANBALAGAN
PROGRAM : M.Sc.,(N) I Year.
ME
SUBJECT : Child Health Nursing
TOPIC : CIRRHOSIS OF LIVER
FACULTY : Mrs. R. JEYASUNDARI, M.Sc.,(N)
M.Phil.
Tutor in Nursing
Mrs. N. MAHESWARI, M.Sc., (N),
Tutor in Nursing

Date :
Signature of Faculty

BIBLIOGRAPHY

BOOKS:
 1. Assuma Beevi. T.M. (2009). Text book of Pediatric Nursing (1 st Ed., PP

238-239) Noida : Reed Elsevier India Private Limited.

2. Ghai O.P., Piysh Gupta, Paul. K.K. (2004) Ghai Essential pediatrics (6 th

Ed., PP. 268) New Delhi : CBS Publisher.

3. Marilyn J.Hockenberry (2006). Wong’s Essentials of pediatric nursing

(7th Ed., PP 882-883). New Delhi : Reed Elsevier India Private Limited.

4. Sandra M. Nettina (2001). The Lippincott manual of Nursing Practice (7 th

Ed., PP 1268-1261).

5. Suraj Gupte (2009). The short text book of Pediatrics (11 th Ed., PP 698-

699). New Delhi : Jaypee Brothers Medical Publishers (P) Ltd.,

JOURNALS:

1. Cameron J. Clare, Walsh, David Finlayson, Alan R. Bord, James. H (15

March 2006). Oral Polio Vaccine and Intussusception. American Journal

of Epidemiology, 163(6), PP. 528-533.

2. Trudy V.Murphy, Paul M. Gangiullo, Mehran S.Massoudi, David Nelson,

Aisha O.Jumaan, Catherine A. Okor, et. al., Oral Rotavirus Vaccine. The

New England Journal of Medicine, 344 (8), PP 564-572.

 POST OPERTIVE TREATMENT
S. Name of the
Dose Route Action Side effects Nurses responsibility
No drug
1. Inj.Cefotaxine 400mg Bd IV It is a third generation. Headache, nausea, Check solution for
sodium 50- Cephalosporin antibiotic vomiting, phlebitis, particles and discoloration.
180mg drug is primarily a interstitial, nephritis, Normal color ranges from
/kg/day bactericidal, but it may be diarrhea. Transient light yellow to amber.
bacteriostatic. Drug neutropenia, eosinophilia Drug should not be mixed
adheres to bacterial hemolytic anemia, thrombo with amino glycosides or
penicillin binding proteins cytopenia, erythematous sodium bicarbonate or
there by inhibiting cell rashes, urticaria, fluids with PH above 7.5.
wall synthesis. Drug is induration, temperature Drug should be given
achieve against some elevation and tissue slowly over 3-5 minutes in
gram+bacilli and many sloughing at injection site IV. Solution is used within
gram(-) bacilli 24 hours of preparation.
Watch or allergic
manifestations.

2. Inj.Amikacin 60mg Bd IV It is a amino glycoside, Neuromuscular Holkade, Use cautiously in patients

 sulphate 15mg/ kg / antibiotic. It is a ototoxicity, nephrotoxicity, with impaired renal
day bactericidal, inhibits azotemia, arthralgia, and function and
bacterial protein synthesis. acute muscular paralysis neuromuscular disorders.
Its activity mainly on gram Watch the urine output and
negative organisms and hearing impairment.
some aerobic gram Adequate fluid intake
positive organisms should be monitored.
Monitor intake and output.
3. Inj.Metronida 25mg TDS It has bactericidal and Vertigo, headache, ataxia, I.V. administration should
zole 7.5mg/ kd/ amebicidal action. It syncope, confusion, be done slowly. Drug
day in interacts with DNA to irritability, insomma, should not be given by I.V.
cause destruction of DNA thrombophelebitis, push. Discontinue the I.V.
structure and protein abdominal cramping, fluid during infusion.
synthesis inhibition and epigastric distress, nausea, Educate the parents about
cell death in susceptible vomiting, anorexia, metallic taste and
organisms diarrhea, constipation, dry discolored urine. Watch
mouth, metallic taste, the I.V. cannula site for
darkened urine, polyuria, thrombo phlebitis.
cystitis
4. Inj. 12.5mg Bd TID It is a H2 receptor Malaise, vertigo, blurred Drug should be diluted in
Ranitidine 2-4 mg / antagonist, ant ulcerative vision increased serum 5% dextrose water solution
 kg/ day action competitively
inhibits the action of
histamine at H2 receptors
in gastric parietal cells.
This reduces basal and
nocturnal gastric acid
secretion as well as that
caused by histamines’, for
amino acids and insulin
5. Paracetamol 10-15mg/ TID It is an antipyretic and
suppositories kg/ dose analgesic exhibits action
per rectum by peripheral blockage of
pain impulse generation. It
inhibits prostaglandin
synthesis in the CNS and
elevates the pain thrushold.
creatinine level, and administered over 15-
leucopenia, 20 minutes. Oral drugs
thrombocytopenia, should be swallowed and
granulocytopenia, elevated not chewed. Drug should
liver enzymes, jaundice, be administered after
burning and itching at dialysis as it may be
injection site, angioneurotic removed in dialysis.
edema.
Hemolytic anemia, Suppositories must be
neutropenia, leucopenia, retained in the rectum for
pancytopenia, severe liver at least 1 hour. Watch for
toxicity, hypoglycemia, rectal bleeding before and
rashes and urticaria. after suppositories. High
does should be avoided as
it may cause liver damage.

Subjective data : Mother verbalizes that child has continuous cry. Not sleeping
Objective data : Child underwent surgical procedure, cry excessively, during knees upto the chest
Nursing diagnosis : Pain related to surgical procedure secondary to intussusceptions
Goal : Child will experience no pain or reduction of pain to acceptable level.
S.No Plan of Action Nursing Intervention Rationale Evaluation
1. Assess the level of pain Assessed the level of pain Assessment provides Child has reduction of
baseline data for further plan pain to acceptable
of action level.
2. Provide mild head end Child is positioned in the Good body alignment will
elevation and position the mother’s legs. reduce pain
child
3. Administer analgesics as Paracetomol suppositories Analgesics reduces pain by
prescribed administered acting on the pain centre in
UNS for further planning
4. Reassess the child’s pain Reassessed the pain level -
level after 20 minutes pain is
minimized to certain
extend
Subjective data : Mother verbalizes that child has fever
Objective data : Child skin hot, tongue dry, child underwent surgery had G.I. obstruction
Nursing diagnosis : Hyperthermia related to infection secondary to obstruction of intestinal contents.
Goal : Child will have normal body temperature
 S.No Plan of Action Nursing Intervention Rationale Evaluation
1. Assess the temperature, vital Assessed the vital parameters. Assessment helps for Child’s body
signs and other signs of Temperature-101, Pulse further planning temperature
infection -132/mt, Respiration-38/mt. reduced from
Child has surgical incision 101 to 98.4
2. Provide tepid sponging and Tepid sponging given for 20 Helps to bring down the
continue for 20 minute minutes temperature by heat
conduction
3. Administer medications as Paracetomol suppositories It has antipyretic action
prescribed administered rectally reduces temperature
4. Re-record the temperature after Rerecorded the temperature, Helps for further planning.
30 minutes of paracetomol Temperature-98.4. Child is Make the child comfortable
suppositories position the child positioned in mild head and free from pain
comfortably elevated.
Subjective data : Mother verbalizes that child has dry tongue and lips, passed small amount of urine
Objective data : Child on NPO, lips and tongue dry, passed high colored urine for the past 4 hours had fever
Nursing diagnosis : Risk for fluid volume definite related to nil oral and loss of fluid in pre operatively.
Goal : Child will have adequate hydration
S.No Plan of Action Nursing Intervention Rationale Evaluation
1. Assess the child’s Assessed the dehydration status. Lips and tongue Helps for planning Risk for fluid
 dehydration status dry. Craving for liquids. On nil per oral. Had effectively volume deficient
fever. Passed high colored. Small amount of urine. minimized. Child
No loss in skin turgor. No sunken eyes. No has adequate
anterior fontanelle depression hydration after
2. Administer As per prescription of the surgeon I.V. Isolyte P Replacing the loss
I.V. infusion
intravenous fluids started and maintained flow at the rate of 0.5ml/mt through I.V.
as prescribed in 30 drops/mt micro set.
3. Maintain nil per NPO status maintained. Lips and tongue are made Helps for wetting of
oral status to met with wet cotton. dry lips and tongue
4. Monitor intake Intake and output monitored after 150ml IV -
and output infusion child passed about 25ml of urine