INTUSSUSCEPTION

Definition of the disease

Intussusception is a condition in which one segment of intestine "telescopes"
inside of another, causing an intestinal obstruction or the blockage. Although
intussusception can occur anywhere in the gastrointestinal tract, it usually occurs
at the junction of the small and large intestines. The obstruction can cause
swelling and inflammation that can lead to intestinal injury.

This is sometimes called "TELOSCOPING" because it's similar to the way a

collapsible telescope slides together

 Most common cause of intestinal obstruction

 Common sight is in the eleocecal valve

 The majority cases are considered are idiopathic ( they happens without a
clear cause.

Risk factors :

 Having had one PREVIOUSLY

 Having a sibling with INTUSSUSCEPTION

 Having intestinal MALROTATION ( It is a condition where the intestine

doesn't rotate correctly during fetal development.
Symptoms of intussusception
The main symptom of intussusception is severe, crampy abdominal pain
alternating with periods of no pain. Painful episodes may last 10 to 15 minutes or
longer, followed by periods of 20 to 30 minutes of no pain, after which the pain
returns. Some children may become lethargic. Small children may draw their
knees up to their chest during the episodes of pain.

Other possible symptoms of intussusception include:

  Nausea

 Vomiting

- Initially, vomiting is non bilious and reflexive, but when the intestinal
obstruction occurs, vomiting becomes bilious.

 Rectal bleeding

- or Currant jelly stool. Parents also report the passage of stools that look

 like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed
blood.

 Lethargy

- Lethargy is a relatively common presenting symptom with

intussusception; the reason lethargy occurs is unknown because lethargy
has not been described with other forms of intestinal obstruction.

Epidemiology
 The male-to-female ratio is approximately 3:1

 Most common in babies 5 to 9 months old, but older children also can have
it

 Intussusception occurs most frequently in the fall and winter months

during viral season, but can happen at any time of the year.

 It is seen in approximately one in 1,200 children

 And most episodes occur in otherwise healthy and well-nourished children.

Complications of Intussusception
 Bowel Perforation. If the blood supply is cut off in the affected part of the
intestine, that tissues in that area may die. This can cause a tear in the wall
of the intestine, also known as bowel perforation.
  Peritonitis and Shock. If left untreated, bowel perforation can cause the
infection of the peritoneum, or the lining of the abdominal cavity. This can
trigger a more severe abdominal pain, swelling, and fever. Peritonitis is a
fatal condition that can lead to shock.

Diagnostic
 History of symptoms

 Physical examinations

- "sausage shape" mass felt on RUQ

- distended abdomen

- bowel sounds increase/decrease

 Abdominal X-ray - this Imaging test may show a blockage in the intestine

 Abdominal Ultrasound - this test uses sound waves and a computer

generate image of inside of the body. An ultrasound of the intestine can
often detect tissue problems or circulation disruptions.

Priority Nursing Diagnosis

 Acute pain related to bowel invagination

 Deficient fluid volume related to vomiting, nausea, fever, and diaphoresis

 Anxiety related to change in health status

Pathophysiology
a. Most commonly occurs at the terminal ileum.
b. The telescoping proximal portion of bowel invaginates into the adjacent distal bowel.

c. The mesentery of the intussusceptum is compressed, and the ensuing swelling of the bowel wall
quickly leads to obstruction.

d. Venous engorgement and ischemia of the intestinal mucosa cause bleeding and an outpouring
of mucous, which results in the classic description of red “currant jelly” stool.

Treatment
 Air or barium enema
 - a therapeutic procedure that can improved and correct intussusception

- pressure by the enema returns bowel to normal position and relieves

obstruction

- monitor for passage of stools( may indicate resolution)

- sign of perforation (such as acute pain, spreading over abdomen: pains

worsens with movement, rigid abdomen, N/V, fever, chills, tachycardia,
abdominal distention, decreased bowel sounds)

 Surgery

- unresolved intussusception will need surgery to prevent perforation

- the surgeon can treat the intestinal obstruction and correct the telescoped
position of the affected intestine. If there is an evidence of tissue death, the
surgeon remove such dead portion of the intestinal wall.

After treatment, the child will stay in the hospital and get IV feedings until they
can eat and have normal bowel function. Doctors will watch the child to make
sure that the intussusception does not come back. Some babies also may get
antibiotics to prevent infection.

Most infants treated within the first 24 hours recover completely with no
problems. But untreated intussusception can cause serious problems that get
worse quickly

Drug therapy is not currently a component of the standard of care for

intussusception. Medications are limited to those used for pain control after
surgery. In the immediate postoperative period, weight-adjusted intravenous
morphine is usually administered.

Discharge Instructions and Health Teaching for

Instussusception
Nutrition

 Give your child a variety of healthy foods. This includes fruits, vegetables,
whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask
if your child needs to be on a special diet. Continue to breastfeed or bottle
feed your infant.

Home care

 Let your child get back to normal activity as soon as he or she feels up to it.

 This health problem can sometimes come back. Watch your child for signs.
Look for belly (abdominal) pain that gets worse, or vomiting. Also look for
crying spells without a cause and drawing the legs up toward the belly.

 Feed your child a normal diet.

When to call your child’s healthcare provider

Call your child's healthcare provider right away if your child has:

 Fever

 Belly pain that comes and goes

 Constant belly pain that doesn't get better or seems to be getting worse

 Vomiting

 Extreme sluggishness, tiredness, or fatigue

 Dark, mucus-like, bloody stools

 Pale skin color

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a
mercury one.
For infants and toddlers, be sure to use a rectal thermometer the right way. The
thermometer may accidentally poke a hole in the rectum. It may also pass on
germs from the stool. Always follow the product maker’s directions for proper
use. If you don’t feel comfortable taking a rectal temperature, do it another way.
When you talk to your child’s healthcare provider, tell him or her which way you
used. Don’t take an oral temperature until your child is at least 4 years old.

NURSING CARE PLAN

ASSESSMENT NURSING NURSING NURSING RATIONALE EVALU
DIAGNOSIS PLANNING INTERVENTION ATION

Subjective Acute Pain The patient • Prepare the • Prepare the After
Data: related to will patient for patient for the
intestinal demonstrat air/barium air/barium nursing
•Colicky obstruction
e relief of enema or enema or interve
abdominal secondary to
pain as surgery, usually surgery, ntion
pain(pain intussusceptio
evidenced by putting usually by the
score of 10 out n as
evidenced by by a pain him/her in a putting patient
of 10 )
pain score of score of 0 nothing per orem him/her in a will
•Lethargy 10 out of 10, out of 10, / nothing by nothing per demons
verbalization stable vital mouth status. orem / trate
Objective of abdominal
signs, and nothing by relief of
Data: pain and
absence of mouth status. pain as
irritability
•Crying or restlessness evidenc
• To monitor
fussiness . • Post-operative effectiveness ed by a
( Intermittentl care: Administer of pain
medical
y 15-30 pain medication treatment for score of
minutes as prescribed. 0 out of
the relief of
interval) 10,
post-
stable
•Blood and operative
vital
mucus in stool pain. The
signs,
(red currant time of
and
jelly stools) monitoring absence
of vital signs of
•Irritability
may depend restless
Vital signs: on the peak ness.
time of the
PR: 126
drug
RR:26 administered

TEMP. : 38 • To monitor
effectiveness
• Assess the
of medical
patient’s vital
treatment for
signs and
the relief of
characteristics of
post-
pain at least 30
operative
minutes after
pain. The
administration of
time of
medication.
monitoring
of vital signs
may depend
on the peak
time of the
drug
administered

• To reduce
stress levels,
• Teach the
thereby
patient on how to
relieving the
perform non-
acute post-
pharmacological
operative
pain relief
pain.
methods such as
deep breathing,
massage,
acupressure,
 biofeedback,
distraction, music
therapy, and
guided imagery.

• Gradually • To allow the

introduce oral patient’s
fluids and food as abdomen to
recommended by heal post-
the surgeon post- operatively,
operatively. as the normal
bowel
function
gradually
becomes
established.

ASSESSMEN NURSING NURSING NURSING RATIONAL EVALUAT

T DIAGNOSIS PLANNING INTERVENTIO E ION
N

Objective Deficient Fluid Child will be • Assess for • Repeated The child
Data: Volume maybe able to signs and vomiting will be
related to
tolerate age symptoms of and able to
• Nausea excessive losses
through normal appropriate dehydration insufficient tolerate
•Vomiting routes as foods and such as poor fluid intake age
evidenced by fluids skin turgor, dry may lead to appropria
•Diarrhea vomiting,
without mucous dehydration te foods
diarrhea, poor
•Poor skin skin turgor vomiting or membranes, . and fluids
turgor and Signs and recurrence irritability, and without
symptoms of of symptoms delayed vomiting
Vital signs: dehydration or
and will be capillary refill. •Measurem or
electrolyte
PR: 118 imbalance free from ent of fluid recurrenc
• Assess fluid
RR: 23 fluid and intake and intake and e of

TEMP. : 37.1 Fluid Volume electrolyte output. output is an symptoms

Deficit related to imbalances. important and will
excessive losses indicator of be free
through normal
child’s fluid from fluid
routes
secondary to status. and
intussusception, electrolyte
• Vital sign
as evidenced by • Monitor vital imbalance
vomiting, changes
signs as s.
diarrhea, such as
decreased urine frequently as
hypotension
output, dry possible.
,
mucous
membranes, tachycardia
poor skin turgor, and
irritability, and increased
reduced oral
temperature
fluid intake
reveals
hypovolemi
a.

• Monitor • Initially, a
characteristic child with
of stool intussuscept
(consistency ion may
and color). pass a
normal
stool, but
later on, a
mucus,
blood-filled
or jelly-like
stool is
observed.

• Sucking on
a pacifier
• Suggest and may
offer infant the promote
use of a peristaltic
pacifier. movement
and passage
of gas.

• Post-
operatively,
intravenous
• Administer IV
fluids are
fluids as
continued to
ordered.
re-
established
electrolyte
imbalance
and to
promote
adequate
fluid intake.

• A clear
liquid diet,
• Instruct then
parents that progressing
they may offer to soft diet
clear liquids is given
then gradually until normal
advanced diet bowel
as tolerated. function is
established.

• Deficient
fluid intake
• Provide can cause a
frequent oral dry, sticky
 hygiene. mouth.
Attention to
mouth care
promotes
interest in
drinking
and reduces
discomfort
of dry
mucous
membranes.

ASSESSMEN NURSING NURSING NURSING RATIONALE EVALUATIO

T DIAGNOSIS PLANNIN INTERVENTIO N
G N

Subjective Anxiety The client • Assess the • Knowing The goal is

Data: related to will use client's level of the coping met. The
change in relaxation anxiety. abilities of client will
•The patient
health status techniques individuals. use
reports
characterized to relieve relaxation
having • The client
by increasing anxiety • Take time to techniques to
“uncontrolla will feel
the pain of listen to relieve
ble anxiety better when
powerlessness, express anxiety anxiety.
attacks” heard.
expressed and fear;
while at trusting
concern. provide
work and relationship
calming.
sleeping. The can be
patient also established
reports to with the
having client.
constant
• Quiet
diarrhea,
forgetfulness, • Maintain a surrounding
and difficulty quiet s make the
in sleeping environment. client more
relaxed and
Objective
can reduce
Data:
anxiety.
•Irritability
• Provide • To divert
•Restlessness diversion the mind
through from stress
Vital signs:
television, and anxiety.
BP: 130/90 radio, games
for lowering
PR: 64
anxiety.
RR: 20
• Describe the • Patient
TEMP. : 36.2 procedures and involvement
actions and in care
give an planning can
explanation of provide a
the sense of
strengthening control and
of disease, and helps reduce
prognosis anxiety.
action.