1. Intussusception PREPYRED BY/ NAWAL AL SULAMI

2. What is intussusception? Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6 years of age. It occurs when a portion of the bowel "telescopes" into itself, causing intestinal obstruction.

3. The condition can progress from intestinal obstruction to necrosis (tissue death) of a segment of the intestine. Initially, blood flow through the intestine is decreased, causing swelling and inflammation. The swelling can lead to perforation (tearing) and generalized abdominal infection. Shock and dehydration can occur very rapidly

4. The cause may be idiopathic (unknown but following a viral infection); lead point (change in the mucosa from another condition such as cystic fibrosis, or hematoma); or post operative

5. Assessment: 1-Paroxysmal abdominal pain; legs drawn up 2-Blood in stool, or later “currant jelly” stools containing sloughed mucosa, blood, and mucus 3- vomiting 4-Increasing absence of stools. 5-Abdominal distention, bowel sound diminished, absent or high pitch. 6-Sausage like mass palpable in abdomen (Dance’s sign). 7-Unusual looking anus; may look like rectal prolapse. 8-Dehydration and fever 9-Shock like state with rapid pulse, pallor, and marked sweating

6. Diagnostic Evaluation: X-ray of abdomen may show absence of gas or mass in right upper quadrant. Barium enema is done if there is no appearance of peritonitis; shows a concave filling defect (will help reduce the invagination). Ultrasonogram may be done to locate area of telescoped bowel. Barium enema

7. How is intussusception treated? Two approaches are used in treating intussusception -- nonoperative reduction and surgery

8. Nonoperative reduction After the diagnosis is confirmed, intussusception is generally reduced (resolved) by gentle pressure exerted within the intestine, using barium or air enemas. Also, if your child is ill with an abdominal infection or has other complications, your physician may choose not to attempt to reduce the intussusception with the enema.barium Both barium and air enemas have a low risk (less than 2%) of complications, which could include tearing the intestine.

9. Surgery For children who are too ill to have this diagnostic procedure, who may have significant infection in the abdomen, or in whom intussusception does not resolve with the enema, surgery is necessary. If the child has several episodes of intussusception, a surgical procedure may be performed in an attempt to determine the cause of the recurrent intussusception. With the child under general anesthesia, the surgeon makes an incision in the abdomen, locates the intussusception, and pushes and manipulates the bowel in order to return it to its normal position. If the bowel is severely damaged as a result of the intussusception, additional procedures may be required

10. Nursing Intervention: Monitor I.V. fluids and intake and output to guide in fluid balance. Be alert for respiratory distress due to abdominal distention. Monitor vital signs, urine output, pain, distention, and general behavior preoperatively and postoperatively. Observe infant’s behavior as indicator of pain; may be irritable and very sensitive to handling or lethargic or unresponsive. Handle the infant gently. Explain cause of pain to parents, and reassure them about purpose of diagnostic tests and treatments. Administer analgesic as prescribed

11. Maintain NPO status as ordered. Insert nasogastric tube if ordered to decompress stomach. Continually reasses condition because increased pain and bloody stools may indicate perforation. After reduction by hydrostatic enema, monitor vital signs and general condition – especially abdominal tenderness, bowel sounds, lethargy, and tolerance to fluids – to watch recurrence. Encourage follow up care.

12. outcome intervention GOLEnursing DIAGNOSIS Infant with adequate weight gain. vital signs stable, fluid and electrolytes in balance. Passing stool. Provide NG tube attached to suction. Administer IV fluides to decompress bowel and maintain hydrtion status. Administer parenetral fluids and electrolytes as prescribe. Monitor vital signs frequently for changes in BP and pulse(indicate dehydration or fluid volume overload. Record intake and out put. measure Wight daily. Assess for presence of bowel sounds to evaluate return of bowel function. Evaluate for abdominal distention,vomiting,,which may indicative obstruction. Monitor stool for frequency,amount, and consistency. Administer laxative as ordered; to promote comfort with elimination. Encourage diet with adequate fiber and fluids Provide adequate nutrition. Prevent dehydration. Prevent constption Imbalanced nutrtion less than body reqirment R/t inability to ingest and digest food RISK FOR deficient fluid volume R/t excessive losses through normal routes

13. No signs of infection or No fever Assess pain (location, level, and characteristics) Place the childe in a comfortable position for resting and breathing. Provide wound care. Administer prescribed pain medication [analgesia] Report increase in severity of pain (inadequate dosage of the drugs) Assess wound dressing for any increased drainage (report decrease in drainage). Administer antibiotics as prescribed. Monitor vital signs may incidence to signs infection (fever). Relive pain. preventing Infection Acute pain R/t surgical incision. Risk for infection R/t surgical procedure

14. THANK YOU Nawal Alsulami Any question