1、Intussusception,NURSING ROUND,Pediatric Surgical Department 2015.9.25,Contents,Case Report,Knowledge of Intussusception,Therapeutic Management,Health Guidance for Discharged Patients,Case Report,BIOLOGICAL DATA:Name ：Chen JingyaSex： femaleAge： 7-month-oldDate of Admission：2015-04-23 14:40,Case Repor
2、t,Chief Complaint：paroxysmal cryingvomitingbloody stoolERX-Ray:Intussusception unable to reset,Case Report,Case Report,Admission Diagnosis: Acute IntussusceptionPhysical Examination: T:36.9 P:110/minR:20/min Wt:7.5kg,Laboratory examination: routine blood roution urine full biochemical full blood coa
3、gulation test HIV,HBV,HCV,RPR Date of Intussusception surgery:2015-04-23 Date of discharge:2015-05-05,Case Report,Knowledge of Intussusception,Etiology,Symptoms & Signs,Definition,Intussusception,What is intussusception?,Intussusception is a medical condition in which a part of the intestine has inv
4、aginated into another section of intestine.,Knowledge of Intussusception-Definition,Children intussusception,Intussusception is an common abdominal emergency in children. It is one of the most common causes of abdominal obstruction in infants.,4-10month,Knowledge of Intussusception-Definition,ETIOLO
5、GY,Knowledge of Intussusception,Age: 80%2 years old, most common in infants aged 4-10 months.Sex: the ratio of the male-to-female is approximately 3:1.Season: the seasonal peak is in spring and summer.,Incidence:,Knowledge of Intussusception-Etiology,Whats the reason of the disease?Why it happens to
6、 infants mostly?,Knowledge of Intussusception-Etiology,Predisposing factors: caused by disorder of the intestinal peristalsis, such as:Dietary alteration: complementary solid food.Diseases: gastroenteritis, diarrhea, fever,etal.Virus infections: adenovirus, rotavirus,reovirus, echovirus.,Knowledge o
7、f Intussusception-Etiology,Dietary alteration,Knowledge of Intussusception-Etiology,The complementary food of children can not be changed too soon.It is supposed to be transformed step by step.,Dietary alteration,Knowledge of Intussusception-Etiology,Predisposing factors: caused by disorder of the i
8、ntestinal peristalsis, such as:Dietary alteration: complementary solidfood.Diseases: gastroenteritis, diarrhea, fever,et al.Virus infections: adenovirus, rotavirus, reovirus, echovirus.,Knowledge of Intussusception-Etiology,fever (acute upper reappiratory tract infection),lost its normal function /e
9、nterospasm,Disease,Knowledge of Intussusception-Etiology,Predisposing factors: caused by disorder of the intestinal peristalsis, such as:Dietary alteration: complementary solidfood.Diseases: gastroenteritis, diarrhea, fever,et al.Virus infections: adenovirus, rotavirus,reovirus, echovirus.,Knowledge
10、 of Intussusception-Etiology,Researchers suspect that infectious agents: rotavirus&adenovirus.,Virus infection,Knowledge of Intussusception-Etiology,Intussusception causes have not clearly established or understood. They can include infections, anatomical factors, and altered motility. Studies and a
11、nalysis have not conclusively established this.,Knowledge of Intussusception-Etiology,A review of sparse data on the possible association: the virus & intussusception has not demonstrated until very recently.,Knowledge of Intussusception-Etiology,Symptoms and Signs,1、General appearance,2、Paroxysmal
12、crying,3、Bilious vomiting,4、Red currant jelly stool,5、Sausage-shaped mass,Knowledge of Intussusception,Therapeutic Management,Nonsurgical Therapy,Surgical Therapy,Nonsurgical Therapy,Air Enema Barium Enema,Nonsurgical Therapy - Barium Enema,Nonsurgical Therapy-,Barium Enema,Nonsurgical Therapy -Bari
13、um Enema,complication,chemical peritonitis,Nonsurgical Therapy-,Barium Enema,Intussusception presenting 48 hours. Good general appearance. Without abdominal distention, high temperature and toxicosis .,ETIOLOGY,Nonsurgical Therapy - Air Enema 1.Indications,Nonsurgical Therapy-,Air Enema,2.ProcedureR
14、estrained the patient, inserted the Foley catheter into rectum, inflated the balloon.,Nonsurgical Therapy-,Air Enema,2.head of intussusceptum located in the hepatic flexure of the colon,1.before air clysis,3.reduction occur,4.reduction go on,5.the filling of numerous loops of intestine,3. Signs of C
15、omplete Reduction Free flow of air into several loops of small bowel with simultaneous expulsion of feces. Stop crying, be quiet. Disappear of the abdominal mass.,Nonsurgical Therapy-,Air Enema,4. Nursing Care of Post- air enema Carbon test: take 0.5-1g activated carbon orally, appearing in stool 6-
16、8 hours later. Basic therapy. Dietary guidance. Clinical observation closely.,Nonsurgical Therapy-,Air Enema,Surgical Therapy,Pure manual reductionIntestinal anastomosisEterostomy,Surgical Therapy,1.Surgical Indication,Enema failure. Intussusception occuring more than 48-72 hours. Intestinal necrosi
17、s. Intestinal perforation.,Surgical Therapy,2.Nursing Diagnosis,Pain Anxiety Hight risk for fluid volume deficit Potencial complicaion: shock,Surgical Therapy,3.Postoperative Nursing Intervention,Monitoring the vital signs and consciousness state. Oral feeding on a gradual schedule -obeying the doct
18、ors instruction.,Surgical Therapy,Intensive care for nasogastric tube. Prevention of complications: prevention of intestinal adhesion, fluid infusion to prevent bleeding, infection, etc.,3.Postoperative Nursing Intervention,Surgical Therapy,Activity : Passive activity,3.Postoperative Nursing Interve
19、ntion,Surgical Therapy,Health Guidance for discharged patients,An important way to prevent intussusception and finddiseases in time.,* Living guide * Disease observation * Diet guide * Special care guide,Living Guide,*Let the parents realize the importance of keep moving. *Enough physical activities
20、. *Prevention of intestinal adhesion.,EXERCISE,INFECTION PREVENTION,Adenovirus infection Intestinal lymoph follicles hyperplasiaExcessive intestinal Stimulate the autonomic nervous system peristalsisIntussusception,So,*Prevent colds *Safety food,Living Guide,Disease Observation,WOUND NURSING,* Take
21、a shower instead of bath. * Get rid of the risk factors of damaging the wound. * If the wound is red or cracks,please go to hospital.,Disease Observation,Pain nursing,Attentions! If the child cries with any paroxysmal,you had better do a timely manner B to exceed cheek,against to rule out the possib
22、ility of intussucception.,pain,3-10 months healthy fat infant,*colicky abdominal pain *abdominal swelling or distention*bilious vomiting*“red currant jelly“ stool *“sausage-shaped“ mass,Diet Guide,VS,Infant period add assist food should follow : keep from less to more from fine to coarse the origina
23、l is from single to multiple,Diet Guide,How to eat?,Diet Guide,Diet Guide,After operation: once a week in 3 monthsNEED: observe the spirits, defecate and the condition of appetite.,monitor weight,Special Nursing Guidepost-fistulation,Skin care guide,* Often change or clean the colostmy bag. * Wipe the stoma by warm water. * Often observe the condition of the stoma.,Special Nursing Guidepost-fistulation,THE USE OF COLOSTOMY BAG,Choose:,* More comfortable and soft colostmy bag.* Choose appropriate to the size of the pocket.,for your appreciation!,
