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Nursing Care for Intussusception Samples Ã¢â¬ MyAssignmenthelp.com
Question: Discuss about the Nursing Care for Intussusception. Answer: Intussusception Intussusception is the one of the leading cause of intestinal blockage in children between three months old and three years of age. 1 to 4 out of 1000 infants suffer from this condition. Boys get intussusception more often than girls (Gupta, 2014). It is a life threatening condition which requires medical attention within 24 hours for better prognosis and survival rate. It is uniformly fatal in 2-5 days if left untreated. It is the process through which segment of intestine telescopes or sinks into the adjacent intestinal lumen, causing lumen obstruction. It commonly occurs between the ileum and colon (Bothara, 2018). The pathogenesis of this condition is idiopathic (Douglas, 2015). Risk factors include bacterial enteritis, tumors and rotavirus vaccine. Although it is also believed to be caused by imbalance in the longitudinal forces along the intestinal walls. This imbalance can be as a result of tumors, masses or haphazard peristalsis pattern for instance ileus in the postoperative period. As a result of the imbalance, an area of the intestine invaginates into the lumen of adjacent bowel. The invaginating portion is called intussusceptum while the receiving part is referred to as intussusception (Paul, 2014). The process continues and more proximal areas follow allowing the intussusceptum to proceed along lumen of the intussuscipien. In severe cases, if the mesentery of the intussusceptum is relaxed and the progression is rapid, the intussusception can occur all the way to the distal colon or sigmoid and even prolapse out of anus. The above processes lead to pathophysiologic process of bowel obstruction. The flow of food and fluids through the bowel is blocked leading to irritation and swelling of the intestines. This blockage lead to reverse peristalsis thus causing vomiting. In early stages, the lymphatic return is the first to be hindered and with increasing pressure within the walls of the intussusceptum, venous drainage is also impaired. Finally, more pressure builds up further hindering arterial inflow and infarction ensues. This leads to ischemia of the intestinal mucosa which then sloughs off leading to currant jelly stool which is made of sloughed mucosa, blood and mucus. If medical attention is not sought early enough, Trans mural gangrene and perforation occur especially at the prime edge of the intussusception. The perforation leads to bleeding. Severe bleeding lead to development of shock which is life threatening condition. The perforation of the intestinal wall also allows intestinal contents to leak into the peritoneal cavity. This increases the risk of infections like peritonitis. Nursing care for intussusception The medical management of intussusception depends on the severity, the health of the child, preference of the care giver and the time of intervention. In some instances, the intussusception corrects itself on its own. Other medical interventions involves non-operative reduction and surgical reduction. In non-operative reduction, therapeutic enemas are used. They include hydrostatic- which may contain barium or water soluble contrast or with air insufflation; this is the treatment of choice in many institutions because of less risks and complications associated with it. Surgical intervention is done if the intussusception is severe (Rogers Robb,2012). Most cases surgery is done if the section of intussusception necrotizes fully and requires re-sectioning. In this view, nurses play a major role in the management of the child. Nurses role include assessment and history taking, preoperative care, counselling and health education to the mother- the primary care giver. In Jays case a contrast enema will be administered. The major role of a nurse will include history taking and physical assessment, electrolyte monitoring and intravenous care in preparation of enema administration. Several factors thus play a role in management and care of this baby. First is the consideration of developmental theories in regards to the child. Developmental theories are a collection of theories that explain in details about how desirable change in society is best achieved. Infants of four months old are rapidly undergoing development, both physical and psychological that should be nurtured well by primary care givers and parents to achieve desirable characters. The major developmental theories applicable to a four month old infant are Freud's psychosexual theory, Erikson's psychological theory and Piaget's cognitive development theory (McLeod 2017, Rautava, 2013). Firstly, a nurse caring for a four month old infant and wants to use Piaget cognitive theory would much focus on the first stage. Sensorimotor stage occur from birth to two years of age. It is shown that infants normally "think" by manipulation of the world around them using the five sense and there after producing responses by "doing" such as throwing objects to experience what results. The nurse should therefore provide them with playing toys for them to use. At this age infants begin to believe in object permanence even if something is out of sight they believe it still exists (Rautava, 2013). The nurse should make such environment possible to elicit such reactions. Secondly, using the Sigmund Freud's psychosexual theory the nurse can play a major role in shaping up the infant's sexual and aggressive drives (Rautava, 2013). This is usually so as to foster their proper development. The super ego part of personality would be the center of interest as it develops through interactions with other people who want the infant to conform to norms of society. The nurse would then concentrate on the oral stage that occur between births to one year of age. The mouth is a pleasure center of development at this stage, the nurse should ensure that the oral needs of the infant are met such as sucking so that the child may not develop negative habits like thumb sucking because they were stuck in the oral stage (McLeod, 2017). It is therefore necessary to allow more visiting time from the mother. Lastly, Erikson's psychological theory has revealed that at the first stage the child is uncertain about the world we live in. The infant therefore looks upon the care giver to feel secure. Under trust verses mistrust (Dooki, 2015), the nurse can take the opportunity to resolve the infants uncertainty and provide security when they are threatened. The mother who is the primary care giver should also be allowed to bond and interact with her baby more often. This will help the infant have hope but failure to acquire this virtue will in turn lead to development of fear (McLeod, 2017). The physical development is also a factor to consider, the childs masculinity has not fully developed thus they are precipitating factors in development of intussusceptions. The mother then should be educated on this to alleviate anxiety. Another determining factor in the care for the baby is its mother. The mother play a vital role in the care for this baby and therefore needs counselling about the condition to alleviate anxiety and doubts. Counselling empowers the mother about the babys condition, disease process, intervention outcome and also increases the acceptance of the nursing care. The mother should be cancelled on the future vaccinations. The benefits of continuing with vaccination of her child despite the side effect of the recently administered rotavirus (Nylund, 2015). She should be enlightened about the side effects of vaccines and that they are not very common with the incidence at 1case per every 100000 vaccinated babies (Koch, 2014). Moreover, counselling should be accompanied with health education on how the family can participate in care, the danger signs to watch on their baby and the overall prognosis. In addition, there is risk of recurrence of this condition, though low, only 1 in 1000 cases recur (Rautava, 2013) and therefore equipped with this, the family is able participate in the care of the baby inclusively. Hospitalization process is involving and has its effects on the family as well on the child. The child is separated from the mother most of times to give the hospital staff time to carry out hospital procedures. This is psychologically demanding and stressing for the baby. The baby also faces the challenge of adapting to new environment which sometimes may not be conducive from the infrastructure, noise, light and disturbance from many health care providers (Simpson Ivey, 2014). The infants have not fully developed immunity and can easily contract nosocomial infections. The setting is not conducive for exclusive breastfeeding for the infant as the baby is getting supplemental parenteral feeds and more so there is a lot of disruptions from hospital. This reduces the bonding time between the baby and its mother (Prasanna, 2013). Apart from the baby, the hospitalization also affects the family especially the parents. First, they face a lot of stress and anxiety as they are worried about their babys outcome. If no necessary support is accorded, the parents can suffer from depression. Secondly, the process disrupt the work schedule as most of the times the parents are around the hospital for visitation. The other siblings at home may also lack the required parental care (Simpson Ivey, 2014). The hospital care especially in emergency department are costly and this drains the familys kitty especially in event of long term stay and lack of insurance covers. In conclusion, intussusception is a life-threatening condition that affect mostly children under 3 years of age and require rapid multispectral management within 24 hours to save life (kamis, 2013). References Bothara,V.P., Pandey,A., Rawat,J. (2018). Neonatal intussusception: A review. Journal of Neonatal Surgery, 7(1), 5. Dooki,E. (2015). Erik Erikson's Focus on Psychosocial Development.An Introduction to Theories of Human Development,15(6), pg.139-156. Douglas,D. (2015). CSurgeries: Intussusception Rduction.67(3), pg.880. Gupta,C. (2014). Journal of Paediatrics and Child Health. Probiotic supplementation in neonates with major gastrointestinal surgical conditions: A systematic review.,53(4), pg.83-83. Jim,P., Buttery,C., Standish,J., Bines,E. (2014). The pediatric infections. Disease journal, 2, 20-24. Kamis,T. (2013).Nursing Care Indicators in newborns.Journal ofNursing Care,01(03), 1168- 1170. doi:10.4172/2167-1168.1000107 Koch,J. (2014). Vaccination: vaccination as a Preventive Measure. 40(8), pg.12-21. McLeod,S. (2017). Simply Psychology Journal.Developmental theories,5(2), 99-103. doi:10.4324/9781315517933 Rogers, T. Robb, A. (2012) Intussusception in infants and young children.Surgery; 28: 8, 402-405. Nylund, M. (2015) Journal of Pediatrics. Rotavirus vaccine as a risk factor for childhood intussusception: a retrospective cohort study; 15(6): pg.761-765. Paul,S. (2014). A case series on intussusceptions in infants presenting with listlessness. Infant intussusception, 6(5), 174-177. Prasanna,B.K. (2013). Rapunzel syndrome: A rare presentation with multiple small intestinal intussusceptions.World Journal of Gastrointestinal Surgery,5(10), pg.282. Rautava P., (2013) Pediatrics Journal. Effect of newborn hospitalization on family and child behavior: a 12-year follow-up study; 111(2):277-283. Simpson T., Ivey J(2014) Pediatric Nursing Journal. Pediatric management problems; 30(4) pg. 326.