Definition
Intussusception is the inclusion of part of the intestine into the
border or the more distal parts of the intestine (general, ileal
invagination into the descending colon). (Nettina, 2002)
Invagination or intussusception occurs when some gastrointestinal
driven such that a portion of it will cover most of the other to shrink
or retracts fully into a segment that is located next to the caudal.
(Nelson, 1999).
An intussusception is a medical condition in which a part of the
intestine has invaginated into another section of intestine, similar to
the way in which the parts of a collapsible telescope slide into one
another. This can often result in an obstruction. The part that
prolapses into the other is called the intussusceptum, and the part that
receives it is called the intussuscipiens. (wikipedia)
Clinical Manifestations
Early symptoms can include nausea, vomiting (sometimes bile stained
(green color)), pulling legs to the chest area, and intermittent
moderate to severe cramping abdominal pain. Pain is intermittent not
because the intussusception temporarily resolves, but because the
intussuscepted bowel segment transiently stops contracting. Later signs
include rectal bleeding, often with “red currant jelly” stool (stool
mixed with blood and mucus), and lethargy. Physical examination may
reveal a “sausage-shaped” mass felt upon palpation of the abdomen.
In children or those too young to communicate their symptoms
verbally, they may cry, draw their knees up to their chest or experience
dyspnea (difficult or painful breathing) with paroxysms of pain.
Fever is not a symptom of intussusception. However, intussusception
can cause a loop of bowel to become necrotic, secondary to ischemia due
to compression to arterial blood supply. This leads to perforation and
sepsis, which causes fever.
Nursing Care Plan for Intussusception
Nursing Assessment – Nursing Care Plan for Intussusception
1. Assessment of general physical
2. Medical history
3. Observation stool patterns and behavior before and after surgery
4. Observations of behavior of children / infants
5. Observation manifestations occur intussusception:
- Paroxysmal abdominal pain.
- Children screamed and fold knees toward your chest.
- Children seem normal and comfortable during the interval between episodes of pain.
- Vomiting.
- Lethargy.
- Currant jelly-like stool containing blood and mucus, hemocculi test positive.
- Feces no increase.
- Abdominal distention and tenderness.
- Palpable mass in the abdomen are like sausages.
- The anus that looks unusual, it can seem like a rectal prolapse.
- Dehydration and fever to rise 41 0C.
- Things like shock with rapid pulse, pale and sweating a lot.
6. Observation of the chronic manifestations of intussusception:
- Diarrhea.
- Anorexia.
- Losing weight.
- Sometimes vomiting.
- Periodic pain.
- Pain without other symptoms.
7. Assess the diagnostic procedures and tests such as plain abdominal examination, barium enema and ultrasonogram.
Nursing Diagnosis – Nursing Care Plan for Intussusception
1. Acute Pain related to bowel invagination.
2. Ineffective Tissue Perfusion: shock hipolemik related to vomiting, bleeding and accumulation of fluid and electrolytes in the lumen.
3. Anxiety related to lack of knowledge, foreign environment.
4. Ineffective Thermoregulation related to the process of inflammation, fever.
5. Acute Pain related to surgical incision.
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