Intussusception: Causes, Symptoms, and Nursing Care

Intussusception is a life-threatening condition that affects children under 3 years of age. This article discusses the causes, symptoms, and nursing care for this condition. It also covers the medical management, developmental theories, and hospitalization process for intussusception.

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Intussusception
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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,

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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, Tran’s 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 Jay’s 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.

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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

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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 infant’s
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 child’s 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 baby’s 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).

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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 baby’s 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 family’s kitty
especially in event of long term stay and lack of insurance covers.

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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).

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