Pediatric Nursing Case Study: Assessment and Care for Intussusception

This case study presents a detailed analysis of a pediatric patient, Jay, diagnosed with intussusception. It explores the pathophysiology of the condition, emphasizing the imbalance in intestinal forces leading to the telescoping of the bowel. The essay highlights the importance of considering growth and development theories, such as Piaget's and Erickson's stages, to tailor appropriate nursing interventions. It emphasizes developmentally appropriate care, family-centered care, and the significance of involving family members in the patient's care plan. The study discusses aspects of hospitalization, including creating a comfortable environment, minimizing pain, and providing support to the family. The document also addresses the role of nurses in educating the family, managing their concerns, and ensuring effective communication throughout the treatment process. References to support the discussed interventions are included in the study.

Nursing Case Study
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Introduction:
In this essay, case of Jay is discussed. He is diagnosed with intussusception. Pathophysiology of
intussusception is discussed. Multiple factors need to be considered for providing nursing
intervention to Jay. These factors include role of growth and development theories,
developmentally appropriate care, family centered care and hospitalization of Jay. Importance of
family centered care and factors which need to be considered for providing nursing intervention
to Jay are discussed. Points to be considered for hospitalization and provisions to be made during
Jay’s hospitalization are discussed. Along with medical intervention, nurse need to work on the
factors which can improve well-being of Jay.
Pathophysiology:
It mainly occurs due to the inequality in the longitudinal forces across the intestinal walls. Mass
in the form of lead point and disturbed pattern of peristaltic movement are mainly responsible for
imbalance in the longitudinal forces. Due to these imbalanced forces, intestine enters the lumen
of the adjutant bowel. Intussusception is a pathological condition of GI tract in which there is
part of intestine folds into the next section. It is mainly associated with the small bowel and in
few cases with the large bowel. It results in the small bowel destruction and bowel perforation. In
most common intusssception, ileum enters the cecum. In other few of the cases, ileum or
jejunum enters inside itself. Most of the cases, intussusceptions can occur due to location of
intussusceptum proximal to the intussuscipiens. This proximal location is mainly due to the
peristaltic action of intestine which brings proximal end towards distal end. If progression is
rapid, intussusceptum can enter distal colon, sigmoid colon and even prolapse out of the anus.
Lead point mainly occurs due to projection of intestinal tissue into the bowel lumen. Lead point
occurs in approximately 10 % of the cases of intussusceptions. Due to blockage of bowel, there
is prevention of blood supply, which causes ischemia (Aybay et al., 2016).
Gut mucosa in sensitive to the ischemia and it leads to inactivity of mucosa in the gut. It results
in the occurrence of red currant jelly stool. This stool is combination of mucosa, blood, and
mucus. However, this red currant jelly stool occurs in few of the children with intussusception.
Hence, it can be used as a differential diagnostic tool for children with bloody stool. Due to this
pathological condition of gut, there can be abdominal pain, nausea, vomiting, leg pulling towards
chest and moderate to severe cramping of the abdomen can occur in patients with
intussusceptions (Loeffler, 2014). Jay is also exhibiting all these symptoms. Intermittent pain
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can occur in children with intussusception because intussuscepted bowel segment transiently
stops contracting. Loop of the bowel become necrotic due to ischemia which occurs due to
compression of arteries. Barium or water-soluble contrast enema or an air-contrast enema can be
used as treatment of intussusception (Patcharatrakul and Rao, 2017). Earlier rotavirus was linked
to the occurrence of pathology of intussusceptions, however recent studies are not indicating link
between rotavirus and intussusception (Otero et al., 2017).
Growth and developmental theories:
Nurse should incorporate various growth and developmental theories for providing nursing care
to Jay. Various theories include Pigets’s theory of intellectual development and Erickson
trust/mistrust stage.
According to Pigets’s theory of intellectual development, sensory organ and muscles become
more functional. Infants produces reflexes to the alterations in the body. Nurse need to identify
these reflexes. In this case nurse need to recognize drawing legs up and high-pitched crying in
response to pain. It can be helpful in the early assessment and early intervention to be planned
for Jay. There is no place for emotions of nurse in evaluating cognitive developmental theory in
Jay. By avoiding this emotional factor, nurse can perform objective assessment in Jay. According
to Erickson trust/mistrust stage children relied completely on their caregiver for fulfilling their
basic need for growth and development. Children trust their parents more as compared to the
nurses, hence his parents need to administer drugs to Jay. These children are completely
dependent on their caregivers for food, shelter, and protection. In this stage Jay can seek help
from caregivers for his diseased condition (Reimann et al., 2017). Evaluation and execution of
these growth and developmental theories in Jay can provide him with effective nursing
intervention and improve his disease condition.
Developmentally appropriate care:
Diseased state of Jay can impact his future growth and development. It can negatively impact his
physical and psychological development. Nurse should make realize his family members about
its negative impact on his future development. Hence, his family members can take appropriate
measures to tackle this issue. Nurse should convince his parents to improve their moral because
it can be helpful in augmenting their attention towards his care. Special efforts need to be taken
to provide treatment in the form of enema on regular basis. Children of his age would not be
cooperating to take enema and might be afraid to take it. Hence, family members need to give
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more attention for using enema. This age appropriate care for Jay can improve his disease
condition (Lowry-Lehnen, 2015).
Family centered care:
Family centered care is important aspect for providing care to children of Jay’s age. This is
important for Jay because children like Jay can not manage their symptoms and disease condition
on their own. Jay’s family should stand firmly behind him and take part in every aspect of his
care. Nurse should consider this aspect and involve his family members in his care. Nurse should
collect information related to Jay form his family members. Nurse should collect information
related to health issues, eating habits and psychological behavior. Nurse should analyze collected
information and prepare effective care plan for him. It can help nurse to provide nursing care in
smooth manner. Family members confidence about the Jay condition can be improved by giving
them assurance that proper treatment can improve his condition (Law, 2012).
There should be involvement of family members of Jay in planning and delivering care to Jay.
Nurse should educate Jay’s family members to manage pain due to intussusception. Nurse should
understand his mother’s feelings and should give respect to her feelings. Jay’s mother is worried
about rotavirus vaccine because she was informed that his condition was exaggerated due to
rotavirus vaccine Nurse should educate that rotavirus vaccine would not affect his condition
significantly because in recent studies it is evident that rotavirus vaccine is not linked to his
intussusception. Nurse should maintain their dignity and use respectful words with them. Nurse
should understand strengths and weaknesses of his mother and plan nursing intervention with
respect to her strengths and weaknesses. Socioeconomic and cultural aspects of his family should
be considered while providing nursing intervention to Jay. Jay’s actual status of health should be
informed to his family members and inform them about the anticipated effects after the
completion of nursing intervention for intussusception (Barnsteiner et al., 2014).
Children at the age of Jay can feel comfortable, if nursing intervention is provided in the
presence of their family members. Considering this, nurse should provide nursing intervention to
Jay in the presence of his family members. It is well established that effective communication
with the family members can be helpful in providing complete nursing intervention to the
children. Hence, nurse should establish effective communication with his family members
because few of the aspects of the nursing intervention cannot be communicated to Jay due to his
age factor. Family members need to be educated about application of enema in Jay. Through this
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communication, nurse can improve knowledge of family members about his disease condition
and treatment to be provided. Through communication, nurse can improve participation of
family members in decision making of his care and inform them about the care to be taken at
home. Jay’s hospitalization can be reduced by providing him with family centered care. Family
centered can be helpful in improving satisfaction of Jay and his mother about the care provided
(Shaul, 2014; Watson and Rodwell, 2014). Family centered care can be helpful in relieving stress
of Jay and his mother.
Hospitalization:
Hospitalization is the significant part of children care. However, long duration hospitalizations of
children can negatively affect children both physically and mentally. Comfortable environment
need to be provided for Jay in the hospital. There should not be separation of Jay and his family
members during his stay in the hospital. All sorts of interventions need to be provided for Jay in
the presence of his family members. Children with age of Jay might feel fear of pain and become
anxious during their hospitalization stay. Hence nurse need to ensure that all the care to be
provided to Jay should be with minimal pain. Family members of Jay might be more worried
about his hospitalization. Nurse should give them assurance that hospital is going to give
freedom from his painful condition and improve his wellbeing. Nurse should assure them that he
is going to be discharged from hospital immediately after his recovery (Thurston, 2014).
Family members of Jay should be informed about the nursing and medical procedures and nurse
should demonstrate them all the procedures. It would be helpful in reducing hospitalization stress
on his family members. Nurse need to counsel his family members for his hospital admission.
Nurse should provide flexibility to his family members to stay with him in hospital. Nurse should
give counseling to his mother about financial issues due to hospitalization. Nurse should
maintain confidentiality of Jay’s hospitalization. Nurse should provide suitable environment for
Jay in the hospital with respect to his medical history, behavior, cultural background and
socioeconomic status (Tehrani et al., 2012; Brykczynska and Simons, 2011). Nurse should
consider all these aspects during hospitalization of Jay.
Conclusion:
Intussusception in the pathological condition of the GI tract associated with pain, vomiting and
bloody stool. Disease condition can worsen due to ischemia. In this case Jay is diagnosed with
intussusception. Implementation growth and development theories for nursing care of Jay can be
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helpful in providing holistic care to Jay. Person centered care for Jay can be helpful in improving
morale his mother and relieve stress about his diseased condition. Provision of suitable hospital
environment for the Jay can be helpful in his speedy recovery.
References:
Aybay, M.N., Erol, S., Kaya, H.E., and Guler, I. (2016). Appendix Invagination Mimicking
Ileocecal Intussusception in a Pediatric Patient: A Case Report. Journal of Emergency
Medicine, 51(5), 589-591.
Barnsteiner, J., Disch, J., and Walton, M. (2014). Person and Family Centered Care. Sigma
Theta Tau.
Brykczynska, G.M., and Simons, J. (2011). Ethical and Philosophical Aspects of Nursing
Children and Young People. John Wiley & Sons.
Law, M. (2012). Family-Centred Assessment and Intervention in Pediatric Rehabilitation.
Routledge.
Loeffler, A.G. (2014). Introduction to Human Disease: Pathophysiology for Health
Professionals. Jones & Bartlett Publishers.
Lowry-Lehnen, T. (2015). Theories of Human Growth and Development: Developmental
Psychology. Create Space Independent Publishing Platform.
Otero, J., Posa, M.R., and Kelly, M.N. (2017). Rectal Bleeding and Abdominal Pain Following
Vaccination in a 4-Month-Old Infant. Case Reports in Pediatrics, 9461315. doi:
10.1155/2017/9461315.
Patcharatrakul, T., and Rao, SSC. (2017). Update on the Pathophysiology and Management of
Anorectal Disorders. Gut Liver. 23. doi: 10.5009/gnl17172.
Reimann, M., Schilke, O., and Cook, K.S. (2017). Trust Is Heritable, Whereas Distrust Is Not.
Proceedings of the National Academy of Sciences in the United States of America,
114(27), 7007-7012.
Shaul, R. Z. (2014). Paediatric Patient and Family-Centred Care: Ethical and Legal Issues.
Springer Science & Business.
Tehrani, T. H., Haghighi, M., and Bazmamoun, H. (2012). Effects of Stress on Mothers of
Hospitalized Children in a Hospital in Iran. Iranian Journal of Child Neurology, 6(4),
39–45.
Thurston, C. (2014). Essential Nursing Care for Children and Young People: heory, Policy and
Practice. Routledge.
Watson, G. and Rodwell, S. (2014). Safeguarding and Protecting Children, Young People and
Families: A Guide for Nurses and Midwives. SAGE.
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