English小儿肠套叠2课件

NursingCareofChildrenwithIntussusceptionJiangXiaopingTheChildren’sHospitalofChongqingMedicalUniversityAletterfromInternetDearDoctor,

Lastnight,my7-month-oldsoncriedloudlyanddrewhistinylegsuptohischestaswetriedtosoothehim.Hiscryingwasmoreurgentthanbefore,andhismoodmuchmoreirritable.About10minuteslater,hestopcryingandseemfine.Butcryingrecursandbecomesstrongerlater.WhenIchangedhisdiaper,Inoticedthathissmallbellywasdistended.Hedidnotsleepinthewholenight,upto8’clockthismorning,6timesofvomitinghadoccurred.Someredjellylikesubstanceoccurredinhisstoolthismorning.Whathappenedtomybaby?WhatshouldIdonow?Ineedyourhelp!

Sincerely,Aanxietymother

learningoutcomes：1.Canrecognizethecharactersofclinicalmanifestations2.Canknowthetherapeuticmanagement3.Cangivethenursingintervention4.Canunderstandthepathologycontents:IntroductionEtiologyPathologyClinicalManifestationsTherapeuticmanagementNursingProblemsandNursingIntervention1.definitionIroductionItisoneofthemostfrequentcausesofintestinalobstructionduringinfancy.1.Age:80%<2yearsold,mostcommonininfantsaged4-10moths.2.Sex:themale-to-femaleratioisapproximately3:13.Season：seasonalpeakoccurringinspringandsummer2.IncidenceEtiology

Primary:

95%,butthecauseisunknown.

Maycorrelationwithmoremobilityandlessfixationofintestinalmesentery

2.Secondary:5%，relatedtointestinalpolypiortumors

3.Predisposingfactors:

causedbydisorderoftheintestinalperistalsis,suchas

Diseases:gastroenteritis,diarrhea,fever,etal

Dietaryalteration:complementarysolidfood

Virusinfections:adenovirus,rotaviruses,reoviruses,echovirusesPathologytheproximalportionofbowel(intussusceptum)

theadjacentdistalbowel(intussuscipiens)

ThemesenteryoftheintussusceptumiscompressedTheensuingswellingofthebowelwallquicklyleadstoobstruction.Venousengorgementandischemiaoftheintestinalmucosacausebleedingandanoutpouringofmucous,whichresultsintheclassicdescriptionofredcurrantjellystool.ClinicalManifestationAcuteintussusceptionChronicintussusceptionAcuteIntussusception

Abdominalpain

Vomiting

Bloodystool

Abdominalmass1.AbdominalpainAcuteabdominalpaininsuddenonset:loudcries,screaminganddrawingthekneesuptothechest.Appearsnormalandcomfortableattheintervaltime.OnsetandintervaloccursregularlyCausedbydraughtofmesenteryandconstrictionoftheintestines.2.Vomiting:Occursinmostcases,>90%,

morefrequentatearlystage.Inthelaterphase,thevomitusbecomesbilestainedorstoolliquid,demonstratesobstructionofintestines.3.Bloodystool:Averyimportantsymptom,occursinthefirst6to12hours.Stoolcontainingredbloodandmucus,jellystoolRectalexaminationshowsbloodymucusonthefinger4.Abdominalmass:aslightlytendersausage-shapedmass,oftenintheupperrightabdomen.5.Generalappearance:Normalinearlystage,mayoccurspale,poorappetite.Inlaterstage,mayoccursdehydration,highbodytemperature,comaandshock.ChronicIntussusception

ParoxysmalabdominalpainAbdominalmass(mayoccur)

jellystool(none/lateoccur)

vomiting(rarely)LaboratoryExaminations1.Abdominalultrasound:KidneysignCirclesign2.X-rayAirclysiswiththepressureof50-60mmHg,thefilmshowscalabash-shaped,forcipate-shapedanddumbbell-shaped。

:

cup-shapedfilm

fillingdefect

TherapeuticManagement

NonsurgicaltherapySurgicaltherapyNonsurgicaltherapy-Airclysis1.Indications:Intussusceptionpresenting<48hours,Goodgeneralappearance,Withoutabdominaldistention,hightemperatureandtoxicosis.2.equipments:anautopressurecontrolmachine,aFcedure:Restrainedthepatient,insertedtheFoleycatheterintorectum,inflatedtheballoon;instillationpressure:60mmHg100mmHg；beforeairclysisheadofintussusceptumlocatedinthehepaticflexureofthecolonreductionoccurreductiongoonthefillingofnumerousloopsofintestine

4.

Signsofcompletereductionfreeflowofairintoseveralloopsofsmallbowelwithsimultaneousexpulsionoffecesstopcrying,bequiet.disappearoftheabdominalmass.carbontest:take0.5-1gactivatedcarbonorally,appearinginstool6-8hourslater.

SurgicalTherapy

1.indication:failedinairenema;prolongedintussusception>48hours,suspiciousofdevelopingshock,intestinalperforation,peritonitis,andintestinalnecrosis.

2.praparationbeforeoperation：

fasting,insertingnasogastrictube,intravenousinfusion,correctingimbalancesoffluid,electrolyteandacid-alkali,oxygentherapy,reducingtemperature.3.surgicalintervention:manualoperativereduction,resectionoftheintussusceptionwithend-to–endanastomosisNursingCare

Nursingassessment

1.symptonandsigns2.generalappearance3.healthhistory,feedinghistoryNursingdiagnosis1.Pain:relatedtothedraughtofmesenteryandconstrictionoftheintestines4.Potentialcomplication:shock,sepsisandrecurrence2.Anxiety:relatedtounknownthenatureofchild’sdisease3.Highriskforfluidvolumedeficit:relatedtobowelobstructionNur