NU225 Unit 3 Intussusception Case Study Example

Screaming Every Twenty Minutes, Limp in Between: A Case Study Analysis of Ileocolic Intussusception in a Composite Nine-Month-Old Boy, From the Episodes His Mother Timed to the Air Enema and the Night After

[Student Name]

Purdue University Global

NU225: Pediatric Nursing

Unit 3 Case Study Analysis

[Instructor Name]

[Date]

The infant and family are composite; values are bracketed where illustrative, and diagnosis and reduction are performed by the medical and radiology teams.

Presentation

[Mateo], composite, 9 months, previously well, had a cold last week. Since [0300] he has had episodes of sudden, inconsolable screaming, drawing his knees to his chest for one to two minutes, then lying pale and limp. His mother timed seven episodes about [20] minutes apart. He vomited twice, the second time with a yellow-green tinge. One diaper at [0700] held a small stool streaked with blood and mucus. On arrival: temperature [37.6] C, heart rate [168], respirations [36], capillary refill [3] seconds, sleepy between episodes. A firm, sausage-shaped mass is felt in the right upper abdomen.

What Is Normal at Nine Months

A heart rate of up to about [160] and respirations in the [30]s are expected in an infant this age, so his rate of [168] is mildly high, likely from pain and early dehydration. A nine-month-old normally sits, babbles and engages with his parent. His limpness between episodes is not normal sleepiness; it is the most worrying finding.

Pathophysiology

Intussusception occurs when one segment of bowel slides into the segment beyond it, like a telescope. The most common form in infants is ileocolic, with the end of the small bowel pulled into the colon. A recent viral illness can enlarge lymph tissue in the bowel wall, which may act as the leading point. Peristalsis pulls the inner segment further in, causing cramping waves of pain. The outer segment squeezes the blood vessels of the inner one, so blood flow out is blocked first, then flow in. The trapped bowel swells, leaks blood and mucus, and if not reduced, it can die and perforate (Edwards et al., 2017).

The quiet minutes between his screams were not his pain easing; they were a sick infant too tired to cry.

Findings Interpreted

The episodic screaming matches the waves of peristalsis. The limpness and pallor between episodes reflect pain, vagal response and early shock. Bilious vomiting signals bowel obstruction. Blood and mucus in the stool, the classic red currant jelly stool, is a late sign of bowel wall injury and appears in only a minority of children, so its absence would not rule the condition out (Applegate, 2009). The sausage-shaped mass is the telescoped bowel itself.

Priority Problems

1. Risk for shock from fluid loss and bowel ischemia: heart rate, capillary refill, urine output.

2. Acute pain: episodic and severe.

3. Risk for bowel perforation: rising distention, a rigid abdomen or sudden worsening.

4. Family anxiety: a frightened mother who sensed something was wrong before anyone else.

Interventions and Rationale

Keep him nothing by mouth, because he may need a procedure and his bowel is obstructed. Start an IV and give fluid as ordered to restore circulation; check capillary refill and diaper weight. A nasogastric tube may be placed to decompress the stomach if vomiting continues. Pain is assessed with an infant scale such as FLACC during and between episodes, and analgesia is given as ordered. Prepare for ultrasound, which shows the telescoped bowel as a target-shaped mass. If no perforation is present, the radiologist reduces it with an air or liquid enema; a surgeon is notified beforehand in case the enema fails or perforates the bowel (Edwards et al., 2017). The nurse stays with the family, explains each step and keeps the mother close where the procedure allows (Perry et al., 2022).

The Mother's Timing

Her phone record of seven episodes twenty minutes apart was the most useful history the team received. The nurse told her so. Parents who feel their observations are valued are more likely to report early the next time something seems wrong.

Evaluation After Reduction

After a successful air enema, the nurse watches for the return of normal behavior, often a sleeping infant who wakes playful, tolerance of fluids by mouth as ordered, and the passage of stool. Recurrence happens in a minority of children, often within the first day, so the nurse watches for any return of screaming episodes overnight. Mateo slept for two hours after the procedure, woke smiling, took [90] mL of formula and had a normal stool by evening.

Discharge Teaching

His mother is taught that intussusception can recur, most often in the first days, and that the warning signs are the same: sudden bouts of screaming with legs drawn up, vomiting, especially green, blood in the stool or unusual sleepiness. She is told to return immediately if any appear rather than wait to see if they pass. She is also told that the cold he had last week is a common trigger, not something she could have prevented, since parents often blame themselves for missing the first episodes.

References

Applegate, K. E. (2009). Intussusception in children: Evidence-based diagnosis and treatment. Pediatric Radiology, 39(Suppl. 2), S140-S143. https://doi.org/10.1007/s00247-009-1178-9

Edwards, E. A., Pigg, N., Courtier, J., Zapala, M. A., MacKenzie, J. D., & Phelps, A. S. (2017). Intussusception: Past, present and future. Pediatric Radiology, 47(9), 1101-1108. https://doi.org/10.1007/s00247-017-3878-x

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.