What is Intussusception?

Discuss about the Nationwide Epidemiological Survey of Childhood.

Intussusception refers to the medical condition where a portion of the intestine is found to get folded into the section that lies adjacent to it. This medical disorder generally involves the small bowel (Mandeville et al., 2012). The most common sign or symptom of the condition is abdominal pain, which had been reported by the patient Jay, in the case scenario. Furthermore, he also reported other symptoms related to vomiting, and abdominal pains. This essay will explain the underlying pathophysiology of the presenting condition.

Intussusception is found to affect the terminal ileum in most cases. According to research evidences, the terminal ileum is found to enter the cecum in most cases of intussusception that are found to occur frequently among children. Moreover, evidences also suggest that other types of intussusception that involve prolapse or entry of the jejunum or ileum into themselves also occur (Reilly, Aguilar & Green, 2013). The pathophysiology in most cases involve occurrence of intussusceptions in cases where research findings have correlated presence of intussusceptum or part of bowel that has invaginated another portion, at a location that is proximal to the distal intestinal loop or intussuscipiens. This can be attributed to the fact that the intestine exerts a peristaltic action that works by pulling the proximal part of the intestine, into the distal potion (Jiang et al., 2013). Further studies also provide evidence for presence of a portion of the intestinal tissue (lead point) that invaginates into the bowel lumen among patients reporting intussusceptum. Presence of such anatomical lead points has been reported by approximately 10% of the population suffering from intussusceptions (Apelt, Featherstone & Giuliani, 2013).

Further explanation of the presenting condition can be associated with the fact that the trapped portion of the bowel often shows signs of cutting off its primary blood supply. This in turn is responsible for causing a life-threatening condition called ischemia, where the tissues in the bowel get deprived of oxygen (Zhu et al., 2014). The gut lining made up of mucosal cells are found to be extremely sensitive to this deprivation of oxygen and respond to his physiological abnormality by, and responds by casting off into regions of the gut. This accounts for the formation of the major clinical sign of intussusceptions, the “red currant jelly” stool (Lioubashevsky et al., 2013). The stool is commonly a mixture of blood, sloughed mucosa, and mucus.

Further studies establish a correlation between bacterial or viral infections that result in inflammation or swelling of the lymphoid tissue that fights against infections. Viral isolates have also been associated with intestinal obstruction in young children (Okubo et al., 2016). Furthermore, evidences that established a link between rotavirus vaccination and increased risks of intussusceptions can explain its pathophysiology. These vaccines lead to complications in the form of  pneumatosis intestinalis and intestinal intussusceptions, thereby accounting for intestinal obstruction in children (Yih et al., 2014). While there is lack of adequate evidence for the mechanism by which these vaccines lead to intussusceptions in children, the first week after the first dose has been correlated with peak time of replication of the intestinal vaccine virus (Shui et al., 2012). These inflamed tissues line the intestine and lead to pulling of one part of the intestine into the other part. 

Pathophysiology of Intussusception

Intussusception is found to occur in infants and children, aged between 2-5 years and requires appropriate management of the conditions presented by these infants. The role of a primary nurses revolves around formulating a specific care plan that can be applied to the particular patient for improving the overall health and wellbeing. The nurse was found to conduct an ultrasound for diagnosing the condition in the patient, followed by close observation, monitoring the electrolyte balance and intravenous therapy. Owing to the fact that the condition involves prolapse of a part of the intestine, ultrasound is the preferred diagnostic tool due to lack of radiation and its high accuracy (Riera et al.., 2012). Hence, the nurse was accurate in diagnosing the condition. Furthermore, sequestration of fluid in obstructed bowel and persistent vomiting often results in dehydration. These symptoms were presented by Jay, which might have resulted in electrolyte imbalance (Hotouras et al., 2013). Thus, the nurse was able to successfully manage the presenting complaints. In addition, early diagnosis also reduces risks of open surgery. Thus, intravenous therapy for fluid resuscitation was an appropriate nursing procedure (Chien et al., 2013). Moreover, the fact that the nurse suggested conduction of contrast enema upon the patient was also accurate as the contrast air or solution will help in creating a pressure in the large intestine and relive the obstruction, thereby providing relief to the patient.

Throughout the nursing career and training, nursing professionals are responsible for delivering appropriate care to all patients, regardless of their age. Hence, it is imperative for the nurses to get a sound understanding of the infant to whom appropriate care services will be provided, from a cognitive and developmental perspective. This will enhance the patient outcome and will also improve satisfaction of the nurses. According the different theories related to growth and development, development and growth are considered interdependent. Piaget’s theory that focuses on different phases of cognitive development states that a child aged 1-4months is found to hold perceptions that are centred on the body of the individual. Furthermore, such infants belong to the primary circular reaction stage where all objects are perceived as an extension of the individual (Beilin & Pufall, 2013). The patient Jay is aged 4 months during which, in addition to holding perceptions about different objects, the child is also aware of the external environment and initiates actions in a manner that changes the movement.

Thus, it can be stated that the nurse will have to identify the fact that Jay is extremely sensitive to the external environment. Hence, an appropriate care plan should be formulated, in addition to implementation of enema for expelling contents of the rectum, in order to create significant positive impacts on the overall growth and development of the patient. Furthermore, Erikson’s psychosocial development theory suggests that infants learn to trust other in the early stages of their development and are often involved in mistrust, estrangement and withdrawal (Patterson, 2012). Thus, the primary nurse will be responsible for implementing a treatment plan that helps her to establish a good therapeutic relationship with Jay, which in turn will help in delivering appropriate care services. Owing to the fact that the patient is not in a stage where he can exert his autonomy and demonstrate a willingness or refusal for the proposed treatment plan, the nurse will be involved in educating his mother about all steps encompassed by the care plan.

Symptoms and Possible Causes

Family centred care refers to the approach that focuses on partnership between families, patients and healthcare providers to deliver optimal care services to all clients. It is imperative to the role of a nurse and facilitates implementation of a holistic and efficient care that takes into account the preferences and opinions of the family (Kuo et al., 2012). This approach is considered as a pivotal factor in ensuring smooth stay of a child during the hospitalization period. Furthermore, it acts by empowering the patient’s family to exert their opinion during clinical decision making, by discussing about the needs and demands of children, suffering from chronic health conditions.

Hence, the family oriented values, and their attitudes form the foundation of this care approach, which when combined with implementation of appropriate evidence based intervention techniques help in enhancing the health status of a child (Trajkovski et al., 2012). The nurse involved in caring for Jay will have to adorn the role of an active listener and respect Jay’s families’ values, beliefs, and choices, which might be influenced by their cultural background. In addition, disclosing essential information regarding the current health status of the patient and forming an effective collaboration with the family will foster their independence and build on their strength. Furthermore, the family best understands the emotional and developmental needs of a child. Hence, involving the family to understand the perception of a child will redefine relationship between the healthcare provider and the service users and ensure rapid recuperation of Jay.

Hospitalization is found to exert negative impacts not only on the behaviour of children, but also increases the risks of emotional problems among family members. Hospitalisation has several psychological impacts due to the fact that the child gets separated from the people that leads to the development of anxiety and disappointment. In this case scenario Jay has been diagnosed with intussusception that has been associated with rotavirus vaccination. This can be life threatening if not treated accurately. Thus, chances of uncertainty regarding future vaccinations are bound to create an impact on the overall psychology of his parents. This will create significant effects on the physical and emotional wellbeing of the patient and his family (Cockcroft, 2012). The primary role of the nurse would be to establish a rapport by fostering effective communication that will create provisions for Jay’s mother to express her doubts and fears. A child suffering from chronic diseases often gets afraid and anxious on being separated from the family. This can directly interfere with the therapeutic interventions such as, intravenous therapy and enema. Impacts of hospitalization can also lead to irritation and concerns in parents regarding safety of their child (Lerwick, 2013). Thus, there is a need to provide counseling to the parents regarding the clinical progress of the child.

Conclusion

To conclude, it can be stated that professional nurses play an essential role in paediatric patient management and are required to implement interventions in a successful manner, with the aim of enhancing patient outcomes. Nurses are required to provide specialized attention to all paediatric clients depending on their healthcare needs, according to the presenting condition and age. Thus, extra compassion and patience are essential while caring for paediatric patients.

References

Apelt, N., Featherstone, N., & Giuliani, S. (2013). Laparoscopic treatment of intussusception in children: a systematic review. Journal of pediatric surgery, 48(8), 1789-1793.

Beilin, H., & Pufall, P. B. (Eds.). (2013). Piaget’s theory: Prospects and possibilities. Psychology Press, 107-140.

Chien, M., Willyerd, F. A., Mandeville, K., Hostetler, M. A., & Bulloch, B. (2013). Management of the child after enema-reduced intussusception: hospital or home?. Journal of Emergency Medicine, 44(1), 53-57.

Cockcroft, S. (2012). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care?. Journal of Neonatal Nursing, 18(3), 105-110.

Hotouras, A., Murphy, J., Boyle, D. J., Allison, M., Williams, N. S., & Chan, C. L. (2013). Assessment of female patients with rectal intussusception and prolapse: is this a progressive spectrum of disease?. Diseases of the Colon & Rectum, 56(6), 780-785.

Jiang, J., Jiang, B., Parashar, U., Nguyen, T., Bines, J., & Patel, M. M. (2013). Childhood intussusception: a literature review. PloS one, 8(7), e68482.

Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: current applications and future directions in pediatric health care. Maternal and child health journal, 16(2), 297-305.

Lerwick, J. L. (2013). Psychosocial implications of pediatric surgical hospitalization. In Seminars in pediatric surgery, Elsevier, 22(3), 129-133.

Lioubashevsky, N., Hiller, N., Rozovsky, K., Segev, L., & Simanovsky, N. (2013). Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation?. Radiology, 269(1), 266-271.

Mandeville, K., Chien, M., Willyerd, F. A., Mandell, G., Hostetler, M. A., & Bulloch, B. (2012). Intussusception: clinical presentations and imaging characteristics. Pediatric emergency care, 28(9), 842-844.

Okubo, Y., Nochioka, K., Sakakibara, H., Hataya, H., Terakawa, T., Testa, M., & Sundel, R. P. (2016). Nationwide epidemiological survey of childhood IgA vasculitis associated hospitalization in the USA. Clinical rheumatology, 35(11), 2749-2756.

Patterson, A. V. (2012). Emerging Adulthood As A Unique Stage In Erikson’s Psychosocial Development Theory: Incarnation V. Impudence. Retrieved from- https://uta-ir.tdl.org/uta-ir/bitstream/handle/10106/11059/Patterson_uta_2502D_11766.pdf?sequence=1

Reilly, N. R., Aguilar, K. M., & Green, P. H. (2013). Should intussusception in children prompt screening for celiac disease?. Journal of pediatric gastroenterology and nutrition, 56(1), 56-59.

Riera, A., Hsiao, A. L., Langhan, M. L., Goodman, T. R., & Chen, L. (2012). Diagnosis of intussusception by physician novice sonographers in the emergency department. Annals of emergency medicine, 60(3), 264-268.

Shui, I. M., Baggs, J., Patel, M., Parashar, U. D., Rett, M., Belongia, E. A., … & Weintraub, E. (2012). Risk of intussusception following administration of a pentavalent rotavirus vaccine in US infants. Jama, 307(6), 598-604.

Trajkovski, S., Schmied, V., Vickers, M., & Jackson, D. (2012). Neonatal nurses’ perspectives of family?centred care: a qualitative study. Journal of Clinical Nursing, 21(17?18), 2477-2487.

Yih, W. K., Lieu, T. A., Kulldorff, M., Martin, D., McMahill-Walraven, C. N., Platt, R., … & Nguyen, M. (2014). Intussusception risk after rotavirus vaccination in US infants. New England Journal of Medicine, 370(6), 503-512.

Zhu, Q. C., Shen, R. R., Qin, H. L., & Wang, Y. (2014). Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies. World Journal of Gastroenterology: WJG, 20(3), 738.