A 3-year-old patient is being prepared for potential surgical intervention due to intussusception with signs of ischemia. Which nursing intervention is most important to implement immediately to stabilize the patient prior to surgery?

B) Initiate an IV infusion of normal saline to address potential hypovolemia

A) Administer a prescribed dose of acetaminophen for fever management

B) Initiate an IV infusion of normal saline to address potential hypovolemia

C) Apply supplemental oxygen to maintain saturation above 94%

D) Prepare the patient for a nasogastric tube insertion to decompress the stomach

A 3-year-old patient with confirmed intussusception presents with increasing abdominal pain, lethargy progressing to unresponsiveness, and vital signs indicating possible shock. Which nursing intervention is the priority to stabilize the patient before surgical intervention?

A) Administering IV fluids to address potential hypovolemic shock

B) Applying oxygen via nasal cannula to maintain oxygen saturation

C) Preparing the patient for immediate transport to the operating room

D) Administering analgesics for pain management

A 3-year-old patient is receiving isotonic IV fluids and broad-spectrum antibiotics due to suspected ischemic bowel changes. Despite initial stabilization, the patient's oxygen saturation has decreased to 92% and there is persistent abdominal distension with rebound tenderness. What should be the priority nursing intervention at this time?

B) Prepare the patient for immediate surgical intervention.

A) Increase the rate of IV fluid infusion.

B) Prepare the patient for immediate surgical intervention.

C) Administer additional oxygen to maintain saturation above 95%.

D) Consult with the healthcare provider about increasing antibiotic coverage.

A 3-year-old patient with suspected ischemic bowel changes is experiencing ongoing hypotension, abdominal distension, and metabolic acidosis despite fluid resuscitation and antibiotics. Which nursing intervention is most critical to prioritize at this time?

D) Ensuring readiness for immediate surgical intervention by verifying preoperative checklist completion.

A) Initiating continuous hemodynamic monitoring to assess fluid resuscitation effectiveness.

B) Preparing the patient for an urgent abdominal ultrasound to evaluate bowel perfusion.

C) Administering additional IV fluids to further correct hypotension and acidosis.

D) Ensuring readiness for immediate surgical intervention by verifying preoperative checklist completion.

A 6-year-old patient is scheduled for an emergency exploratory laparotomy due to suspected intussusception with potential ischemic bowel changes. Preoperative nursing care should include which priority intervention to address the child's current metabolic and hemodynamic status?

B) Preparing for blood transfusion to address the low hemoglobin level.

A) Administering a sodium bicarbonate infusion to correct metabolic acidosis.

B) Preparing for blood transfusion to address the low hemoglobin level.

C) Initiating a hypertonic saline infusion to correct hyponatremia.

D) Providing supplemental oxygen to support respiratory compromise.

A pediatric patient presents with intussusception confirmed by ultrasound, significant anemia, hyponatremia, and metabolic acidosis. Which nursing intervention is the highest priority prior to the surgical intervention?

A) Administer isotonic IV fluids to correct fluid imbalance

B) Prepare the child and family for the surgical procedure

C) Monitor and record vital signs every 15 minutes

D) Administer a blood transfusion to address anemia

A 6-year-old child is being prepared for exploratory laparotomy due to suspected bowel perforation. The child presents with tachycardia, hypotension, tachypnea, and hypoxemia. Which nursing intervention is most critical in stabilizing the child's condition before surgery?

A) Administering isotonic crystalloids rapidly to address hypovolemia

B) Placing the child in a high Fowler's position to improve oxygenation

C) Initiating a continuous infusion of broad-spectrum antibiotics

D) Applying a warm blanket to prevent hypothermia

A pediatric patient is being prepared for exploratory laparotomy due to suspected bowel perforation. Despite initial stabilization efforts, the patient's vital signs indicate worsening shock. Which nursing intervention is most critical to address first to improve the patient's hemodynamic status?

A) Administer a bolus of packed red blood cells

B) Start broad-spectrum antibiotics

C) Initiate continuous oxygen therapy

D) Monitor vital signs every 15 minutes

A child is being closely monitored in the PICU following surgery for bowel necrosis and perforation. The child's post-operative laboratory values reveal sodium at 128 mmol/L and potassium at 5.8 mmol/L. Which nursing intervention should be prioritized to address these electrolyte imbalances?

C) Prepare to administer insulin and glucose to manage hyperkalemia.

A) Administer intravenous sodium bicarbonate to correct acidosis.

B) Administer a hypertonic saline solution to correct hyponatremia.

C) Prepare to administer insulin and glucose to manage hyperkalemia.

D) Initiate a fluid restriction to prevent further dilutional hyponatremia.

A pediatric patient has undergone surgery for bowel necrosis and perforation, resulting in the placement of a temporary colostomy. Post-operatively, the nurse in the PICU notes the following vital signs: heart rate 140 beats per minute, blood pressure 95/60 mmHg, and temperature 38.3°C (100.9°F). Which nursing intervention is the highest priority at this time?

B) Monitoring for signs of septic shock and initiating fluid resuscitation if necessary.

A) Administering antipyretics to address the elevated temperature.

B) Monitoring for signs of septic shock and initiating fluid resuscitation if necessary.

C) Checking the colostomy site for signs of infection or leakage.

D) Initiating parenteral nutrition to support healing and recovery.

intussusception ped - Nursing Case Study

Pathophysiology

• Primary mechanism: Intussusception occurs when a segment of the intestine telescopes into an adjacent segment, often starting at the ileocecal junction. This invagination leads to bowel obstruction, impeding the normal passage of intestinal contents.

• Secondary mechanism: The telescoped segment of bowel can cause compression of mesenteric vessels, leading to venous congestion and reduced arterial blood flow. This can result in edema, ischemia, and potential necrosis of the affected bowel tissue.

• Key complication: If untreated, intussusception can advance to bowel perforation, peritonitis, and sepsis, posing serious threats to the patient's life. Prompt recognition and intervention are crucial to prevent these severe outcomes.

Patient Profile

Demographics:

3 years old, male, preschool student

History:

• Key past medical history: History of gastroenteritis, no previous surgeries

• Current medications: None

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Intermittent abdominal pain and vomiting

• Key symptoms: Abdominal distension, lethargy, red currant jelly stools, decreased appetite

• Vital signs: Temperature 38.3°C (100.9°F), Heart rate 130 bpm, Respiratory rate 30 breaths per minute, Blood pressure 90/60 mmHg, Oxygen saturation 95% on room air

Section 1

As the healthcare team continued to monitor the 3-year-old patient, his condition began to show signs of new complications. During the early evening assessment, his abdominal pain intensified, and his lethargy progressed to unresponsiveness to verbal stimulation, raising alarm. A repeat set of vital signs revealed a slight increase in temperature to 38.7°C (101.7°F), a heart rate that had climbed to 140 bpm, respiratory rate increased to 36 breaths per minute, and a drop in blood pressure to 85/55 mmHg. His oxygen saturation remained at 94% on room air. The abdominal examination showed increased distension and guarding, indicating worsening of the underlying condition.

In light of these changes, an urgent abdominal ultrasound was performed and confirmed the presence of intussusception with signs of bowel wall edema and possible ischemia. This prompted the team to conduct additional laboratory tests. The laboratory results revealed a rising white blood cell count of 18,000/mm³, signaling an inflammatory response. Additionally, there was a concerning metabolic acidosis with a blood pH of 7.29 and elevated lactate levels at 3.5 mmol/L, suggesting impaired perfusion and potential tissue hypoxia.

Given the escalating clinical picture, the team recognized the immediate need for intervention to prevent further deterioration. Discussion with the pediatric surgery team was initiated for potential surgical reduction of the intussusception, as non-operative treatment might not suffice due to the suspected ischemic changes. The healthcare team prepared to stabilize the patient with IV fluids and antibiotics to address the risks of sepsis and ensure he was well-prepared for potential surgical intervention. This step was crucial to counter the complications that were now apparent and to prevent further progression to bowel perforation and peritonitis.

Section 2

As the healthcare team swiftly initiated the stabilization protocol for the 3-year-old patient, they administered isotonic IV fluids to address his hypotension and potential dehydration due to the ongoing gastrointestinal compromise. The initial bolus of normal saline was given, followed by a maintenance infusion to support his circulatory status. Concurrently, broad-spectrum intravenous antibiotics were started to combat the risk of sepsis given his elevated white blood cell count and the suspected ischemic bowel changes. These interventions aimed to stabilize the patient hemodynamically and combat any underlying infectious process.

In the hours following these interventions, the patient's status showed both promising and concerning developments. His heart rate decreased slightly to 130 bpm, and his blood pressure modestly improved to 90/60 mmHg, suggesting a positive response to fluid resuscitation. However, his responsiveness remained limited, and his oxygen saturation dipped further to 92% despite supplemental oxygen, indicating ongoing respiratory compromise. The abdominal distension persisted and was now accompanied by signs of rebound tenderness, heightening the suspicion of worsening intra-abdominal pathology.

The team noted these mixed responses and decided to expedite the surgical consultation. The possibility of a bowel perforation or worsening ischemia needed urgent exploration, as indicated by the continued metabolic acidosis and increasing lactate levels, now at 4.1 mmol/L. The potential for significant surgical intervention was becoming more likely as the clinical picture pointed towards an acute abdomen, necessitating immediate surgical evaluation and possibly an exploratory laparotomy to address any complications such as necrosis or perforation. This critical juncture underscored the importance of multidisciplinary collaboration to navigate the complex and evolving nature of the patient’s condition effectively.

Section 3

As the surgical team prepared to assess the patient, new diagnostic results from a recent abdominal ultrasound and laboratory tests emerged, shedding further light on the situation. The ultrasound confirmed the presence of a classic "target sign," consistent with intussusception, and revealed free fluid in the peritoneal cavity, raising concerns about potential perforation or severe inflammation. The radiologist's report highlighted a segment of bowel with questionable perfusion, correlating with the clinical suspicion of ischemic bowel changes. These findings prompted urgent discussions among the healthcare team regarding the need for immediate surgical intervention.

Concurrently, laboratory results indicated a significant drop in the patient's hemoglobin level to 8.5 g/dL, suggesting ongoing blood loss, possibly into the abdominal cavity. His electrolyte panel showed hyponatremia with a sodium level of 128 mEq/L, likely secondary to fluid shifts and ongoing gastrointestinal losses. The patient's metabolic acidosis persisted, with a venous blood gas revealing a pH of 7.28 and a base deficit of -10, pointing towards worsening systemic compromise. These results reinforced the necessity for rapid surgical resolution to prevent further deterioration.

In light of these diagnostic revelations, the healthcare team coordinated an immediate handover to the surgical team, emphasizing the need for exploratory laparotomy. The escalating clinical scenario underscored the importance of timely intervention to address the potential for bowel necrosis, perforation, and subsequent sepsis. The collective focus remained on stabilizing the child and tailoring perioperative management to optimize outcomes, with plans for intensive postoperative monitoring and support given the child’s current hemodynamic instability and respiratory compromise.

Section 4

As the surgical team prepared the patient for exploratory laparotomy, the child's condition began to change, signaling new complications. Despite initial stabilization efforts, the patient's heart rate increased to 160 beats per minute, with blood pressure dropping to 85/50 mmHg, indicating a worsening state of shock. The child's respiratory rate also rose to 40 breaths per minute, with oxygen saturation levels falling to 89% on room air. These vital signs suggested a deterioration in hemodynamic stability, likely due to ongoing blood loss and systemic inflammatory response.

During the rapid pre-operative assessment, the child's abdomen was noted to be more distended and tender, with decreased bowel sounds, further indicating possible bowel perforation or necrosis. The surgical team quickly initiated fluid resuscitation with isotonic crystalloids and administered a bolus of packed red blood cells to address the significant anemia and hypovolemia. The team also started broad-spectrum antibiotics to mitigate the risk of sepsis due to suspected bowel perforation. These interventions aimed to stabilize the child long enough to endure surgical exploration and definitive treatment.

Despite these efforts, the child's condition remained precarious, emphasizing the urgency of surgical intervention. The team discussed the potential need for bowel resection during surgery if necrotic tissue was found, and the possibility of a temporary colostomy if extensive repair was necessary. The immediate focus was on preventing further complications, such as septic shock or multi-organ failure. As the child was transferred to the operating room, the healthcare team remained vigilant, understanding that the unfolding scenario required continuous clinical reasoning and adaptability to ensure the best possible outcome.

Section 5

As the child was wheeled into the operating room, the surgical team conducted a quick, yet thorough, initial assessment to prioritize action plans. The latest laboratory results had just arrived, revealing a significant drop in hemoglobin levels to 6.5 g/dL, confirming ongoing blood loss. Additionally, the white blood cell count had spiked to 22,000/mm³, a strong indicator of a systemic inflammatory response possibly due to infection or bowel necrosis. Electrolyte imbalances were also noted, with hyponatremia at 128 mmol/L and hyperkalemia at 5.8 mmol/L, suggesting both dehydration and cellular injury. These lab values reinforced the need for immediate surgical intervention and guided the anesthesia team in preparing for potential complications during the procedure.

As the operation commenced, the surgical team was prepared for the worst-case scenarios discussed earlier. Upon making the initial incision, they were met with a disturbing sight: a section of the bowel was deeply congested and showed signs of necrosis, confirming the suspected bowel perforation. The team swiftly proceeded with the resection of the necrotic segment to prevent further deterioration. Meanwhile, the anesthesiologist carefully monitored the child's hemodynamic status, adjusting fluid and blood product administration to maintain stable vital signs. Despite the critical state, the child's heart rate slowly decreased to 140 beats per minute, and blood pressure stabilized at 95/60 mmHg, indicating a positive response to the interventions.

The surgery concluded with the placement of a temporary colostomy to allow healing and reduce the risk of further complications. As the child was transferred to the pediatric intensive care unit (PICU), the team remained cautiously optimistic. The immediate post-operative plan involved close monitoring for signs of septic shock or electrolyte disturbances, and the initiation of nutrition support to aid recovery. The coming hours would be crucial in observing the child's response to surgery and ongoing treatment, with the multidisciplinary team ready to adapt their approach as necessary to ensure the child's stabilization and recovery.