A 6-year-old male patient with confirmed intussusception is showing signs of abdominal distension, guarding, rebound tenderness, tachycardia, hypotension, and decreased oxygen saturation. What is the nurse's priority intervention to address the hemodynamic instability in this patient?

C) Initiate fluid resuscitation to stabilize blood pressure.

A) Administer supplemental oxygen to improve oxygen saturation.

B) Prepare the patient for immediate surgery as per surgical consultation.

C) Initiate fluid resuscitation to stabilize blood pressure.

D) Administer broad-spectrum antibiotics to prevent sepsis.

A 6-year-old male with diagnosed intussusception is showing signs of hypovolemic shock with increased heart rate, decreased blood pressure, and reduced oxygen saturation. Which of the following nursing interventions is the most critical to address the patient's current condition?

C) Initiate IV fluid resuscitation to stabilize hemodynamic status.

A) Administer broad-spectrum antibiotics as prescribed.

B) Prepare the patient for immediate surgical intervention.

C) Initiate IV fluid resuscitation to stabilize hemodynamic status.

D) Provide supplemental oxygen to improve oxygen saturation.

A 6-year-old patient is admitted with suspected bowel perforation and signs of hypovolemic shock. After initial fluid resuscitation and antibiotic therapy, the surgical team prepares for an emergent exploratory laparotomy. Which nursing intervention is a priority to ensure the patient's safety and stability before surgery?

C) Monitor and document the patient's vital signs and oxygen saturation continuously

A) Administer an additional bolus of isotonic fluids to maintain blood pressure

B) Educate the family about the surgical procedure and obtain informed consent

C) Monitor and document the patient's vital signs and oxygen saturation continuously

D) Prepare the patient for possible blood transfusion by ensuring IV access and cross-matching blood

A 6-year-old patient is experiencing signs of hypovolemic shock due to suspected bowel perforation. Despite interventions including fluid resuscitation and broad-spectrum antibiotics, the patient's condition remains unstable. Which nursing intervention is the highest priority at this time?

B) Preparing the patient for emergent exploratory laparotomy

A) Administering additional pain medication to manage discomfort

B) Preparing the patient for emergent exploratory laparotomy

C) Increasing the rate of intravenous fluid administration

D) Initiating a second line of antibiotics to cover potential resistant organisms

A 6-year-old child is being prepared for an exploratory laparotomy due to suspected bowel perforation. The child is currently receiving oxygen via a high-flow nasal cannula due to respiratory compromise. Which nursing intervention is the most critical to prevent further respiratory deterioration while awaiting surgery?

B) Position the child in a semi-Fowler's position to enhance breathing.

A) Administer a bronchodilator to improve airflow.

B) Position the child in a semi-Fowler's position to enhance breathing.

C) Encourage deep breathing exercises to expand lung capacity.

D) Reduce oxygen flow to prevent oxygen toxicity.

A pediatric patient undergoing an exploratory laparotomy shows signs of respiratory compromise due to abdominal distension. What is the most appropriate nursing intervention to prioritize before surgery?

A) Assist with the insertion of a nasogastric tube to decompress the stomach.

B) Administer sedative medication to decrease anxiety and respiratory rate.

C) Prepare for immediate intubation by the anesthesiology team.

D) Elevate the head of the bed to a 90-degree angle to facilitate breathing.

A pediatric patient is in the postoperative period following an exploratory laparotomy and bowel resection due to a perforated bowel and septic shock. The patient is currently stable but remains critically ill. Which nursing intervention is a priority to prevent further complications?

B) Monitor urine output closely to assess renal perfusion and function.

A) Administer pain medication as prescribed to ensure patient comfort.

B) Monitor urine output closely to assess renal perfusion and function.

C) Encourage early mobilization to prevent pneumonia and deep vein thrombosis.

D) Provide continuous enteral nutrition to support metabolic demands.

A pediatric patient is recovering from surgery for a perforated bowel and is currently in the ICU with signs of metabolic acidosis and septic shock. Which of the following nursing interventions is the priority to address the metabolic acidosis?

B) Increase the rate of intravenous fluids to improve tissue perfusion.

A) Administer sodium bicarbonate as prescribed to correct the acidosis.

B) Increase the rate of intravenous fluids to improve tissue perfusion.

C) Monitor the child's blood glucose levels to prevent hypoglycemia.

D) Administer broad-spectrum antibiotics to manage the infection.

A pediatric patient in the ICU is experiencing decreased urine output and elevated BUN and creatinine levels postoperatively. The care team is adjusting fluid management and considering diuretics. Which nursing intervention is most appropriate to evaluate the effectiveness of these interventions in this patient?

A) Monitor the patient's weight daily

B) Measure abdominal girth every 4 hours

A pediatric patient in the ICU is experiencing decreased urine output and elevated BUN and creatinine levels indicative of acute kidney injury. The healthcare team adjusts the fluid management plan to include increased isotonic fluids and considers the use of diuretics. As the nurse caring for this patient, which intervention should you prioritize to prevent further renal impairment?

B) Monitor daily weights and fluid balance closely.

A) Administer diuretics as ordered to increase urine output.

B) Monitor daily weights and fluid balance closely.

C) Encourage oral fluid intake to supplement IV fluids.

D) Reduce the frequency of vital sign monitoring to minimize patient disturbance.

Intususception - Nursing Case Study

Pathophysiology

• Primary mechanism: Intussusception occurs when a segment of the intestine telescopes into an adjacent segment, often leading to bowel obstruction. This invagination typically involves the ileum moving into the colon.

• Secondary mechanism: The telescoping causes compression of the mesentery, leading to venous congestion and edema. As the condition progresses, arterial blood flow is compromised, causing ischemia of the affected bowel segment.

• Key complication: If untreated, the ischemia can lead to necrosis of the bowel tissue, increasing the risk of perforation and peritonitis, which are life-threatening conditions requiring urgent medical intervention.

Patient Profile

Demographics:

6-year-old male, primary school student

History:

• Key past medical history: Previous episodes of abdominal pain, no known chronic illnesses

• Current medications: None

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe abdominal pain and vomiting

• Key symptoms: Intermittent, cramping abdominal pain; abdominal distension; red currant jelly stools; lethargy

• Vital signs: Temperature 100.4°F (38°C), heart rate 130 bpm, respiratory rate 28 breaths/min, blood pressure 90/60 mmHg, oxygen saturation 94% on room air

Section 1

In the hours following the initial presentation, the 6-year-old male's condition began to show signs of deterioration, indicating new complications. His abdominal pain intensified, becoming more constant rather than intermittent, and he exhibited increased restlessness and irritability. The abdominal distension worsened, and upon examination, guarding and rebound tenderness were noted. These findings suggested the possibility of bowel perforation. The patient's vital signs showed a concerning trend: his heart rate increased to 150 bpm, respiratory rate rose to 32 breaths/min, and his blood pressure dropped to 85/55 mmHg, indicating potential hypovolemic shock. Oxygen saturation decreased to 90% on room air, further raising concerns about respiratory compromise. The fever persisted, with a temperature of 101.3°F (38.5°C), pointing to a possible onset of infection.

Given these developments, immediate diagnostic investigations were prioritized to assess the severity of the situation. An abdominal ultrasound revealed the classic "target sign," confirming the diagnosis of intussusception, but also indicated free fluid in the abdominal cavity, suggestive of perforation or peritoneal irritation. Laboratory tests showed elevated white blood cell count and a rising lactate level, supporting the presence of inflammation and possible ischemia. These findings necessitated swift clinical reasoning: the risk of bowel necrosis and peritonitis was high, necessitating immediate surgical consultation and intervention to prevent further complications. The management plan now required addressing the hemodynamic instability, possibly through fluid resuscitation and the initiation of broad-spectrum antibiotics to preempt sepsis, alongside preparation for possible surgical repair of the affected bowel.

These critical decisions underscored the urgency of the situation, steering the clinical team towards comprehensive monitoring and intervention strategies to stabilize the child and mitigate the life-threatening risks associated with the progressing intussusception. The patient's journey now hinged on rapid and effective response to prevent the dire consequences of untreated intestinal obstruction and its complications.

Section 2

In response to the deteriorating condition of the 6-year-old patient and the immediate risk of bowel necrosis and peritonitis, the clinical team swiftly initiated fluid resuscitation to address the hypovolemic shock. An isotonic crystalloid solution was administered via intravenous access, aiming to stabilize the blood pressure. Concurrently, broad-spectrum antibiotics, including ceftriaxone and metronidazole, were commenced to combat the potential development of sepsis due to bowel perforation. Continuous monitoring of vital signs was implemented, with a focus on maintaining adequate oxygenation through supplemental oxygen therapy, raising the patient's oxygen saturation levels to 95%.

Despite these interventions, the patient's condition continued to demand urgent attention. The heart rate remained elevated at 148 bpm, and blood pressure showed only slight improvement at 90/60 mmHg, indicating ongoing hemodynamic instability. Abdominal examination revealed persistent guarding and rebound tenderness, raising concerns about worsening peritoneal inflammation. Repeat laboratory tests showed an increasing lactate level of 4.5 mmol/L, suggesting continued tissue hypoperfusion and potential progression towards metabolic acidosis. The white blood cell count further escalated to 22,000/mm³, underscoring the systemic inflammatory response.

Recognizing the limitations of non-surgical management in the face of suspected bowel perforation and impending necrosis, the surgical team was mobilized for an emergent exploratory laparotomy. Preparation for surgery included cross-matching blood for possible transfusion, given the risk of intraoperative bleeding. The family was updated regarding the critical nature of the situation and the necessity of surgical intervention to resect the compromised bowel segment and prevent further complications. The clinical team remained vigilant, ready to adapt the treatment plan based on intraoperative findings and postoperative recovery needs, with the primary goal being the stabilization and recovery of the young patient.

Section 3

As the surgical team prepared for the exploratory laparotomy, a sudden change in the patient's status necessitated immediate action. The child's respiratory rate increased to 38 breaths per minute, and the oxygen saturation began to drop to 92% despite supplemental oxygen. These changes indicated potential respiratory compromise possibly related to the increasing abdominal distension and pressure on the diaphragm. The clinical team adjusted the oxygen delivery method to high-flow nasal cannula to improve oxygenation and instructed the anesthesiology team to be on heightened alert for potential airway management challenges during the induction of anesthesia.

Simultaneously, a rapid bedside ultrasound was performed to reassess the abdominal status. The imaging revealed free fluid in the abdominal cavity, likely indicative of perforation and leaking intestinal contents. This finding confirmed the urgency of surgical intervention and highlighted the increased risk of peritoneal contamination. The ultrasound also showed dilated bowel loops with decreased peristalsis, correlating with the child's ongoing abdominal pain and guarding.

Despite these complications, the child remained responsive and oriented, which was reassuring in terms of neurological status. The clinical team discussed the potential need for intensive postoperative care, considering the risk of sepsis and the anticipated metabolic demands following bowel resection. Blood products were prepared, and the surgical team, now fully briefed on the patient's evolving condition, proceeded with the operation, emphasizing the need for meticulous surgical technique to minimize further complications and ensure a favorable outcome. The multidisciplinary approach and rapid adaptation of the treatment plan underscored the importance of comprehensive clinical reasoning in managing this intricate pediatric case.

Section 4

As the surgical team proceeded with the exploratory laparotomy, they were met with the anticipated challenges. Upon entering the abdominal cavity, they confirmed the presence of a perforated bowel segment with significant contamination of the peritoneal cavity. The affected section of the intestine was severely edematous and necrotic, necessitating resection. Throughout the procedure, the anesthesiology team closely monitored the child's hemodynamic status, noting a drop in blood pressure to 78/45 mmHg, which prompted the administration of intravenous fluids and vasopressors to maintain adequate perfusion.

Intraoperative blood tests revealed worsening metabolic acidosis, with a blood pH of 7.28 and elevated lactate levels at 4.5 mmol/L, indicative of ongoing tissue hypoperfusion and metabolic distress. These findings correlated with the clinical picture of septic shock, likely due to peritoneal contamination from the perforated bowel. The surgical team worked efficiently to debride the infected tissue and perform an end-to-end anastomosis, while the pediatric intensivist prepared for aggressive postoperative management, anticipating the need for continued respiratory support and potential renal involvement due to hypoperfusion.

Postoperatively, the child's condition remained critical but stable. Despite the challenges, the multidisciplinary team's swift actions and adaptive strategies had mitigated the immediate life-threatening complications. The next 24 hours would be crucial, with a focus on close monitoring for signs of multi-organ dysfunction and ensuring optimal fluid balance to support recovery. The team planned for frequent reassessment of vital signs and laboratory parameters, particularly monitoring for any further shifts in electrolytes or markers of infection, to guide ongoing treatment and interventions.

Section 5

As the first postoperative day progressed, the pediatric intensivist noted a troubling change in the child's status. Despite aggressive management, the child's urine output decreased significantly to 0.3 mL/kg/hr, raising concerns about acute kidney injury secondary to the earlier hypoperfusion and ongoing septic process. Blood urea nitrogen (BUN) and creatinine levels were elevated at 45 mg/dL and 2.1 mg/dL respectively, confirming the development of renal impairment. The team promptly adjusted the fluid management plan, increasing the administration of isotonic fluids and considering the judicious use of diuretics to stimulate renal function while avoiding fluid overload.

Concurrently, the child's vital signs revealed a persistent tachycardia at 145 beats per minute and a low-grade fever of 38.3°C, suggesting an ongoing inflammatory response. Repeat blood cultures were obtained to identify any resistant organisms that might necessitate a change in antibiotic therapy. The intensivist and infectious disease specialist reviewed the child's current antibiotic regimen, which included broad-spectrum coverage, to ensure it was adequate pending culture results.

These developments required careful clinical reasoning to balance fluid resuscitation, manage infection, and support organ function. The multidisciplinary team held a strategy meeting to reassess the plan of care, emphasizing the need to monitor for further signs of multi-organ dysfunction. The next steps involved close observation for any neurological changes or further respiratory compromise, as these could indicate worsening systemic involvement. The team prepared to escalate interventions, including renal replacement therapy, should renal function continue to decline, and maintained a vigilant watch for any emerging complications.