Disorders of the Gastrointestinal System, 2nd Edition
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| NURSING CONSIDERATION
CASE STUDY 12 Shannon is an experienced pediatric nurse who recently relocated from a large urban area to a small community in an- other state. After many years of specializ- ing in pediatrics, Shannon decides to ex- plore a new employment opportunity as a nurse in a large outpatient family practice where she cares for adults and children. On a warm summer afternoon, Mr. Wil- liams arrives for an appointment with his physician and sits uncomfortably in the waiting room. He complains of vomiting, diarrhea, and colicky abdominal pain. His pain radiates from the right lower abdom- inal quadrant to the back and increases after he eats. A nurse comments, “I bet he has that awful GI flu that is going around.” Shannon disagrees and hurries to see Mr. Williams’s physician. She tells her, “I have observed this a lot in infants. It is rare in adults, but I think Mr. Williams has an intussusception. He needs to be seen now!” Question Which finding would not be consistent with a diagnosis of intussusception? a. Intermittent colic-like cramping and tenderness. b. Vomiting. c. Constipation. d. Diarrhea. Answer/Rationale: The correct answer d. Constipation, not diarrhea, is more a consistent sign of intussusception.
Once a patient has had intussuscep- tion, he has an up to 20% risk of de- veloping it again. Patients and care- givers must be taught to remain alert for intussusception signs and symp- toms and to seek immediate emer- gency medical treatment if they occur (Yeh, 2019). Intussusception Intussusception is a serious, potentially fatal condition in which a portion of the small intestine or the colon moves into another part of the intestine. This move- ment is called telescoping , and it can cause a blockage of the intestine and pre- vent the passage of food and liquids, as well as cut off the blood supply to the af- fected portion of the intestine (Vo & Sato, 2022). Mortality often occurs if treatment is delayed for more than 24 hours and occurs in almost every case that is not treated within two to five days. If treat - ed appropriately, the mortality rate is only about 1% (Chahine, 2018). When the bowel segment (the intussus- ception) moves into another part of the intestine (invagination), it is moved along the intestine via peristalsis. This move- ment pulls even more bowel and mes- entery along. Invagination causes edema, hemorrhage, incarceration, and obstruc- tion. If treatment is not initiated within 24 hours, strangulation of the affected areas of the intestine occurs, resulting in shock, perforation, and gangrene (Vo & Sato, 2022).
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