1、英语护理查房英语护理查房1234ContentsContents Case ReportName Name：Chen JingyaChen Jingya Sex Sex：female female Age Age：7-month-old 7-month-old Date of Admission Date of Admission：2015-04-23 14:402015-04-23 14:40 Case Report paroxysmal cryingparoxysmal crying vomitingvomiting bloody stool bloody stool :I Intussu
2、sception unable to resetntussusception unable to resetCase Report Case ReportAcute IntussusceptionAcute IntussusceptionT:36.9 P:110/minT:36.9 P:110/min R:20/min Wt:7.5kg R:20/min Wt:7.5kgroutine bloodroutine bloodroution urineroution urinefull biochemicalfull biochemicalfull blood coagulation testfu
3、ll blood coagulation testHIV,HBV,HCV,RPRHIV,HBV,HCV,RPR 2015-04-232015-04-232015-05-052015-05-05 Case Report KnowledgeKnowledge ofof I IntussusceptionntussusceptionEtiologySymptoms&SignsDefinitionIntussusception What is intussusception?What is intussusception?Intussusceptionis a medical condition in
4、 Intussusceptionis a medical condition in which a part of the intestine has invaginated which a part of the intestine has invaginated into another section of intestineinto another section of intestine.Knowledge of Intussusception-Definition Children intussusceptionChildren intussusception Intussusce
5、ptionIntussusception is is an common abdominal an common abdominal emergency in children.It is one of the most emergency in children.It is one of the most common causes of abdominal obstruction in common causes of abdominal obstruction in infants.infants.Knowledge of Intussusception-Definition ETIOL
6、OGYETIOLOGY Knowledge of Intussusception.Incidence:Incidence:Knowledge of Intussusception-Etiologyv Whats the reason of Whats the reason of the disease?the disease?v Why it happens to Why it happens to infants mostly?infants mostly?Knowledge of Intussusception-EtiologyKnowledge of Intussusception-Et
7、iologyDietary alterationKnowledge of Intussusception-EtiologyTheThe complementary complementary foodfood of of childrenchildren can can not be not be changed changed tootoo soon.soon.It is supposed to be transformed step by stepIt is supposed to be transformed step by step.Dietary alterationKnowledg
8、e of Intussusception-EtiologyKnowledge of Intussusception-EtiologyNonsurgical Therapy-Nonsurgical TherapyPredisposing factors:Infantperiodaddassistfoodinfants mostly?Surgical Indicationrotavirus,reovirus,echovirus.*Wipe the stoma byflexure of the colonTherapeutic Management*If the wound is red orNon
9、surgical TherapyKnowledge of Intussusception-EtiologyName：Chen Jingyatheoriginalisfromsingletomultiple5、Sausage-shaped mass3-10 months healthy fat infantHight risk for fluid volume deficitfeverfever(acute upper reappiratory(acute upper reappiratory tract infection)tract infection)lost its normal fun
10、ction/enterospasmlost its normal function/enterospasmDiseaseKnowledge of Intussusception-EtiologyKnowledge of Intussusception-EtiologyvR Researchers suspectesearchers suspect that that infectious agents:infectious agents:rotavirus&adenovirus.rotavirus&adenovirus.Virus infectionKnowledge of Intussusc
11、eption-EtiologyvIntussusception causes have not clearly established Intussusception causes have not clearly established or understood.or understood.vThey can include infections,anatomical factors,They can include infections,anatomical factors,and altered motility.and altered motility.vS Studies and
12、analysistudies and analysis have not conclusively have not conclusively established this.established this.Knowledge of Intussusception-EtiologyvA review of sparse data on the possible A review of sparse data on the possible association:the virus&intussusception has not association:the virus&intussus
13、ception has not demonstrated until very recently.demonstrated until very recently.Knowledge of Intussusception-EtiologySymptoms and Signs1、General appearance2、Paroxysmal crying3、Bilious vomiting4、Red currant jelly stool5、Sausage-shaped massKnowledge of Intussusception Therapeutic ManagementTherapeut
14、ic ManagementNonsurgical TherapyNonsurgical TherapySurgical TherapySurgical TherapyNonsurgical TherapyNonsurgical Therapy Air Enema Air Enema Barium EnemaBarium Enema Nonsurgical Therapy-Barium Enema Nonsurgical Therapy-Barium EnemaNonsurgical Therapy-Barium Enemacomplicationcomplicationc chemicalhe
15、mical peritonitisperitonitisNonsurgical Therapy-Barium EnemavIntussusception presenting 48 hours.Intussusception presenting 48 hours.vGood general appearance.Good general appearance.vWithout abdominal distention,high temperature Without abdominal distention,high temperature and toxicosis and toxicos
16、is.ETIOLOGY1.Indications1.IndicationsNonsurgical Therapy-Air Enema 2.Procedure2.Procedure Restrained the patient,inserted the Foley catheter into rectum,inflated the balloon.Nonsurgical Therapy-Air Enema 2.head of intussusceptum 2.head of intussusceptum located in the hepatic located in the hepatic
17、flexure of the colonflexure of the colon1.before air clysis1.before air clysis3.reduction occur3.reduction occur4.reduction go on4.reduction go on5.the filling of numerous loops of intestine5.the filling of numerous loops of intestine3.Signs of Complete Reduction3.Signs of Complete ReductionFree flo
18、w of air into several loops of small Free flow of air into several loops of small bowel with simultaneous expulsion of feces.bowel with simultaneous expulsion of feces.Stop crying,be quiet.Stop crying,be quiet.Disappear of the abdominal mass.Disappear of the abdominal mass.Nonsurgical Therapy-Air En
19、ema 4.Nursing Care of Post-air enema4.Nursing Care of Post-air enemaCarbon test:take 0.5-1g activated carbon orally,Carbon test:take 0.5-1g activated carbon orally,appearing in stool 6-8 hours later.appearing in stool 6-8 hours later.Basic therapy.Basic therapy.Dietary guidance.Dietary guidance.Clin
20、ical observation closely.Clinical observation closely.Nonsurgical Therapy-Air Enema Surgical TherapySurgical Therapy Pure manual reductionPure manual reduction Intestinal anastomosis Intestinal anastomosis Eterostomy EterostomySurgical Therapy 1.Surgical Indication1.Surgical IndicationEnema failure.
21、Enema failure.Intussusception occuring more than 48-72 Intussusception occuring more than 48-72 hours.hours.Intestinal necrosis.Intestinal necrosis.Intestinal perforationIntestinal perforation.Surgical Therapy 2.Nursing Diagnosis2.Nursing DiagnosisPainPainAnxietyAnxietyHightHight risk for fluid volu
22、me deficitrisk for fluid volume deficitPotencial complicaion:shockPotencial complicaion:shockSurgical Therapy 3.Postoperative 3.Postoperative Nursing InterventionNursing InterventionM o n i t o r i n g t h e v i t a l s i g n s a n d M o n i t o r i n g t h e v i t a l s i g n s a n d consciousness
23、state.consciousness state.Oral feeding on a gradual schedule-Oral feeding on a gradual schedule-obeying the doctors instruction.obeying the doctors instruction.Surgical Therapy Intensive care for nasogastric tubeIntensive care for nasogastric tube.Prevention of complications:prevention ofPrevention
24、of complications:prevention of intestinalintestinal adhesion,fluid infusion to prevent adhesion,fluid infusion to prevent bleeding,infection,etc.bleeding,infection,etc.3.Postoperative 3.Postoperative Nursing Intervention Nursing InterventionSurgical Therapy Activity:Passive activityActivity:Passive
25、activity3.Postoperative 3.Postoperative Nursing Intervention Nursing InterventionSurgical Therapy HealthHealth GuidanceGuidance for discharged patientsfor discharged patientsAn important way to preventAn important way to preventintussusception and finddiseases intussusception and finddiseases in tim
26、ein time.*Living guideLiving guide*Disease observationDisease observation*Diet guideDiet guide*Special care guide Special care guide Living Guide*Let the parents realize the importance of keep moving.*Enough physical activities.*Prevention of intestinal adhesion.Adenovirus infection Intestinal lymop
27、h follicles hyperplasiaExcessive intestinal Stimulate the autonomic nervous systemperistalsisIntussusception*Prevent colds*Safety foodLiving GuideDisease Observation*Take a shower instead of bath.*Get rid of the risk factors of damaging the wound.*If the wound is red or cracks,please go to hospital.
28、Disease ObservationAttentions!If the child cries with any paroxysmal,you had better do a timely manner B to exceed cheek,against to rule out the possibility of intussucception.pain3-10 months healthy fat infant *colicky abdominal pain *abdominal swelling or distention *bilious vomiting *“red currant
29、 jelly stool *sausage-shaped mass*If the wound is red or*Often change or cleanStudies and analysis have not conclusively established this.Nonsurgical Therapy-*Disease observationTHE USE OF COLOSTOMY BAGChildren intussusceptionAir EnemaMonitoring the vital signs and consciousness state.Predisposing f
30、actors:Diet GuideVSInfant period add assist food should follow:keep from less to morefrom fine to coarsethe original is from single to multipleDiet GuideDiet GuideDiet GuideAfter operation:once a week in 3 monthsNEED:observe the spirits,defecate and the condition of appetite.Special Nursing Guidepost-fistulation*Often change or clean the colostmy bag.*Wipe the stoma by warm water.*Often observe the condition of the stoma.Special Nursing Guidepost-fistulationChoose:*More comfortable and soft colostmy bag.*Choose appropriate to the size of the pocket.
