{
  "name": "Intussusception",
  "slug": "intussusception",
  "url": "https://nursingplex.com/care-plans/intussusception",
  "category": "Gastrointestinal",
  "summary": "Telescoped bowel in infants; urgent recognition of currant-jelly stools and obstruction.",
  "nursing_diagnoses": [
    "Acute pain",
    "Deficient fluid volume",
    "Risk for injury"
  ],
  "overview": [
    "Intussusception occurs when one segment of bowel telescopes into the segment ahead of it, dragging its mesentery with it. The trapped mesentery obstructs venous drainage, the wall swells, arterial supply fails, and untreated the bowel becomes ischemic and perforates. It is the most common cause of intestinal obstruction in infants between 3 months and 3 years, typically at the ileocecal junction.",
    "The classic picture is a previously well infant who suddenly draws the knees to the chest and screams for a few minutes, then falls quiet or lethargic between episodes. Vomiting follows, and the stool may become the described 'currant jelly' mixture of blood and mucus — a late sign, not one to wait for. A sausage-shaped mass may be palpable in the right upper quadrant.",
    "Treatment is usually non-surgical: an air or hydrostatic (contrast/saline) enema under ultrasound or fluoroscopy reduces the telescoped segment in most cases. Surgery follows failed reduction, perforation or signs of necrosis. Recurrence is possible within the first 24–48 hours, so post-reduction monitoring is a nursing priority rather than a formality."
  ],
  "key_facts": [
    {
      "label": "Classic triad",
      "text": "Intermittent colicky pain with drawn-up legs, vomiting, and currant-jelly stool — the full triad appears in a minority of cases."
    },
    {
      "label": "Key reassuring sign",
      "text": "Passage of a normal brown stool may indicate spontaneous reduction; report it, do not assume it."
    },
    {
      "label": "First-line treatment",
      "text": "Air or hydrostatic enema reduction; success rate is high when performed early."
    },
    {
      "label": "Contraindication to enema",
      "text": "Peritonitis, perforation, or shock — these go straight to surgery."
    },
    {
      "label": "Recurrence",
      "text": "Most recurrences happen within 24 hours of reduction; keep the child observed."
    }
  ],
  "nursing_priorities": [
    "Recognize obstruction early and keep the child NPO with IV access.",
    "Restore fluid volume and correct electrolyte imbalance before reduction.",
    "Detect perforation and shock immediately.",
    "Support the child and family through a frightening, fast-moving illness.",
    "Monitor closely after reduction for recurrence."
  ],
  "assessment": {
    "subjective": [
      "Parent reports sudden episodes of inconsolable crying with legs drawn up",
      "Refusal to feed and vomiting, later becoming bile-stained",
      "Reports of blood or mucus in the diaper",
      "Parental fear and exhaustion from unexplained screaming episodes"
    ],
    "objective": [
      "Paroxysms of pain alternating with lethargy or normal behavior",
      "Bilious vomiting, abdominal distention and high-pitched or absent bowel sounds",
      "Sausage-shaped right-upper-quadrant mass with an empty right lower quadrant",
      "Currant-jelly stool or blood on rectal examination",
      "Tachycardia, poor perfusion, sunken fontanel, decreased wet diapers",
      "Fever, rigid abdomen and shock in perforation"
    ],
    "related_factors": [
      "Telescoping of bowel with mesenteric compression and venous congestion",
      "Bowel obstruction with third-spacing and vomiting losses",
      "Ischemia and possible necrosis of the involved segment",
      "Recent viral illness or lead point such as a Meckel diverticulum or lymphoma"
    ]
  },
  "goals": [
    "The child will maintain adequate hydration with normal vital signs, moist mucous membranes and appropriate urine output.",
    "The child will show relief of pain and return of normal behavior between assessments.",
    "The child will pass normal stool and tolerate feeds after reduction.",
    "The child will remain free of perforation, peritonitis and shock.",
    "The parents will describe recurrence signs before discharge."
  ],
  "interventions": [
    {
      "title": "1. Stabilizing before reduction",
      "points": [
        "Keep the child strictly NPO and insert a nasogastric tube for decompression if ordered.",
        "Establish IV access and give isotonic fluid boluses and maintenance fluid as prescribed.",
        "Monitor vital signs, perfusion, capillary refill and urine output closely — infants decompensate suddenly.",
        "Draw electrolytes, CBC and type and screen; correct imbalances before the procedure.",
        "Notify the provider immediately of fever, rigid abdomen, absent bowel sounds or worsening tachycardia."
      ]
    },
    {
      "title": "2. Caring for the child during enema reduction",
      "points": [
        "Explain the procedure to parents in plain terms, including the small risk of perforation and the possibility of surgery.",
        "Ensure consent, IV access and a surgical team on standby are in place before the study begins.",
        "Position and comfort the child during the procedure; use non-pharmacologic soothing plus prescribed analgesia.",
        "Watch for sudden abdominal distention, pain change or deterioration during reduction — this signals perforation."
      ]
    },
    {
      "title": "3. Post-reduction monitoring",
      "points": [
        "Observe for the return of normal brown stool, which confirms successful reduction.",
        "Monitor for recurrence over the next 24–48 hours: repeat colicky episodes, vomiting or a returning mass.",
        "Advance feeding gradually as ordered, starting with clear fluids, and document tolerance.",
        "Continue strict intake and output and daily weight."
      ]
    },
    {
      "title": "4. Postoperative care when surgery is needed",
      "points": [
        "Monitor the incision, drains and any stoma for bleeding, drainage and viability.",
        "Manage pain with scheduled age-appropriate analgesia and comfort positioning.",
        "Keep the nasogastric tube patent and NPO status until bowel sounds and flatus return.",
        "Watch for postoperative ileus, wound infection and dehiscence."
      ]
    },
    {
      "title": "5. Supporting the family",
      "points": [
        "Keep parents at the bedside and involved in comfort measures; a familiar voice reduces distress measurably.",
        "Give short, repeated explanations — frightened parents retain very little the first time.",
        "Reassure that intussusception is not caused by anything the parents did or fed the child.",
        "Teach the exact recurrence signs and instruct them to return immediately rather than call and wait."
      ]
    }
  ],
  "patient_teaching": [
    "Return immediately for repeated screaming episodes with legs drawn up, vomiting, blood in the stool or a child who becomes floppy and hard to wake.",
    "Expect stools to normalize over a few days; report continued bloody or mucus stools.",
    "Advance feeds as instructed and report vomiting or refusal to feed.",
    "Keep the incision clean and dry after surgery and report redness, drainage or fever.",
    "Attend all follow-up visits; recurrence is possible even after successful reduction."
  ]
}