LPN Nursing · GI and Renal Disorders in Children · Practice question
The nurse reviews the provider's progress report. Select words from the choices below to fill in each blank in the following sentence. The complications that the infant is at greatest risk for developing are ____ and ____
Nurses' Notes
Day 1, 0800:
Guardians report infant has had frequent, sudden episodes of crying and has been pulling their knees to their chest over the past several hours. Infant vomits during these episodes. Guardians report a soft stool that contained blood and mucus 2 hr ago. Infant is eating solid foods and was recently switched from formula to whole cow's milk. Infant is currently receiving amoxicillin for otitis media following an upper respiratory infection.
Guardians report the infant is happy and plays in between these crying episodes.
Day 1, 1800:
Infant sleeping in crib.
Guardian states that the infant has been sleeping most of the time but with intermittent periods of extreme fussiness.
Guardian reports trying to feed the infant when awake but intake was refused. Moderate amount of urine and currant jelly-
like stool noted in diaper. Hypoactive bowel sounds. Infant cries when abdomen is palpated.
Vital Signs
Day 1, 0800:
Temperature 37.2° C (99° F) axillary
Heart rate 128/min (Apical)
Respiratory rate 26/min
Pulse oximetry 98%
Day 1, 1800:
Temperature 37.3° C (99.2° F) axillary
Heart rate 120/min (apical)
Respiratory rate 28/min
Pulse oximetry 97%
Diagnostic Results
Day 1, 0830:
Hemoglobin 8.1 g/dL (9.5 to 14 g/dL)
Hematocrit 26% (29% to 43%)
Progress Report
Day 1, 0900:
Abdomen tender to palpation. Sausage-shaped mass palpated in right upper quadrant.
Ultrasound confirms the presence of an intussusception.
Plan: Attempt reduction of intussusception by administration of gas enema in interventional radiology.
Answer & explanation
Correct:
The infant has confirmed intussusception with a sausage-shaped mass in the right upper quadrant and the plan is to attempt reduction via gas enema. The two most serious complications associated with intussusception, particularly if reduction is delayed or unsuccessful, are bowel perforation and necrosis. When a segment of bowel telescopes into an adjacent segment, it traps the bowel wall and its mesentery, compromising vascular supply. Progressive ischemia leads to tissue necrosis of the affected bowel segment. Increased intraluminal pressure and ischemic damage weaken the bowel wall, creating the risk of perforation, which can lead to peritonitis and sepsis. These are the life-threatening complications that necessitate urgent treatment. Constipation is not a complication of intussusception — the condition actually causes obstruction leading to passage of bloody mucus. Steatorrhea is characteristic of malabsorptive conditions like celiac disease or pancreatic insufficiency and is not relevant to intussusception. Malnutrition is a long-term concern in chronic conditions but is not the acute complication priority here. The keyed answer designating bowel perforation (index 2) and necrosis (index 3) correctly identifies the greatest acute risks in this clinical scenario. Both these complications are directly caused by the vascular compromise inherent to the telescoping bowel mechanism.
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