【英語護(hù)理查房】（課堂PPT）

1、1IntussusceptionIntussusceptionNURSING ROUNDPediatric Surgical Department2015.9.2521234ContentsContents 3 Case Report4Name 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 Report5 paroxysmal

2、 cryingparoxysmal crying vomitingvomiting bloody stool bloody stool : :I Intussusception unable to resetntussusception unable to resetCase Report6 Case ReportAcute IntussusceptionAcute IntussusceptionT:36.9 P:110/minT:36.9 P:110/min R:20/min Wt:7.5kg R:20/min Wt:7.5kg7routine bloodroutine bloodrouti

3、on urineroution urinefull biochemicalfull biochemicalfull blood coagulation testfull blood coagulation testHIV,HBV,HCV,RPRHIV,HBV,HCV,RPR 2015-04-232015-04-232015-05-052015-05-05 Case Report8 KnowledgeKnowledge ofof I Intussusceptionntussusception9EtiologySymptoms & SignsDefinitionIntussusceptio

4、n10 What is intussusception?What is intussusception? Intussusceptionis a medical condition in 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.Knowle

5、dge of Intussusception-Definition11 Children intussusceptionChildren intussusception IntussusceptionIntussusception 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

6、 causes of abdominal obstruction in infants. infants. Knowledge of Intussusception-Definition12 ETIOLOGYETIOLOGY Knowledge of Intussusception13. . Incidence:Incidence:Knowledge of Intussusception-Etiology14v WhatWhats the reason of s the reason of the disease?the disease?v Why it happens to Why it h

7、appens to infants mostly? infants mostly?Knowledge of Intussusception-Etiology15Knowledge of Intussusception-Etiology16Dietary alterationKnowledge of Intussusception-Etiology17TheThe complementary complementary foodfood of of childrenchildren can can not be not be changed changed tootoo soon. soon.I

8、t is supposed to be transformed step by stepIt is supposed to be transformed step by step.Dietary alterationKnowledge of Intussusception-Etiology18Knowledge of Intussusception-Etiology19feverfever(acute upper reappiratory (acute upper reappiratory tract infection)tract infection)lost its normal func

9、tion /enterospasmlost its normal function /enterospasmDiseaseKnowledge of Intussusception-Etiology20Knowledge of Intussusception-Etiology21vR Researchers suspectesearchers suspect that that infectious agents: infectious agents: rotavirus&adenovirus.rotavirus&adenovirus.Virus infectionKnowled

10、ge of Intussusception-Etiology22vIntussusception 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 mo

11、tility. vS Studies and analysistudies and analysis have not conclusively have not conclusively established this. established this. Knowledge of Intussusception-Etiology23vA review of sparse data on the possible A review of sparse data on the possible association: the virus & intussusception has

12、not association: the virus & intussusception has not demonstrated until very recently. demonstrated until very recently. Knowledge of Intussusception-Etiology24Symptoms and Signs1、General appearance2、Paroxysmal crying3、Bilious vomiting4、Red currant jelly stool5、Sausage-shaped massKnowledge of In

13、tussusception25 Therapeutic ManagementTherapeutic ManagementNonsurgical TherapyNonsurgical TherapySurgical TherapySurgical Therapy26Nonsurgical TherapyNonsurgical Therapy Air Enema Air Enema Barium EnemaBarium Enema27 Nonsurgical Therapy - Barium Enema Nonsurgical Therapy - Barium EnemaNonsurgical T

14、herapy-Barium Enema28complicationcomplicationc chemicalhemical peritonitisperitonitisNonsurgical Therapy- Barium Enema29vIntussusception presenting 48 hours.Intussusception presenting 48 hours.vGood general appearance.Good general appearance.vWithout abdominal distention, high temperature Without ab

15、dominal distention, high temperature and toxicosis and toxicosis . ETIOLOGY1.Indications1.IndicationsNonsurgical Therapy- Air Enema 30 2.Procedure2.Procedure Restrained the patient, inserted the Foley catheter into rectum, inflated the balloon.Nonsurgical Therapy- Air Enema 312.head of intussusceptu

16、m 2.head of intussusceptum located in the hepatic located in the hepatic 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 in

17、testine323. Signs of Complete Reduction3. Signs of Complete ReductionFree flow 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 o

18、f the abdominal mass.Disappear of the abdominal mass. Nonsurgical Therapy- Air Enema 334. 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

19、in stool 6-8 hours later.Basic therapy.Basic therapy.Dietary guidance.Dietary guidance.Clinical observation closely.Clinical observation closely. Nonsurgical Therapy- Air Enema 34Surgical TherapySurgical Therapy 35 Pure manual reductionPure manual reduction Intestinal anastomosis Intestinal anastomo

20、sis Eterostomy EterostomySurgical Therapy 361.Surgical Indication1.Surgical IndicationEnema failure. Enema failure. Intussusception occuring more than 48-72 Intussusception occuring more than 48-72 hours.hours.Intestinal necrosis. Intestinal necrosis. Intestinal perforationIntestinal perforation. .S

21、urgical Therapy 37 2.Nursing Diagnosis2.Nursing DiagnosisPainPainAnxietyAnxietyHightHight risk for fluid volume deficitrisk for fluid volume deficitPotencial complicaion: shockPotencial complicaion: shockSurgical Therapy 383.Postoperative 3.Postoperative Nursing InterventionNursing InterventionM o n

22、 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 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 39Inte

23、nsive care for nasogastric tubeIntensive care for nasogastric tube. .Prevention of complications: prevention ofPrevention of complications: prevention of intestinalintestinal adhesion, fluid infusion to prevent adhesion, fluid infusion to prevent bleeding, infection, etc.bleeding, infection, etc.3.P

24、ostoperative 3.Postoperative Nursing Intervention Nursing InterventionSurgical Therapy 40 Activity : Passive activityActivity : Passive activity3.Postoperative 3.Postoperative Nursing Intervention Nursing InterventionSurgical Therapy 41HealthHealth GuidanceGuidance for discharged patientsfor dischar

25、ged patientsAn important way to preventAn important way to preventintussusception and finddiseases intussusception and finddiseases in timein time. .42* Living guideLiving guide* Disease observationDisease observation* Diet guideDiet guide* Special care guide Special care guide 43Living Guide*Let th

26、e parents realize the importance of keep moving.*Enough physical activities.*Prevention of intestinal adhesion.44Adenovirus infection Intestinal lymoph follicles hyperplasiaExcessive intestinal Stimulate the autonomic nervous systemperistalsisIntussusception*Prevent colds*Safety foodLiving Guide45Disease 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.46Disease ObservationAttentions!If the c