CASE PRESENTATION

OF A CHILD
WITH
INTESTINAL
OBSTRUCTION

Submitted to – Submitted by
–
Madam, Swarnali Chakraborty Dipika
Singha Roy
Sr. Lecturer 1 st YR MSc.
Nursing Student
W.B.G.C.O.N
W.B.G.C.O.N
SSKM HOSPITAL SSKM
HOSPITAL
KOLKATA
KOLKATA
Introduction: As a part of my Child Health Nursing clinical posting , I am Dipika Singha Roy of
MSc . Nursing 1st Year student posted in pediatric surgery ward . Here I took the case of Falguni Bari
with the chief complain of Suffering from severe pain in abdomen, not passing stool for 7 days &
Abdominal distension, under physician Dr. Sujoy Pal , Dr. Arindam Ghosh . After all investigation,
diagnosed as Small Intestinal Obstruction .

 Identification Data
Name : Falguni Bari
Age: 3 Year
Sex: Male
ID No: 2302182415
Bed No: Alex S 61
Ward: Paediatric Surgery
D.O.A: 16/11/2023
Diagnosis: Small Intestinal Obstruction
Address: Vill-E/71/2 PH-1 EWS HS4 55 Township, P.O +P.S -Sarsuma ,
Dist.-Kolkata, W.B
Father’s Name- Rabin Bai
Mother’s Name- Mousumi Bari
Doctor: Dr. Sujoy Pal , Dr. Arindam Ghosh
Name of Surgery: Reduction intussusception & resection of polyp in small bowel
& primary anastomosis
Date of Surgery: 29/11/23
Name of Hospital: SSKM hospital
Date of assessment: 28/11/2023
Name of the informant: Mousumi Bari
 Chief Complain:
On admission: Suffering from severe pain in abdomen, not passing stool for 7
days ,fever, headache,& Abdominal distension.
After admission: Abdominal Pain was present after admission in hospital ,
 & abdominal distension was also present.
At Present illness in details: He feels severe pain in abdomen , nausea & vomiting
,abdominal tenderness, inability to pass flatus.

 Past History:

 Past medical History: Nil

 Past Surgical History: Nil

 Birth history:
Hospital Delivery: No
Term: Yes (37 weeks)
Cried after birth : Yes
Any complication: No
 Obstetric history
History of baby: Nothing abnormality
History of mother: Nothing abnormality
 Personal History:
Immunization: Baby is immunized as per age
Education: Nothing applicable
Food habit: Normal diet
Allergic History of : No
Sleep rest pattern: He slept well at night, she slept 8 hours in
whole night.
Elimination Pattern: His elimination pattern is abnormal,
constipation is present. Bowel is not passed for
7 days.
 Family History:
Family type: Nuclear
Member: 7 members
History of illness: No
Socio economic condition : Poor
Water supply : Sajal Dhara ( Govt. Water supply )
Drinking: Sajal Dhara ( Govt. Water supply )
Ventilation: well ventilated
Sanitation: Sanitary latrine present
Total Monthly income: 7000/-
Per capita income: 1000/-
Consanguineal marriage No
Genetic disorder: No
Sibling suffer from
Any disease : No
History of HTN, Diabetes,
Hyperthyroidism, cancer : No
Feeding and Nutrition
Mode and Route: Oral
Types of food: Normal
Family tree:
54 50

29 28

- MALE

- Female

- Patient

Family Chart:
Name of Relationship Age Gender Marital Education Occupation
the family [YR] status
members
Mr. Grand 54 Male Married Illiterate Labourer
Shankar father
Mrs. Grand 50 Female Married Illiterate House
Yamuna mother wife
Mr. Rabin Father 29 Male Married 11 Koolie
passed
Mrs. Mother 28 Female Married 8 passed House
 Mousumi wife
Kumkum Sister 6 Female Un Class I student
married
Falguni Him self 3 Male - - -

Physical Assessment
Date:28/11/2023 Time:10 am Place: Pediatric Surgery ward
Age: 3 years

Anthropometric Measurements:

Measurements Expected Child picture Remarks

normal range
Birth weight 2.5-3.8 kg 2.8 kg Adequate as per
age
Present weight 7.5-7.8 kg 7.4 kg Adequate as per
age
Length/Height 80 cm 84 cm Adequate as per
age
Head 47-50cm 48cm Adequate as per
circumference age
Chest 54-58cm 58 cm Adequate as per
circumference age
Mid arm Greater than 13.5 15 cm Adequate as per
circumference cm age
Abdominal 44 cm-56 cm 62 cm Abdominal
circumference distension present
Vital Parameter

Parameter Expected Child picture Remarks

normal range
Heart rate 110 bpm 106 bpm Adequate as per
age
Respiratory rate 34 bpm 32 bpm Adequate as per
age
Temperature 99.8˚ F 98.8˚ F Adequate as per
age
Blood pressure 90/60 mm of Hg 90/60 mm of Hg Adequate as per
age

 General Appearance

• Body Built: Endomorphic/Mesomorphic/Ectomorphic: Endomorphic

• Color: Dark/Fair: Fair
• Posture: Flexion/Partial flexion/Extension/Symmetrical/ Asymmetrical/
 Normal/ Abnormal: Normal.
• Activity: Lethargic/ Active/Irritable: Lethargic
• Gait: Normal/Limping/Hemiplegic/Scissor's gait/ Waddling/Hysterical gait (Psychogenic)/
Ataxic Gait: Normal
•Level of Consciousness (LOC): Conscious/Confused/ Drowsy/ Delirious/Responds only to
maximum painful stimuli/Comatose: Conscious
•Behaviour: Normal
• Cry: Normal/ High pitched/ Absent: Normal

 Skin

• Color: Pink/Bright red/ Peripheral cyanosis/Central Cyanosis/ Jaundice/Pallor: Pink

• Texture: Dryness/ Flaking/ Wrinkling/ Edema: Dryness

•Skin Turgur: Normal

• Skin Integrity: Intact/ Impaired

•Lesion: Absent

• Vernix / Lanugos/Mongolian Spot//Erythema: Present / Absent - Absent

•Sensation: Touch/Pain/Hot/Cold - Normal

• Temperature: 102˚F
 Head

• Shape of the Head: Normal/ Molding/ Widely Separated Suture/

Cephalhematoma/ Caput Succedaneum/Bulging of fontanels/ Depressed Fontanels:
Normal
• Hair: Wolly/Silky/ Black - Black
• Scalp: Presence of infection/ Dandruff/ Pediculosis- Clean
• Injury: Not available
• Fontanels: Anterior: Palpable/ Not palpable, Size: Not palpable
Posterior:Palpable/ Not palpable, Size: - Not palpable
 Face

• Color, Condition and Look: Pale/ Flushed/ Puffy/ Fatigued/Painful/ fearful/anxious:

Fearful
 Eye

• Eyebrow: (Normal/ Absent): Normal

• Eyelashes (infection/ sty): Normal

• Eyelids ((edema/lesions/ectropion/entropion): Normal
• Eyeball (sunken/protruded): Normal
• Conjunctiva (pale/red/ purulent/ hemorrhage spot/ icterus/ infection): - Normal
• Sclera (color): White
• Pupilary reaction: - Normal
• Lens (opacity): Normal
• Vision (Normal/ Metropia/ Myopia): - Normal
• Discharge: Normal
 Ear
• Pina: Position: Normal Symmetry: ✓ Recoiling: Present
• Tympanic Membrane (Perforation/lesions/bulging): Not seen
•Hearing: Normal
 Nose:

• External Nares : Normal

• Nostrils: Normal

• Smell sensation: Present

 Mouth

• Lips: Pink in colour

• Cleft Lip: Absent
• Cleft Palate: Absent
• Presence of oral thrush: Absent
• Odor of the mouth: Nil
• Teeth: 20 deciduous teeth present
• Temporary teeth: 20
• Permanent teeth: Absent
• Mucus membrane and gums: Normal
• Tongue: Cleanliness and Color: Normal
 • Protruded tongue: Absent
• Tongue tie: Absent
• Throat: Normal
• Voice: Normal
• Taste Sensation: Present
 Neck
• Lymph nodes: Present
• Thyroid glands: Present
•Range of motion: Present
•Neck vein: Not distended
 Chest

•Heart Rate: 90 bpm

•Respiratory Rate: 26 bpm
 Thorax (Inspection):

•Shape: Normal
•Size: 53 cm
•Symmetry: Present
•Expansion: Bilateral
•Breast nodule: > 5 mm , No lesion no
discharge
 Thorax (Palpation):

• Axillary Lymph Nodes: Present

• Capillary Refill Time (CRT): < 3 sec
 Thorax (Auscultation):

• Breath sounds: Present, wheezing present

• Heart Sounds: S1- Present , S2- Present , S3-
Absent ,S4-Absent
• Murmur: Absent
 Thorax (Percussion): Normal

• Inspection: Normal
  Abdomen

• Umbilicus: Normal
• Auscultation: Peristalsis movement absent
• Palpation: Palpable
• Percussion: Absent
 Back
• Skin: Normal, no rash, lesion or
redness is absent
• Spinal Curve: Normal
• Spina bifida: Absent.
• Normal/ Dislocation: Normal
 Upper Extremities:

• Size/shape/symmetry:- Normal
• Joints: Movable
• Fingers (Digit/Clubbing/Color) Normal
• Palmar creases: Present
• Reflexes: Present
 Lower Extremities:

• Size/shape/symmetry: Normal
• Joints: Movable
• Fingers : Normal
• Solar Creases: Absent
• Edema: Absent
• Varicose veins: Absent
 Genitalia & Rectum
 Boy- Yes.
Urethral opening: Normal site
Phimosis: Absent.
Penile length: Normal
Void: (freely/ through catheter): Freely
Inguinal lymph node : Absent
Descent Of testes: Yes
 Urine :
  Void: Freely
 Color: Pale yellow
 Frequency: - 6 times in a day
 Volume: Normal
 Odour: No odor
 Anal opening: Present
• Stool: (pass normally/constipation): Not passed
 Pelvic mass: - Absent
 Congenital anomaly (Specify): Absent
 Feeding and Nutrition NPM at present
 Mode and Route: NPM at present

Introduction: Intestinal obstruction is an interruption in the normal flow) of intestinal contents

through the intestine. The obstruction may occur in small or large intestine. It may be complete or
partial obstruction and may be due to mechanical or paralytic cause. It may be found as congenital
anomalies or as acquired conditions.
Intestinal obstruction are common now a days due to care less about self . People
intake many of spicy food & suffers from gastro intestinal disease .

Definition of disease: Intestinal obstruction is surgical condition which interferes with the normal
passage of the bowel contents along the lumen. Obstruction may occur both in small intestine and
large intestine. It may be caused by a mechanical obstruction, paralytic ileus or impairment of blood
supply to the intestine.
Incidence rate : Globally the incidence and prevalence cases of intestinal obstruction in 2019
representing an increase of 86.67 % & 56.91% ,respectively compared with 1990.
In India the proportion increased significantly from 23% in 1996- 2004 to 51.6% in 2013-2019.

Related Anatomy & Physiology :

Intestine: The intestine (bowel) is a winding muscular tube extending from the stomach to the anus.
Its main purpose is to digest food.
Parts: Mainly 2 parts
 Small intestine
 Large ntestine

Small Intestine: The small intestine (also referred to as the small bowel) is the specialized
tubular structure between the stomach and the large intestine (also called the colon or large bowel)
that absorbs the nutrition from food. It is approximately 20-25 feet in length .
It is divided into three parts: the duodenum, jejunum and ileum.

Duodenum: The duodenum is the initial C-shaped segment of the small intestine and is a
continuation of the pylorus. Distally, it is in continuation with the jejunum and ileum, with the
proximal segment being the shortest and widest. Positioned inferiorly to the stomach, the
duodenum is approximately 25 to 30 cm long.
Jejunum: Jejunum is the most extensive part of the small intestine with substantial mesentery
that meets at the top of the abdominal cavity as the root of the mesentery. The jejunum consists of
multiple loops (averaging 6–8 large loops) commonly referred to as the “jejunal mass” lying
between the stomach and the pelvic inlet.

Ileum: The ileum is the final portion of the small intestine, measuring around 3 meters, and ends
at the cecum. It absorbs any final nutrients, with major absorptive products being vitamin B12 and
bile acids.

Large Intestine : The large intestine is responsible for processing indigestible food material
(chyme) after most nutrients are absorbed in the small intestine. The large intestine is composed
of 4 parts. It includes the cecum and ascending colon, transverse colon, descending colon, and
sigmoid colon.

It is divided into three parts: the colon, the rectum and the anus.

Colon :
The colon is also known as the large bowel or large intestine. It is an organ that is part of the
digestive system (also called the digestive tract) in the human body. The digestive system is the
group of organs that allow us to eat and to use the food we eat to fuel our bodies.

Parts of the colon

 Cecum: This is the beginning of the colon.
 Ascending colon (right colon): This is the first part of the colon.
 Transverse colon: This is the middle part of the colon.
 Descending colon (left colon): This is the third part of the colon.
 Sigmoid colon: This is the last part of the colon.
Rectum : Rectum is at the end of colon and on the other side of anal canal. This is where your
poop collect just before it's ready to come out. Rectum absorbs the excess water and holds it until
it's full, when nerves trigger the urge to defecate.
Anus: The anus is the last part of the digestive tract. It's at the end of the rectum. It's where stool
comes out of the body. It consists of a muscular ring (called a sphincter) that opens during a
bowel movement to allow stool (faeces) to pass through, as well as flat cells that line the inside of
the anus.
 INTESTINE
 Types of intestinal obstruction :
Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the
intestinal tract) Two types of processes can impede this flow:
Mechanical obstruction: An intraluminal obstruction or a mural obstruction from pressure on the
intestinal wall occurs. Examples are intussusception, polypoid tumors and neoplasms, stenosis,
strictures, adhesions, hernias, and abscesses.
Functional obstruction: The intestinal musculature cannot propel the contents along the bowel.
Examples are amyloidosis, muscular dystrophy, endocrine disorders such as diabetes mellitus, or
neurologic dis- orders such as Parkinson's disease, The blockage also can be temporary and the result
of the manipulation of the bowel during surgery.
The obstruction can be partial or complete. Its severity depends on the region of bowel affected, the
degree to which the lumen is occluded, and especially the degree to which the vascular supply to the
bowel wall is disturbed.

Etiology :
According to book In my patient
 Congenital Intestinal Obstruction 1) Narrowing of the
It is found as following conditions: intestinal wall as a result of
inflammation
Intestinal atresia-Atresia of the intestine most commonly found in the 2)Polyp present in intestinal
duodenum. Other sites of obstruction are ileum, jejunum and colon. It can wall
be found at multiple sites and may be complete or incomplete. 2) Infection
3) Ileo-illeal intussusception
Malrotation of gut It is incomplete rotation of the gut during intrauterine
life (12 th week), so that cecum comes to lie below pylorus, root of
mesentery becomes very narrow,
ascending and transverse colon become mobile and vulnerable to twisting in
a clockwise direction.

Meconium plug syndrome Obstruction of lower colon by a thick plug of

meconium, found in neonates.

Meconium ileus It occurs due to inspissated putty like meconium plugging

the lumen of the terminal ileum and cause obstruction. It occurs in lack of
pancreatic enzymes and mucoviscidosis (cystic fibrosis).

Annular pancreas-The head of the pancreas compress the second part of

the duodenum giving rise to an extrinsic from of obstruction.

Mickel's diverticulum Diverticulum is circumscribed pouch or sac

occurring normally or created by herniation of the lining mucus membrane
through a tear in the muscular coat. It can be complicated with bleeding,
intestinal obstruction, inflammation as diverticulitis and umbilical fistula.
Hirschsprung's Disease or congenital Megacolon.
 Acquired Intestinal Obstruction
The important causes of acquired intestinal obstruction are
1.Intussusception-It is telescoping of intestinal wall into itself, It is found
as invagination or slipping of one part of intestine into another part just
below it. In children, the most common site is ileocecal region.

2. Volvulus or twisted loop of intestine commonly occurs in sigmoid

colon.
3. Tumor or hematoma as intrinsic or extrinsic to intestine.
4. Hernia and strangulation.
5. Stricture or stenosis of the intestine.
6.Inflammatory diseases Ulcerative colitis, Crohn's disease, appendicitis.
7. Foreign body (e.g. coin) or fecal impaction or polyp.
8. Worm mass (commonly round worms) and amebiasis.
9.Paralytic ileus due to toxic or traumatic disturbances of autonomic
nervous system leading to ineffective peristalsis by reduced motor activity.

Pathophysiology of Intestinal obstruction:

Adhesions-loops of intestine become adherent to areas
that heal slowly or scar after abdominal surgery; produce
kinking of an intestinal loop  SCI, vertebral fractures
 Abdominal surgery
 Peritonitis
Intussusception-one part of the intestine slips into another  Wound dehiscence
part located below it; intestinal lumen becomes narrowed
 GI tract surgery
 Thrombosis, embolism
Volvulus- bowel twists and turns on itself; intestinal lumen
becomes obstructed. Gas and fluid accumulate in the trapped bowel

Hernia- protrusion of intestine through a weakened area

in the abdominal muscle or wall; intestinal flow may be
completely obstructed. blood flow to the area may be obstructed FUNCTIONAL
ADTRABIC
Tumor- within the intestine, extends into the intestinal lumen; NEUROGENIC
outside the intestine, pressure on the wall of the intestine; PARALYTIC ILEUS
intestinal lumen becomes partially or completely obstructed.
 Cessation of peristalsis

MECHANICAL
OBSTRUCTION

Bacterial
Gases & fluids accumulate in Activity
Borborygmi The area

Increase contraction Distension of intestine

Of proximal intestine

Persistent vomiting

Increase intraluminal pressure Loss of hydrogen ions,

Severe
colicky potassium
abdominal Increase secretion into the intestine
pain
Metabolic
Compression of veins alkalosis

Increases venous pressure

Decreases absorption

Edema of the intestine

Decreases arterial Compression of terminal

Blood supply branches of mesenteric artery

Ischemia, anoxia
 Necrosis Perforation of Bacteria or
Necrotic segments toxins leak into:
Gangrenous
intestinal
wall

Decreases
Bowel Cessation of Peritoneal Blood
Sound Peristalsis cavity supply

Peritonitis Bacteremia
Septicemia

Pathophysiology of Intestinal obstruction in my patient

There are various forms of intussusceptions based on the site of invagination such as ileocolic,
ileoileal, jejuno-jejunal, jejuno-ileal, and colocolic.

Ileocolic form is most commonly seen. The proximal segment of bowel telescopes into the distal
segment, dragging the associated mesentery with it.

This causes interference with vascular supply as well as an obstruction of the GI tract. This leads
to the development of venous and lymphatic congestion.

Resulting intestinal edema and increased tissue pressure

This tissue pressure rises until arterial flow is stopped which leads to necrosis.
Intestinal cells are stimulated to discharge mucus, which mixes with the blood to produce a
current jelly stool.
 As the vicious cycle continues, it can ultimately lead to ischemia, perforation and peritonitis.

Clinical Manifestation:
According to book In my patient
The child with intestinal obstruction 1) Pain in abdomen
usually presents with abdominal colic 2) Nausea
(cramps), abdominal distension, 3) Inability to pass flatus
bilious vomiting, absence of flatus and 4) Abdominal tenderness
no passage of stool. Fever drowsiness, 5) Vomiting
dehydration and toxicity are also 6) Inability to pass stool
found m these children. There is 7) Dehydration due to loss of
increased bowel sound, which may water & sodium
reduce gradually. Minimal diffuse 8) Generalised malaise
tenderness of abdomen may also
present. The child may manifest with
shock and respiratory distress.

There may be rectal passage of

bloody mucus (red- currant jelly stool),
sausage-shaped lump palpable in
upper abdomen (in early stage) and
cervix-like mass and blood in rectal
examination. These features are
diagnostic of intussusception.

Investigation
According to book In my patient
History of illness and physical 1.USG of whole abdomen-
examination help in clinical diagnosis. Liver-normal
The diagnosis is confirmed by Spleen-normal
1.X-ray abdomen and chest: are the Pancreas-Obstructed by gas
most powerful diagnostic aids up right & shadow
lateral abdominal x-rays shows the  Ileo-illeal intussusception
presence of gas & fluids in the intestine with a small echogenic
the presence of intraperitoneal air soft tisuue lesion at tip of
indicated perforation intussusception
2.barium enema, 2.Blood test done on – 18/11/23
3.proctoscopy, Hb-12 gm%
4.sigmoidoscopy or WBC-10.8
5.USG. PCV-30.7
6.Blood examination shows reduction of MCH-27.8
sodium potassium and chloride level, MCHC-32.9
elevated WBC count (in case of necrosis, Sodium -133 mmol
 strangulation and peritonitis) and Potassium-3.9 mmol
elevated serum amylase level. Sugar-103 mg/dl
7.Stool should be checked for occult Urea-31 mg/dl
blood

 Management

Medical Management:
According to book In my patient
Initial Management 1)History of patient including his
Initial management is done with I/V fluid therapy family history, medical history,
to correct fluid and electrolyte imbalance, and surgical history
nasogastric suctioning to decompress the bowel. 2)Through physical assessment is
Analgesics and sedatives are administer to done of the patient
reduce pain and to provide comfort. Antibiotics 3)Intubation of NG tube
to be given to treat and prevent infection. 4)NPM Status is maintain
Causes and complications to be detected early 5)IVF RL:DNS(1:1) 800 ml in 24
and necessary management is planned to treat hourly
them promptly. 6)Medicine :
Nonsurgical Hydrostatic Reduction Inj.Pipzo(800mg) IV 8 hourly
Inj. Ondem( 5 mg )IV 12 hourly
•Traditionally with barium enema: Force is Inj. Amikacin (120mg) IV OD
exerted by barium enema to push the Inj MVI + KCL-1 ml in each 100
invaginated portion of the bowel into its' original ml ½ DNS
position. Successful reduction is indicated by the Inj Rantac( 5 mg )IV 12 hourly
free flow of contrast into the small bowel.

• Reduction with water soluble contrast or

air pressure: When there is anticipated risk of
perforation, barium is avoided. Foley's catheter
is placed into the rectum. Fluoroscopy is used to
assess the presence of bowel gas in the
abdomen. Air is then instilled by hand pump and
the intussusception is pushed back gently.

Surgical Management:
According to book In my patient
Surgical management is done to In my Patient reduction of
relieve the obstruction Laparotomy intussusception , resection of polyp in
followed by specific surgery to be small bowel & primary anastomosis is
done. done on- 28/11/23
a. Resection of bowel is done, for
obstructing lesions or strangulated
bowel, along with end-to-end
anastomosis.
b. In malrotation of gut, cutting of
Ladd's band and lengthening of the
roots of the mesentery is done.
c. Enterotomy is performed for
removal of foreign bodies in the
intestine.
d. Closed bowel procedures may be
done to reduce volvulus and
intussusception or incarcerated
hernia. Conservative hydrostatic
reduction is performed in case of
intussusception. Hypertonic enema is
given to relieve the obstruction due to
round worms mass.
e. Ostomy surgery :
 Ileostomy
 Sigmoid colostomy
 Transverse colostomy
 Ascending colostomy &
 Descending colostomy

Nursing Management :
According to book In my patient
Nursing assessment to be done to 1)History taking is done
detect the nature and location of pain,
presence or absence of abdominal 2) Physical assessment is done
distension, flatus, vomiting, stools,
obstipation, bowel sound, etc. General 3)Function of NG tube is maintain
condition of the child should be
assessed thoroughly especially vital 4)The nasogastric output is measured
signs, intake, output and level of & output in 24 hours is 30 ml
consciousness. The following nursing
diagnoses require special attention. 5)Fluid & electrolyte balance is
 Pain related to intestinal maintained
obstruction and abdominal
distension. 6)Nutritional status is maintained

 Risk for fluid and electrolyte 7)The location ,duration ,intensity,&

imbalance relatd to vomiting, frequency of abdominal pain is
poor intake of fluid and determined
diarrhoea. Ineffective breathing
related to abdominal distension. 8)Bowel function including passage of
flatus is determined
 Potential to shock related to
toxicity. 9)Intake output chart is maintain

 Fear and anxiety related to 10)Patient physiologic status

severity of illness. assessed.

 Ineffective coping related to life 11)Vital sign is checked

threatening symptoms.
 Knowledge deficit related to 12)Pain management is done by
long-term care. giving analgesic medicine.
 Nursing interventions should
emphasize on the following aspects:

a. Providing rest and comfort.

b. Relieving pain by analgesics.

c. Maintaining fluid and electrolyte

balance by I/V fluid therapy and
recording of intake and output.

d. Providing adequate respiration by

relieving abdominal distension
through nasogastric tube aspiration.

e. Reducing fear and anxiety by

explanation reassurance and
answering questions.
f. Maintaining normal bowel
elimination.

g. Providing basic pre-operative and

post-operative care and administering
prescribed medications.

h. Promoting effective coping with

hospitalized care.
I. Giving and instructions for home-
based long-term care.

Complication :
According to book In my patient
1.Intestinal perforation Nil
2.Peritonitis due to perforation
3.Sepsis -mostly in which delay in
diagnosis or treatment
4.Intraabdominal abscess
5.Dehydration
6.Electrolyte disturbance
7.Multi organ failure
8.Death

Health Education:
Health education is given to the patient about the following-
1. To work moderate physical activity
2. To do range of motion exercise
3. To maintain personal hygiene
 4. To come for follow up check up after discharge
5. To take adequate amount of fluid
6. To reduce anxiety
7. Increase dietary fibre in diet .
8. Demonstrate ostomy care ,including wound cleaning if colostomy is done .

Nursing Care Plan on Day 1: 27/11/23

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data: Constipati To relief - The cause & -Assessed the Child
Inability or on related from duration of cause & constipati
difficult passing to the constipati constipation & duration of on was
stool, abdominal narrowing on with collect history constipation & relieved
pain & to the normal regarding the collect history as
discomfort, intestinal bowel routine elimination regarding the evidence
indigestion ,abdo lumen eliminatio pattern should be routine d by
minal bloating & secondary n pattern. assessed. elimination normal
distension, to pattern bowel
inability to pass inflammat - The vital signs eliminati
gas or flatus , ory lesions regularly should -Monitor the on
nausea & foul or be monitored vital signs pattern &
smelling projectile obstructio regularly defecatio
vomiting,borbory n - The weight ,I/O n with
gmi proximal to chart & abdominal -Measure the ease &
the obstruction girth daily should weight ,I/O chart comfort
be measured & abdominal
girth daily
- NG tube &
Objective data : connect to -Insert NG tube
increased continuous & connect to
abdominal girth, aspiration should continuous
irregular bowel be inserted aspiration
sounds, weight
loss, I/o chart - IV Fluid & total -Administered IV
monitoring shows parenteral Fluid & total
negative balance, nutrition should be parenteral
vital sign show administered nutrition when
tachycardia & when the client in the client in on
decreased on NPO status NPO status
BP ,abdominal X-
ray detects the - Bowel wash with -provide bowel
presence laxatives every 4- wash with
presence of gas & 6 hours day laxatives every
fluids proximal to should be provide 4-6 hours day
the obstruction
- Anti-emetics like - Administered
ondansetron as anti-emetics like
prescribed should ondansetron as
be administered prescribed

- The client for -Assist &

surgical /invasive prepare the
treatment should client for
be assisted surgical
/invasive
- The client should treatment
be kept in NPM
status
-Administered
- Laxative s as laxative s as
prescribed should prescribed
be administered

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data: Acute pain To - The -Assess the Child pain was
Change in related to reduce precipitating precipitating relieved as
bowel habits the pain, factors ,type factors ,type,qual evidenced by
like alternative accumulati abdomin quality, ity,intensity & decreased in pain
constipation & on of air, al girth intensity & severity of pain score & abdominal
diarrhea,decrea food & & severity of -Monitor pain girth & healing or
sed food & fluid fluids in the regular pain should be score & surgical wound
intake, intestinal bowel assessed abdominal girth
indigestion & lumen sounds regularly
regurgitation ,a causing & bowel - Pain score & -Insert NG tube
norexia, nausea inflammatio pattern abdominal or long intestinal
& n& girth regularly tube & connect
vomiting ,weak perforation should be to continuous
ness, lethargy secondary monitored aspiration
& drowsiness , to the --Provide a
abdominal intestinal - Mother for comfortable bed
bloating & obstruction NPM to the with extra pillow
distension ,dryn baby until to support the
ess moth & obstruction is pain site
mucus treated &
membrane administer -Provide calm &
total quite
parenteral environment &
nutrition as avoid unwanted
prescribed noises
Objective data: should be
Child look like advice -Administer
dull, sad & Proton Pump
depressed, - Comfortable Inhibitor &
presence of bed with extra antacid as
surgical pillow to prescribed
incision, support the
abdominal girth pain site -Administer
increased , pain should be analgesics as
score provide prescribed
increased,
irregular bowel - calm & quite -Administer
sound, vital environment antibiotics as
signs show & avoid prescribed
hyperthermia, unwanted
tachycardia, noises should -Provide
be provide psychological
support
- analgesics as
prescribed
should be
administered

- antibiotics as
prescribed
should be
administered

- the surgical
site for
infection,
bleeding ,colo
r change etc.
& provide
surgical
dressing
following strict
 aseptic
technique
should be
monitored
-
psychological
support
should be
provide

Nursing Care Plan on Day 2: 28/11/23

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data: Deficient To reduce - The -Assess the Client’s
Change in bowel fluid fluid frequency, frequency, fluid
habit like volume volume consistency of consistency of volume
alternative related to deficit Bowel pattern Bowel pattern and status was
constipation & Malabsorpti related to and signs of signs of Nausea/ improved
diarrhoea, on of food Malabsorpti Nausea/ vomiting as
Decreased Food and fluids on of food vomiting should evidenced
& Fluid Intake secondary and fluids be assessed -Monitor the client by normal
Indigestion & to the secondary regularly for s/s of Intake
Regurgitation narrowed to the - The client dehydration output
Anorexia, Intestinal narrowed regularly for s/s balance &
Nausea & lumen Intestinal of dehydration -Monitor the absence of
Vomiting lumen should be weight & I/O chart nausea &
Weakness, monitored daily vomiting
drowsiness
lethargy - The weight & -Monitor the vital
&Abdominal I/O chart should Signs &
bloating & be daily hemodynamic
Distension monitored parameters
Dryness of regularly
Mouth & Mucus - The vital Signs
membrane & - Administer Anti-
hemodynamic emetics as
Objective data: parameters Prescribed
regularly should
Nil per Oral be monitored -Observe for signs
Status of Overt bleeding
Weight - For signs of in stools
Decreased Overt bleeding
I/O Chart show in stools -Advice the client
decreased fluid should be on the need for
intake & observed NPO status and
decreased Urine administer Total
Output - The client on Parenteral
Abdominal girth the need for Nutrition as
Increased NPO status Prescribed
Irregular Bowel should be
Sounds Poor advice and -Assess the need
Skin Turgor & administer Total for blood
Elasticity Parenteral transfusion in case
Vital Signs show Nutrition as of bleeding &
hyperthermia, Prescribed transfuse blood, if
tachycardia & necessary
hypotension - The client on
Presence of foul the need for -Advice the client
smelling Invasive on the need for
vomitus treatment and Invasive treatment
Placed on provide in and provide in
Continuous NG information that information that
Aspiration there may be a there may be a
Stool exam need for need for
show overt temporary or temporary or
bleeding permanent permanent
Abdominal X-ray colostomy, colostomy, Post-
detects the Post-operatively operatively
presence of gas should be
& fluids proximal advice
to the
obstruction
Barium Enema
locates the
presence of
small or large
bowel
obstruction

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data: Acute pain To - The -Assess the Child pain was
Change in related to reduce precipitating precipitating relieved as
bowel habits the pain, factors ,type factors ,type,qual evidenced by
like alternative accumulati abdomin quality, ity,intensity & decreased in pain
constipation & on of air, al girth intensity & severity of pain score & abdominal
diarrhea,decrea food & & severity of -Monitor pain girth & healing or
sed food & fluid fluids in the regular pain should be score & surgical wound
intake, intestinal bowel assessed abdominal girth
indigestion & lumen sounds regularly
regurgitation ,a causing & bowel - Pain score & -Insert NG tube
norexia, nausea inflammatio pattern abdominal or long intestinal
& n& girth regularly tube & connect
vomiting ,weak perforation should be to continuous
ness, lethargy secondary monitored aspiration
& drowsiness , to the --Provide a
abdominal intestinal - Mother for comfortable bed
bloating & obstruction NPM to the with extra pillow
distension ,dryn baby until to support the
ess moth & obstruction is pain site
mucus treated &
membrane administer -Provide calm &
total quite
parenteral environment &
nutrition as avoid unwanted
prescribed noises
Objective data: should be
Child look like advice -Administer
dull, sad & Proton Pump
depressed, - Comfortable Inhibitor &
presence of bed with extra antacid as
surgical pillow to prescribed
incision, support the
abdominal girth pain site -Administer
increased , pain should be analgesics as
score provide prescribed
 increased,
irregular bowel - calm & quite -Administer
sound, vital environment antibiotics as
signs show & avoid prescribed
hyperthermia, unwanted -Monitor the
tachycardia, noises should surgical site for
be provide infection,
bleeding ,color
- analgesics as change etc. &
prescribed provide surgical
should be dressing
administered following strict
aseptic
- antibiotics as technique
prescribed
should be -Provide
administered psychological
support
- the surgical
site for
infection,
bleeding ,colo
r change etc.
& provide
surgical
dressing
following strict
aseptic
technique
should be
monitored
-
psychological
support
should be
provide

Nursing Care Plan on Day 3: 29/11/23

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data: Imbalance To - the Nutritional Assess the Nutritional Child
Anorexia d nutrition mainta Status & Nutritional Status & Nutritional nutritional
Nausea & less than in needs of the client needs of the client status is
vomiting body nutriti should be assessed improved as
requireme on - the weight & BMI -Check the weight & BMI evidenced by
Dyspepsia, nt related of the client of the client regularly increased
Indigestion & to regularly weight & BMI
Heart Burns indigestio Should be checked -Measure the Abdominal & ability to
Inability to pass n& - the Abdominal girth and percuss the tolerate food
gas trapping girth and percuss abdomen to monitor for
Abdominal of food & the abdomen to fluid thrill or Ascites
bloating fluids in monitor for fluid
distension & the thrill or Ascites -Insert NG tube and put
Borborygmi narrowed Should be it on continuous T
proximal intestinal measured Aspiration
obstruction to lumen - IV Fluids with
the Multivitamin -Administer IV Fluids
supplements as with Multivitamin
Objective data: Prescribed should supplements as
be administered Prescribed
Weight- - Total Parenteral
Decreased Nutrition as - Instruct the client and
BMI- Prescribed significant others on the
underweight Should be Importance of Surgical
abdominal girth administered Intervention and a
Increased - The client and Prepare & Assist the
Abdominal significant others client for the Procedure
palpation shows on the Importance
tender & of Surgical -Inform the client on the
distended Intervention and a need for temporary or
Abdomen Prepare & Assist permanent post-
I/0 Monitoring the client for the operatively and educate
shows Procedure the client to consume
decreased Should be well-cooked boiled t and
Intake instructed smashed foods & avoid
St - The client on the fatty foods, dairy
ol for Occult need for temporary products & foods with
blood positive or permanent post- high fibre content while
Presence of operatively and on colostomy
Aspiration educate the client
Continuous NG to consume well- -Administer Antiemetics
Imposed NPO cooked boiled t and like Ondansetron as
status smashed foods & Prescribed
Abdominal X- avoid fatty foods,
ray detects the dairy products & -Monitor the Electrolyte
presence of gas foods with high values & correct
& fluids fibre content while Electrolytes as needed
proximal to the on colostomy Advice the client to eat
obstruction should be informed small & frequent To
- Antiemetics like meals around 6-8
Ondansetron as servings a day, once
Prescribed should oral be Intake is
be administered tolerated
- Electrolyte values
& correct
Electrolytes as
needed
Advice the client to
eat small &
frequent To meals
around 6-8
servings a day,
once oral be Intake
is tolerated
Should be
monitored

Assessment Diagnosis Goal Planning Implementation Evaluation

Subjective data : Ineffective To -Breath sound - Breath sound The
irritable , chest air way reduce should be is ausculted respiratory
tightness, clearance cough ausculted -Assess the pattern is
cough ,Respirator related to -Assess the respiratory normal by
y distress chest respiratory characteristics airway
tightness, characteristics of of cough is clearance.
Objective data: cough cough should be observed
Respiratory rate - observed -4-5 glass of
40bpm, -4-5 glass of warm fluid
warm fluid with with more of
more of water water is given
should be given -Steam
-Steam inhalation is
inhalation should given
be given -Nebulization
-Nebulization is given
should be given -Moist O2 is
-Moist O2 should administered
be administered -
-Bronchodialator Bronchodialat
should be given or is given

Frequent Knowledg To
questioning by e deficit increase Family Knowledge
mother of child, related to knowled members level is
anxiety & stress disease ge level questions Knowledge improved
process & should be level of the than
treatment listened patient is previous
as attentively & assessed
evidenced answer should -Answer is
by patient be given given
family according to -Health
members their education is
frequent understanding given about-
questionin level 1)To give
g proper care
-Health of wound
education
should be 2)To take
given adequate
amount (2
-Knowledge lit/day) of
level of the water
patient should
be assessed 3)To take
high
carbohydrat
e protein &
fat
containing
diet

4)For follow
up check up

5)To notice
any sign &
symptoms of
infection
early &
inform
Disease prognosis:
About 5% to 30% of people with small intestinal obstruction die within 30 days, according to
a 2022 study. The rate is between 10% and 20% for large bowel obstruction.
Day to day report of child:

Parameters 28/11/23 29/11/23 30/11/23

Outlook Alert Alert Alert
Physical examination Abdominal distension Abdominal distension Reduce abdominal
distension
Vital signs T-98.8°F T-98.6°F T-97.8°F

P-106 bts/min P-100 bts/min P-108 bts/min

R-32 brths/min R-36 brths/min R-32 brths/min

BP-90/60 mm hg BP-96/64 mm hg BP-90/62 mm hg

Medication 1)IVF RL:DNS(1:1) 1)IVF RL:DNS(1:1) Same as before
800 ml in 24 800 ml in 24
hourly hourly
2)Syp.PCM (250 2)Medicine :
mg) given
Inj.Pipzo(800mg)
IV 8 hourly
Inj. Ondem( 5
mg)IV 12 hourly
Inj. Amikacin
(120mg) IV OD
Inj MVI + KCL-
1 ml in each 100
ml ½ DNS
Inj Rantac( 5
mg )IV 12 hourly
Investigation USG of whole ------------ ----------------
abdomen -Ileo-
illeal
intussusception
with a small
echogenic soft
tisuue lesion at
tip of
intussusception

Nutrition NPM NPM Liquid diet are given

Sleeping pattern Sleep is disturbed Sleep is disturbed Sound sleep
Elimination pattern Urine passed stool not Urine passed stool not Urine passed & very
passed passed small amount loose
stool passed
SUMMARY:
Patient Falguni Bari, a 3-year-old boy, was admitted with pain abdomen and not passing stool
for 7 days as the chief complaint. During admission had history of nausea vomiting with
abdominal distension and tenderness. USG of whole abdomen -Ileo-illeal intussusception
with a small echogenic soft tisuue lesion at tip of intussusception , intussusception , resection
of polyp in small bowel & primary anastomosis is done.
After operation child was more active, irritation is subside and abdominal tenderness and
distension is reduced.

Conclusion:
Small intestinal obstruction included gastrointestinal disorder some times
identified as severe disease ,many people are affected as severe
disease ,many people are affected due to maintaining careless or
unhygienic life style . people should be aware about this. If they are
already affected ,they should given medical therapy . but it may severe
from then surgery may done to out come from this disease & maintain a
healthy life style .
Bibliography :
1) Pal Panchali ; Text book of pediatric Nursing , 2 ND Edition , CBS Publishers ,
Pp – 280-282

2) Dutta Parul , Pediatric Nursing , 2 nd Edition , Jaypee Publishers, Pp- 301-

302

3) Brunner & Suddarth’s ,Text book of medical surgical nursing ,12 th

Edition,volume -2 , Pp-1096-1108

4) Lowis Sharma , Lowis medical surgical nursing ,Elsevier , a division of India

, private limited ,Pp-1069-1088