What is the priority nursing action for a patient with intussusception?

Priority Nursing Action for Intussusception

The priority nursing action is A: Start IV fluids, as fluid resuscitation is the essential first step to restore intravascular volume and promote physiological stability before any definitive intervention can be safely undertaken. 1, 2

Rationale for IV Fluid Resuscitation as Priority

• Intussusception is a surgical emergency where bowel telescoping leads to obstruction, mesenteric strangulation, ischemia, and potential necrosis 3
• Hemodynamic stabilization must precede all other interventions, including surgical preparation, as patients often present with volume depletion from vomiting, poor oral intake, and third-spacing of fluids 1, 2
• Fluid resuscitation is necessary to restore intravascular volume before the patient can safely undergo either non-operative reduction attempts or surgical exploration 1

Why Other Options Are Incorrect

Option B: Give Laxative

• Laxatives are absolutely contraindicated in bowel obstruction, as they can worsen the obstruction, increase intraluminal pressure, and precipitate perforation 4, 5
• Intussusception causes mechanical obstruction that cannot be relieved by stimulating peristalsis 4

Option C: Prepare for Surgery

• While surgery is the definitive treatment for most adult intussusception cases 1, 2, 4, surgical preparation cannot proceed safely without first establishing IV access and initiating fluid resuscitation 1
• The patient must be hemodynamically stable before anesthesia and surgical intervention 1, 2

Option D: Encourage Oral Fluids

• Oral fluids are contraindicated in bowel obstruction due to risk of aspiration from vomiting and worsening of bowel distension 4, 5
• Patients with intussusception commonly present with vomiting (36-49% of cases) and require NPO status 6

Clinical Context and Timing

• Intussusception presents with intermittent colicky abdominal pain, vomiting, and potentially bloody stools 7, 6
• Mortality increases significantly when surgical intervention is delayed beyond 48 hours 1, 2
• 72% of adult patients present with abdominal pain, 49% with nausea, and 36% with vomiting, indicating significant fluid losses 6
• Surgical consultation should be obtained in all cases even while initiating fluid resuscitation 1, 2

Immediate Nursing Algorithm

1. Establish large-bore IV access and begin fluid resuscitation immediately 1, 2
2. Keep patient NPO (nothing by mouth) 4, 5
3. Notify surgeon immediately for consultation 1, 2
4. Initiate antimicrobial therapy once diagnosis is confirmed or suspected 1
5. Monitor for signs of peritonitis, hemodynamic instability, or clinical deterioration requiring emergent surgical intervention 1, 2