Preoperative Nursing Actions for Hirschsprung Disease
The most appropriate nursing action before surgery for Hirschsprung disease is to prepare for IV fluids (Option D), as patients require bowel decompression and fluid management rather than enemas or high-fiber diets that would worsen obstruction.
Why IV Fluids Are Essential
Patients with Hirschsprung disease have functional bowel obstruction due to absent ganglion cells preventing normal peristalsis, requiring IV hydration and electrolyte management preoperatively 1, 2.
Preoperative fluid management is a core component of enhanced recovery protocols for gastrointestinal surgery, with IV fluids maintained until oral intake can be safely resumed postoperatively 3.
Infants with Hirschsprung disease commonly present with poor feeding, vomiting, and abdominal distension, making them at high risk for dehydration and electrolyte abnormalities that must be corrected before surgery 1.
Why the Other Options Are Incorrect
Option A: Clear Enemas Are Contraindicated
Enemas should NOT be administered routinely before Hirschsprung surgery as they can worsen distension and increase risk of perforation in an already obstructed bowel 1.
While some centers use trans-anal irrigation as preoperative management, this is a specialized technique performed under specific protocols, not a standard nursing action with clear enemas 4, 5.
Option B: High-Fiber Diet Is Dangerous
High-fiber diets are absolutely contraindicated in Hirschsprung disease as they worsen functional obstruction by adding bulk to an already non-propulsive bowel 1, 2.
Patients typically present with poor feeding and inability to tolerate oral intake, making dietary interventions inappropriate preoperatively 1.
Option C: Nasogastric Tube May Be Indicated But Is Not Universal
Nasogastric tube insertion is recommended for gastric decompression in patients with significant abdominal distension, vomiting, or when bowel obstruction symptoms are severe 6.
However, routine NGT placement is not recommended for all surgical patients according to enhanced recovery protocols, which state "avoid nasogastric tubes and drains" unless specifically indicated 3.
NGT placement would be appropriate for symptomatic relief in cases with severe distension or vomiting, but IV fluid preparation is the more universal preoperative requirement 6.
Comprehensive Preoperative Nursing Approach
Immediate Priorities
Establish IV access and begin fluid resuscitation to correct dehydration and electrolyte abnormalities 3.
Monitor for signs of enterocolitis (fever, bloody diarrhea, explosive stools, lethargy) as this occurs in up to one-third of patients and significantly increases mortality 1, 2.
Assess nutritional status as many infants present with poor weight gain and may require preoperative nutritional optimization 3.
Additional Nursing Actions
Insert NGT only if patient has significant vomiting or abdominal distension requiring decompression 3, 6.
Avoid mechanical bowel preparation as routine bowel prep should be omitted in gastrointestinal surgery and is particularly dangerous in obstructed bowel 3.
Maintain NPO status with clear documentation of fasting times (clear fluids until 2 hours before surgery, solids until 6 hours before) 3.
Common Pitfalls and How to Avoid Them
Never administer enemas or laxatives thinking they will "clean out" the bowel—this worsens obstruction and can cause perforation 1.
Do not delay IV fluid resuscitation while waiting for other interventions; dehydration correction is the priority 3.
Watch closely for enterocolitis development even after diagnosis, as this is the leading cause of mortality and requires immediate intervention with IV antibiotics and aggressive decompression 1, 2.
Recognize that preoperative optimization may take days to weeks in severely malnourished patients, and surgery should not be rushed if nutritional support is needed 3.