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

Priority Nursing Action for Intussusception

The priority nursing action for a child with intussusception is to start IV fluids (Option A) to stabilize the child hemodynamically before definitive treatment.

Rationale for Immediate IV Fluid Resuscitation

Intussusception is a surgical emergency where one segment of bowel telescopes into an adjacent segment, leading to obstruction, vascular compromise, ischemia, and potential necrosis 1, 2. The condition requires immediate stabilization before any definitive intervention can be attempted.

Why IV Fluids Are the Priority

• Hemodynamic instability is common: Children with intussusception frequently present with vomiting (leading to dehydration), lethargy, and potential sepsis-like presentations, requiring immediate fluid resuscitation 3.

• Adequate preoperative preparation is essential: Studies demonstrate that adequate preoperative preparation, including fluid resuscitation, is associated with 100% survival rates, while delays in diagnosis and inadequate preparation lead to significant morbidity 3.

• Stabilization precedes all interventions: Whether the child will undergo non-operative reduction (hydrostatic/pneumatic enema) or surgical intervention, hemodynamic stability must be achieved first 2, 4.

Why Other Options Are Incorrect

Option B: Give Laxative

• Absolutely contraindicated: Administering a laxative to a child with bowel obstruction from intussusception could cause perforation, peritonitis, and death 2.
• Intussusception causes mechanical obstruction with vascular compromise, not constipation 1, 4.

Option C: Prepare for Surgery

• While surgery may ultimately be necessary (especially if non-operative reduction fails or if there is perforation, peritonitis, or pathologic lead point), stabilization with IV fluids must occur first 2, 3.
• Patients who are stable without evidence of perforation should first attempt non-operative reduction after stabilization 2.

Option D: Encourage Oral Fluids

• Contraindicated in bowel obstruction: The child likely has complete or near-complete obstruction and will not tolerate oral intake 2, 3.
• Oral fluids increase the risk of aspiration, especially given that many children present with altered mental status or lethargy 2.

Clinical Approach After IV Fluid Initiation

Once IV access is established and fluid resuscitation begun:

1. Maintain NPO status (nothing by mouth) due to bowel obstruction 2, 3.

2. Obtain diagnostic imaging: Ultrasound is the diagnostic modality of choice, showing the characteristic "target sign" or "pseudokidney sign" 2.

3. Assess for surgical emergencies: Look for signs of perforation (peritonitis, free air on imaging) or hemodynamic instability that would require immediate operative intervention 2, 4.

4. Determine treatment approach:

   • Non-operative reduction (hydrostatic or pneumatic) if stable, no perforation, and symptoms <48 hours 2, 3
   • Surgical intervention if unstable, peritonitic, evidence of perforation, or pathologic lead point identified 2, 4

Critical Pitfalls to Avoid

• Never delay IV access and fluid resuscitation to obtain imaging or prepare for other interventions 3.
• Never give laxatives or encourage oral intake in suspected bowel obstruction 2.
• Do not assume the classic triad (abdominal pain, currant jelly stool, palpable mass) will be present—it is uncommon, and younger patients may present atypically with lethargy or altered mental status 2, 3.
• Recognize that delays in diagnosis and treatment result in significant morbidity and mortality, with symptoms present >48 hours associated with higher failure rates of non-operative reduction 3.