MM COLLEGE OF NURSING

CASE STUDY
ON
INTESTINAL OBSTRUCTION
BIOGRAPHIC DATA

Name of patient : Master vansh

Age : 8 years

Sex : Male

Date of admission : 10-4-2019

Ward : Paediatric surgery ward

IPD No : 1904070033

Diagnosis : intestinal obstruction

Name of surgery : Laparotomy

Date of surgery : 11-4-2019

Started care : 12-4-2019

End of care : 17-4-2019

Duration : 5 days

Address : Vill. Saharanpur , Uttar Pradesh India

Religion : Hindu

Education : 1tst standard

 Monthly Income of family : Rs. 7,000/month

HISTORY

1. CHIEF COMPLAINTS-

Master Vansh come in M.M.I.M.S.R hospital Mullana with parents with chief complaints of –

 Abdominal pain from 1 days

 Vomiting 1 episode

3. HISTORY OF PRESENT ILLNESS

Present medical history :According to child’s mother the child was apparently well 1 days back when he developed pain in abdomen which
was acute in onset, non radiating, severe in intensity over the entire abdomen .

Present surgical history: child undergone Exp. laparotomy on for intestinal obstrustion under general anaesthesia.

4.HISTORY OF PAST ILLNESS:

Past medical history: No history of any illness in past.

Past surgical history: No past surgical history.

Trauma : There is no history of any kind of fractures and lacerations.

5. BIRTH HISTORY :G2 P2 A0 L2

Maternal health during pregnancy: There is no history of any kind of bleeding, trauma, hypertension, fever etc. during pregnancy.

Antenatal history: Mother was not antennal registered in 1st trimester, normal symptoms throughout gestation, immunized to TT, folic acid
started from 9 weeks of gestation.
Natal history:

 full term normal vaginal delivery at complete 38 weeks of gestation.

 Baby cried soon after birth
 Home delivery
Neonatal history :

There were no complications in baby during neonatal period.

6. IMMUNIZATION HISTORY: Immunized to BCG only as evidenced by parents and BCG marks present on upper left arm but no
records present.

7. DIETARY / FEEDING HABITS-

A. TYPE OF FEEDING AFTER BIRTH: only breast feeding upto 6 months

B. AGE OF WEANING: Weaning started at the month of 7. Weaning started with dal, soup, bananas.

C. CURRENT DIET- Dal, roti, juice, egg

D. EATING HABITS- Non vegetarian

8.GROWTH AND DEVELOPMENT

a) School- Child is studying in 7th standard and have no problem in intracting with peer.
b) Behaviour- There is no behavioural problem in child.
 c) Language- Child started saying 1st words at 7 month of age.

9.PERSONAL HISTORY

A. Personal hygiene

Oral hygiene- child brushes his teeeths once a day.

Bath- child takes bath once a day.

B.Diet-child is non vegetarian.

No of meals per day- child takes meal thrice a day.

2. FAMILY HISTORY

NAME AGE/SEX RELATION EDUCATION OCCUPATION INCOME HEALTH STATUS

WITH CHILD
Manish 35Yr/Male Father 10 th passed labourer 5000/per Healthy
month
Soma 30Yr/Female Mother 6th House wife - Healthy
Vansh 8Yr/Male Patient 1st Studying - UnHealthy
Aryan 5 Yr/Male Brother - - - Healthy
FAMILY TREE

Mr. Manish Mrs. Soma

35years 35years

Vansh(8 yr) Aryan (5yr)

KEYS-

- Male `

- Female

- Patient

SOCIO-ECONOMIC HISTORY
 - Family class –lower middle class

- Income source- father only

- Per capita income= total income/ number of members

7000/7 = 1,000/ capita

- Housing – own house ,pakka house

- Water supply- limited hours

- Disposal- open waste disposal

HISTORY OF ANY HEREDITARY DISEASE-

No history of any hereditary disease like HTN, DM etc

3. PHYSICAL ASSESSMENT-
a. General appearance

Sensorium – Alert and conscious

Emotional state- Anxious

Activity- Active

Foul body odour- Not present

Foul breath- Not present

Body Build- Thin

Grooming- Well groomed

Nourishment- Well Nourished

Posture- Normal

Gait- Normal

b. Anthropometric assessment

Height – 118c.m

Weight – 19.5kg

Mid arm circumference- 18cm

a. VITAL SIGNS-

DATE TEMPERATURE PULSE RESPIRATION BP

10-11-17 98.40F 98/min 28/min 120/70mmHg

11-11-17 1000F 98/min 24/min 110/70mmHg

12-11-17 99.2oF 92/min 26/min 130/80mmHg
 b. HEAD TO TOE EXAMINATION-

General appearance

 Health- looks unhealthy

 Built - weak and lethargic
 Behaviour pattern - irritable as observed whenever talking
 Mental alertness – alert as evidence by asking question related to orientation

Skin

 Colour- Brown
 Lesion – no lesion present
 Scar -noscar present on skin
 Edema- no edema present
 Birthmark – not present

Hair

 Colour- light brown

 Alopecia- not present
 Distribution- equal distribution
 Dandruff – not present

Nails

 Shape- normal, no clubbing

 Colour- slightly pink
Lymph node

 Neck- no enlargement
 Axillary- no enlargement
 Inguinal- no enlargement

Head

 Fontanels- anterior and posterior both close

Face

 Edema- Absent
 Palsies- normal symmetrical movements

Eye

 Shape- Normal
 Colour- Normal, no redness
 Movements- Symmetrical, normal eye movement and eye coordination
 Eyelids- Normal scaling
 Eyelashes- Sticky eyelashes, equal distribution of hairs
 Conjunctiva – Normal, no inflammation
 Pupil – Normal reaction to light and accommodation
 Vision – Normal

Ear
 Alignment – Normal
 Discharge- No discharge
 Swelling- Not present
 Wax- Present
 Hearing- Normal

Nose

 Symmetry- Normal
 Discharge- Not present, clear nostrils
 Septum- Normal, no deviation
 Mucous – Intact
 Nasal flaring- Not present

Throat and neck-

 Neck movement- Normal movement in both left and right side

 Lymph node – No enlargement of lymph node

Mouth

 Lips – No dryness over lips, no chelosis

 Teeth – Hygiene maintain, no cavity formation, no caries, white in colour
 Tongue – Slightly pink, no coating, no ulcer
 Gums – Pinkish, no sign of bleeding
 Palate – No coating, flat arch

Chest/lungs

 Nipple – No tenderness, in an alignment

  Symmetry – Symmetrical chest movement
 Breath pattern – Regular, normal expansion of chest
 Sound –Normal bilateral sound, no murmur

Abdomen

 Inspection- Abdominal distension present

 Auscultation- Bowel sound not audible

Rectum and anus

 No polyp, no bleeding , fistula or fissure not present

Genitalia

 No any abnormality present

Musculoskeletal

 Upper limbs- Normal movements , normal shape , no clubbing of fingers

 Lower limbs – No arch deviation, gait not properly maintained( due to heaviness of body), flexion and extension of limb
normal

Neurological

NEUROLOGICAL EXAMINATION

 Cerebral –Oriented to time place and person

 Muscles- Good muscle tone
Muscle strength
Normal flexion and extension of muscles when resistance applied

c. INVESTIGATIONS

Date Investigations Patient’s value Normal values

10-4-2019
Haemoglobin 12.2gm% 13-17gm%
Platelets 2.8lakh/mm3 1.5-4.5lakh/mm3
TLC 4.0×1000/cumm 4-10×1000/cumm
Polymorphs 60% 40-70%
Date Lymphocytes
Investigations 36%
Patient’s value 20-45%
Normal values
Eosinophil 02% 01-06%
10-4-2019 Urea 14mg/dl 18-40mg/dl
Monocyte 02% 02-10%
Creatinine 0.44mg/dl 0.7-1.2/dl
Potassium 5.2 MEq/L 3.5- 5.5 mEq/L
Sodium 145 mEq/L 135-145 mEq/L
13-4-2019 HB 12.6 gm% 13-17gm%

Urea 16mg/dl 18-40mg/dl

Creatinine 0.41mg/dl 0.7-1.2/dl
Potassium 3.6MEq/L 3.5- 5.5 mEq/L
Sodium 138mEq/L 135-145 mEq/L
 d. MEDICATION

Date Name of Dose Frequency Route Action Nurse’s responsibility

medication
19-10-16 Inj. Tazact 2.25gm BD IV Antibiotic Minimize patient discomfort,
by slowly inject the drug

Inj.Amikacian 300mg BD IV Antibiotic Minimize patient discomfort,

by slowly inject the drug

Inj. Pantaprazole 20mg OD IV Proton Pump Should be given atleast half an

inhibitor hour before meal

Inj. Kabipara 300mg 6thhrly IV Antipyretics Check the temperature after

given the medicine

ANATOMY AND PHYSIOLOGY OF GI TRACT

The gastrointestinal tract or GI tract, is a set of organs, beginning in the mouth and ending in the anus, that processes the food that we eat, from
its intake till its eventual expulsion after digestion. The GI tract is present in all multicellular animals. However, it can differ drastically from
animal to animal.

The gastrointestinal tract in humans begins at the mouth, continuing through the oesophagus, stomach, small and large intestines. Taken as a
whole, the GI tract is about 9 meters in length. There are many supporting organs as well, such as the liver, which helps by secreting enzymes
that are necessary for the digestion of food.

The human GI tract can be divided into two halves, namely, the upper GI tract and the lower GI tract.
The organs of the upper GI tract are:

Esophagus- It is a muscular tube that carries food from the mouth to the stomach. Once the food reaches the esophagus, the action of swallowing
becomes involuntary and is controlled by the esophagus.

Stomach- This is where most of the digestion takes place. The stomach is a J-shaped bag-like organ that stores the food temporarily, breaks it
down, mixes and churns it with enzymes and other digestive fluids and finally, passes it along to the small intestine.

The lower GI consists of the following organs:

Small intestine- The small intestine is a coiled thin tube, about 6 meters in length, where most of the absorption of nutrients takes place. Food is
mixed with enzymes from the liver and the pancreas in the small intestine. The walls of the small intestine absorb the nutrients from the food
into the bloodstream, which carries them to the rest of the body.

Large Intestine- The large intestine, also known as the Colon, is a thick tubular organ wrapped around the small intestine. The primary function
of the large intestine is to process the waste products and absorb any remaining nutrient and water back into the system. The remaining waste is
then sent to the rectum and discharged from the body as stool.
 DISEASE CONDITION

INTESTINAL OBSTRUCTION

Introduction:-Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon).
Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery, an inflamed intestine
(Crohn's disease), infected pouches in your intestine (diverticulitis), hernias and colon cancer.

Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal
obstruction often can be successfully treated.

TYPES OF INTESTINAL OBSTRUCTION

Type I:  The Complete Intestinal Obstruction:-

In a “Complete Obstruction, the colon will be completely kinked, twisted or blocked off from blood supply.  This condition mandates immediate
surgery.

Type II:  Partial Intestinal Obstruction:

A bowel obstruction may also be “partial,” in which case the bowel is not completely blocked off, but only partially obstructed.  This condition
might also be treated with a few days of “bowel rest.”

Re-booting the Bowel With Bowel Rest

In the hospital, the technique of bowel rest requires that any food in the stomach is drained.  The patient is NPO, which means he or she does not
eat.  Intravenous fluids are given to stay hydrated. Sometimes, within a few days things can open up and start moving along. Thus, no surgery is
needed.  He added, “Patients can respond and do very well.

Intestinal Obstruction:  When “Bowel Rest” Fails

However if the “bowel rest” is ineffective or bowel tissue starts to die because of the blockage, then surgery to untwist kinked bowel or remove
blockage is the only recourse.  During surgery the surgeon will remove the affected part of the bowel. depending upon your disease or condition,
you might need to have a colostomy or an ileostomy.  In bowel surgery, after the obstructed, diseased or “dead” part of the intestine is removed,
sometimes the ends are sewn together, and the bowel “pinks up” nicely

Type III: 3.  Pseudo-obstruction:  A Wolf in Sheep’s Clothing!

At times a patient will exhibit bowel obstruction symptoms but x-rays reveal no true blockages.  This is called intestinal pseudo-obstruction.

In such cases, nerves or muscles fail to move food properly.  “Treatment may involve ingesting liquid food through a feeding tube or
intravenously.”

Other type:-
Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract. Three types of
processescan impede this flow:

• M e c h a n i c a l o b s t r u c t i o n : a n i n t r a l u m i n a l o b s t r u c t i o n o r a m u r a l obstruction from pressure on the abdominal wall. The

lumen of thebowel is blocked due to incarceration, strangulation, neoplasm or  volvulus, intussusceptions, polpypoid tumors,
stenosis,strictures,a d h e s i o n s , h e r n i a s , a n d a b s c e s s e s . C r a m p y a b d o m i n a l p a i n i s typical; inability to pass stools is
always noted. Vomiting is usually p r e s e n t . T h e a b d o m e n i s d i s t e n d e d w i t h h y p e r a c t i v e p e r i s t a l s i s .

• Functional obstruction:The intestinal musculature cannot propel the contentalong the bowel. The blockage can be temporary and the result
of manipulation of the bowel during surgery. Paralyticileus, obstruction is due to inhibition of intestinal motility: Vomitingand intractable
constipation are common symptoms. Peristalsis is m a r k e d l y d i m i n i s h e d o r a b s e n t . T h e a b d o m e n i s d i s t e n d e d a n d may or
may not be tender.

•Vascular obstruction: The most common causes are mesentericartery occlusion and mesenteric vein thrombosis. Patients areusually elderly.
There is sudden onset of severe abdominal pain,vomiting, diarrhea, blood in stools and shock. The abdomen istender, peristalsis diminished or
absent.The obstruction can be partial or complete. Its severity depends on ther e g i o n of bowel affected, the degree to which lumen is obstructed
andespecially the degree to which the vascular supply to the bowel wall is destroyed

ETIOLOGY

Intussusception

The most common causes of intestinal obstruction are:

Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery

Colon cancer

In children, the most common cause of intestinal obstruction is telescoping of the intestine (intussusception).
Other possible causes of intestinal obstruction include:

Hernias — portions of intestine that protrude into another part of your body

Inflammatory bowel diseases, such as Crohn's disease

Diverticulitis — a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected

Twisting of the colon (volvulus)

Impacted feces

Other causes can include:

Abdominal or pelvic surgery

Infection

Certain medications that affect muscles and nerves, including tricyclic antidepressants, such as amitriptyline  and imipramine (Tofranil), and
opioid pain medications, such as those containing hydrocodone (Vicodin) and oxycodone (Oxycontin)

Muscle and nerve disorders, such as Parkinson's disease

Risk factors

Diseases and conditions that can increase your risk of intestinal obstruction include:

Abdominal or pelvic surgery, which often causes adhesions — a common intestinal obstruction

Crohn's disease, which can cause the intestine's walls to thicken, narrowing the passageway

Cancer in your abdomen, especially if you've had surgery to remove an abdominal tumor or radiation therapy
 PATHOPHYSIOLOGY

Blockage in the large intestine

Accumulation of intestinalcontents, fluid, and gas proximalto the obstruction

Bowel distention

Secretory andabsorptive functions of the mucosa are depressed Venousobstruction&arterial occlusion

 Dehydration Infarction

Diagnostic evaluation:

Book picture Patient picture

 History and physical examination Done

 X Rays Not done
 USG Assessed in my patient
 CT scan Not done
 Air or barium enema Not done

Sign and symptoms:

Book picture Patient picture

 Severe bloating  Not present
 abdominal pain  Present in my patient
 decreased appetite  Present in my patient
 nausea  Present in my patient
  vomiting  Present in my patient
 Inability to pass gas or stool  Present in my patient
 constipation  Present in my patient
 diarrhea  Not present
 Severe abdominal cramps  Not present
 abdominal swelling  Present in my patient

Management:

Treating intussusception

A barium or air enema is used both as a diagnostic procedure and a treatment for children with intussusception. If an enema works, further
treatment is usually not necessary.

Treatment for partial obstruction

If child have an obstruction in which some food and fluid can still get through (partial obstruction), child may not need further treatment after
child have been stabilized. The doctor may recommend a special low-fiber diet that is easier for partially blocked intestine to process. If the
obstruction does not clear on its own, child may need surgery to relieve the obstruction.

Treatment for complete obstruction

If nothing is able to pass through intestine, the patient usually need surgery to relieve the blockage. The procedure will depend on what's causing
the obstruction and which part of your intestine is affected. Surgery typically involves removing the obstruction, as well as any section of your
intestine that has died or is damaged.

Alternatively, doctor may recommend treating the obstruction with a self-expanding metal stent. The wire mesh tube is inserted into colon via an
endoscope passed through mouth or colon. It forces open the colon so that the obstruction can clear.
Stents are generally used to treat people with colon cancer or to provide temporary relief in people for whom emergency surgery is too risky.
Child may still need surgery, once child condition is stable.

Treatment for pseudo-obstruction

The doctor determines that signs and symptoms are caused by pseudo-obstruction (paralytic ileus), he or she may monitor your condition for a
day or two in the hospital, and treat the cause if it's known. Paralytic ileus can get better on its own. In the meantime, you'll likely be given food
through a nasal tube or an IV to prevent malnutrition.

If paralytic ileus doesn't improve on its own, doctor may prescribe medication that causes muscle contractions, which can help move food and
fluids through your intestines. If paralytic ileus is caused by an illness or medication, the doctor will treat the underlying illness or stop the
medication. Rarely, surgery may be needed to remove part of the intestine.

In cases where the colon is enlarged, a treatment called decompression may provide relief. Decompression can be done with colonoscopy, a
procedure in which a thin tube is inserted into your anus and guided into the colon. Decompression can also be done through surgery.

Drug therapy

Book picture Patient picture

 Antibiotic  Inj. Tazact 2.25gm andInj.Amikacian (300mg)

 Antacid  Inj. Pantaprazole (20mg)
 Antipyretics  Inj. Kabipara (300mg)

Surgical Management:

 Surgical decompression
 Exporatorylaprotomy
 Caecostomy and caecopaxy
  Young elective sigmoid coleotomy
 Reducible intessusespetion
 Irreducible intessusespetion
 Surgical decompression

Nursing Management :

 Allow the patient nothing by mouth, as ordered.

 Insert a nasogastric tube to decompress the bowel as ordered.
 Begin and maintain I.V. therapy as ordered.
 Administer analgesics, broad spectrum antibiotics, and other medication, as ordered.
 Keep the patient in semi-Fowler’s or Fowler’s position as much as possible to promote pulmonary ventilation.
 Look for signs of dehydration.
 Monitor nasogastric tube drainage for color, consistency, and amount.
 Monitor intake and output.
 Monitor vital signs frequently.
 When administering medication, monitor the patient for the desired effects and for adverse reactions.
 Continually assess the patient’s pain.
 Monitor urine output carefully to assess renal function, circulating blood volume, and possible urine retention due to bladder compression
by the distended intestine.
 Teach the patient about his disorder, focusing on his type of intestinal obstruction, its cause, and signs and symptoms.
 Emphasize the importance of following a structured bowel regimen, particularly if the patient had a mechanical obstruction from fecal
impaction.

NURSING CARE PLAN

LIST OF PROBLEMS

S.NO PATIENT’S PROBLEM SOLVED NOT SOLVED PARTIALLY SOLVED

1 Child complaints of pain in surgical site YES
2 Child complains for fever YES
3 Child complains for discomfort during YES
sleeping
4 Child’s parents want to know about child’s
disease condition and treatment

NURSING DIAGNOSIS

1. Acute pain related to surgical incision as evidenced by pain scale.

2. Fluid volume deficit related to surgical intervention and NPO status as evidenced by intake output chart
3. Risk of infection related to altered immunity
4. Disturbed sleeping pattern related to pain at incision site as evidenced by fatigue during daytime.
5. Knowledge deficit related to condition of child as evidenced by question.
NURSING NURSING GOAL INTERVENTION RATIONAL IMPLEMENTATION EVALUATION
ASSESSMENT DIAGNOSE
Subjective data- Acute pain related to Reduce level of  Assess the post  Proper  Pain is assessed by Pain is reduced
Child says that he is surgical incision as pain. operative pain assessment help visual analogus to some extent.
having pain in evidenced by pain in children in quantifying scale.
incision site. scale. using pain pain and
measuring providing pain
tools. medication.

Objective data-  Check the  Help in  Pain is intense and

Child looks irritable, nature, prescribing radiating in nature.
restless. frequency and appropriate
quality of pain medication.

.
 Provide  Provide  Diversional therapy
diversional distraction from provided.
therapy. pain.

 Provide  Help in  Comfortable

comfortable reducing pain, environment is
environment. provided.

 Administer  Help in  Inj. Kabipara

pain relieving pain. 300mg IV is
medication. administered.
 Help in early
 Encourage recovery.  Early ambulation
early encouraged.
ambulation.
NURSING NURSING GOAL INTERVENTION RATIONAL IMPLEMENTATION EVALUATION
ASSESSMENT DIAGNOSE
Subjective data- Fluid volume Maintain  Assess B.P.  Helps in  B.P. – 110/70mm Hg Intake and
Child’s mother says deficit related to adequate fluid and pulse. checking the Pulse- 84b/min output chart
that child’s lips are surgical balance. status of child. shows that the
dry and child is intervention and adequate fluid
inactive. NPO status as  Inspect mucous  Assess the  Child is assessed for balance is
evidenced by intake membrane, condition of mucous membrane, skin maintained.
output chart. assess skin child. turgor and capillary
turgor and refill.
capillary refill.

Objective data-  Maintain intake  Assess the  Intake and output chart
Child looks dull, and output amount of fluid is maintained one
lethargic, and have chart hourly. loss. hourly.
poor skin turgor.
 Administer IV  Helps in  IV fluids and
fluids and maintaining electrolytes are
electrolytes. fluid balance. administered.

 Provide clear  Helps in  Clear liquids are

liquids when starting oral provided.
oral intake is diet.
resumed.

NURSING NURSING GOAL INTERVENTION RATIONAL IMPLEMENTATION EVALUATION

ASSESSMENT DIAGNOSIS
Subjective data- Risk of infection Reduce the  Practice and  Prevent  Handwashing is put in Chances of
Child mother says related to altered chances of instruct good transmission of practice. infection are
that child’s body immunity. infection in handwashing. infection. reduced to some
feel warm. patient and extent.
prevent  Inspect incision  Assess the site  Incision and dressing is
complication. and dressing. for redness and inspected.
swelling.

 Monitor vital  Temp. - 99°C

Objective data- signs.  Tells about the Pulse- 78b/m
Fever- 100°C condition of Resp.- 22b/m
 Administer child.
antibiotics.  Inj. Tazact 2.25gm
 Antibiotics are given.
necessary for
treating
antibiotics.
 Teach the use  Aseptic technique is
of aseptic  Aseptic used during dressing.
technique technique
during prevents
dressing. transmission of
infection.

NURSING NURSING GOAL INTERVENTION RATIONAL IMPLEMENTATION EVALUATION

ASSESSMENT DIAGNOSE
Subjective data- Disturbed sleeping Improve the  Provide calm  Calm  Calm environment is Sleeping pattern
Child’s mother says pattern related to sleeping pattern environment to environment provided to patient. of child is
that patient is pain at incision site of patient. patient. will help the maintained and
unable to sleep at as evidenced by child in now the child is
nights. yawning during sleeping. able to sleep for
daytime.  Visitors are not allowed 7-8 hours.
 Reduce visitors  Reducing during sleeping hours.
during sleeping visitors will
hours. minimize
Objective data- disturbance.  Tab. Alprex 0.5 mg is
Child looks lazy given to patient.
and yawns during  Provide  Sedatives
daytime. sedatives to the induce sleep.
patient.  Child is not allowed to
sleep during day.
 Avoid day time  Avoiding day
sleeping in time sleep will
child. help the child
to sleep during
night.
NURING NURSING GOAL INTERVENTION RATIONAL IMPLEMENTATION EVALUATION
ASSESSMENT DIAGNOSE
Subjective data- Knowledge deficit Improv the  Explain the  Explaining  Disease condition of Knowledge of
Child’s mother says related to condition knowledge of disease disease patient is explained to child mother is
that she want to of child as child’s mother. condition of condition will mother. improved.
know about the evidenced by child to help mother
child’s treatement question. mother. knowing
and his medication. condition of
child.

 It helps in  Mother is taught about

 Teach the preventing time, action and side
Objective data- mother about cessation of effects of medication.
Mother asks medication and medication.
question about its side effects.
child’s medicine
and condition.  For preparing  Mother is taught about
 Teach mother diet plan for the diet of child.
about the diet. child.

 Teach the  It will increase  Mother is taught about

mother about the confidence the reason for various
reasons for of mother and therapeutic procedures.
various will make her
therapeutic comfortable.
procedures.
 PROGRESS NOTES
DAY 1: Child’s pain relieved and fluid balance maintained.
DAY 2: Child’s body temperature maintained and fever alivated.
DAY 3: Child is able to go toilet himself and is feeling comfortable.

HEALTH EDUCATION-

Rest -
 To take atleast 10 hours of sleep ina day
 To prevent from fatigue ness

Nutrition
 Give high protein diet like chicken, egg, cereal, milk
 Take more liquids in diet

Medication
 Prevent cessation of medication in between
 Continue medication till prescription

Hygiene
 Maintain skin care
 Cut nails and maintain moisture of skin
 Medical help-
 Approach hospital whenever needed
 Early treatment help in survival

Follow up-
 Routinely follow up clinic

Activity
 Allow child to play as tolerated by child

PROGRESS NOTE:

DAY-1: on first day I look vital signs & I talk with the patient and maintained interpersonal relationship.
 Temperature- 100oF
 Pulse- 96/min
 Respiration- 26/min
 SPo2 – 99%
Patient vitals are not stable, patient was looking conscious and restless due to disease condition, All medication done ordered by
physician,

DAY-2: Now patient was having co-operative with staff and other, patient had fever and relived by medication, encourage He took
healthy diet, maintain urine output

DAY-3:Patient has followed the instructions regarding diet and personal hygiene and take medication on time, now patient is feeling
much better she is not having fever and pain, Input and output maintained. Give high protein diet like pea, egg, cereal, milk etc.
The child now relaxed and sleep quietly.
CONCLUSION:

Master Vansh suffering from hypospadias in Paediatric Surgery Ward , provide comfortable environment and provide personal hygiene care,
appropriate coping mechanism and help reduce anxiety, patient parent satisfied with my care.

ABSTRACT
Acute Abdomen; Pre and Post-Laparotomy Diagnosis

Background: Abdominal pain is a common presentation that requires almost immediate management. It is sometimes crucial to diagnose at the
earliest and make a decision as to operate. Therefore it is necessary for the physician to be familiar both with the presentations of common
causes of abdominal pain and the validity of diagnostic tests. Diagnosis of acute abdomen before laparotomy is essential in reducing the
morbidity and mortality while preventing from unnecessary operations especially where the diagnostic facilities are limited and clinical
awareness plays an important role in the diagnosis and management.

Objectives: This study attempted to compare pre and post-operative diagnosis in acute abdomen.

Materials & Methods: This was an observational study, conducted from February to December 2005. The study included 139 consecutive
patients referred to Sina hospital (Tehran, Iran) presented with symptoms of acute abdomen, operated to see the negative laparotomy rate, the
diagnostic accuracy and predictive values of different investigations in acute abdomen. Statistical analysis was performed using SPSS software
version 11.5. P value of < 0.05 was considered as a level of significance.

Results: All 139 patients with diagnosis of acute abdomen underwent emergency laparotomy. Acute abdomen was most common in the age
group 20-29 years with male predominance. Acute appendicitis (57.6%) was the most common cause of surgical condition, and then the most
common causes of acute abdomen were peritonitis (14.4%) and bowel obstruction (7.9%) in male and ovarian cyst torsion (24.5%) in female
patients. The negative laparotomy rate was 12.2% (P value < 0.05). In 77.7% of patients, the pre and post laparotomy diagnoses were the same.
The diagnostic accuracy rates in male and female patients were 92.2% and 79.6%, respectively. In our study granulocytosis had the highest
sensitivity (79.3%) and X-ray had the highest specificity (88.8%).The highest positive predictive value was related to ultrasonography (97.6%),
while urinalysis showed the highest negative predictive value (91%).
Conclusion: The decision to operate is based on the results of a good history and thorough physical examination(s) with the guidance of
investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can
avoid from unnecessary operations so reduces the rate of negative laparotomies.

BIBLIOGRAPHY

a. ParulDatta.Pediatric nursing.2nded.Jaypee brothers medical publisher;2009.p301-03.

b. AssumaBeevi.T.M.Textbook of Paediatric Nursing.Elsevier.Haryana;2009.p236-39.
c. Jacob and Singh.PaediatricNursing.N.R. Brothers.Indore;2009.p308-09.

OTHER SOURCES

 https://www.fortishealthcare.com/india/diseases/intestinal-obstruction-605
 Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fifth
Informational Supplement, CLSI Document M100-S25, CLSI, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087-1898,
USA, 2015.
 http://internalmedicine.imedpub.com/acute-abdomen-pre-and-postlaparotomy-diagnosis.php?aid=6042