Journal of Pediatric Surgical Nursing

Although rare, an ileocolic intussusception extending to the rectum can mimic a rectal prolapse, which may result in delayed diagnosis and treatment, thereby increasing morbidity in affected infants. Anal prolapse of an ileocolic intussusception is a rare complication of intussusception and more rarely reported in the United States than in developing countries. The aim of this case report is to identify physical exam techniques and radiological findings to distinguish between an anal prolapse intussusception versus a rectal prolapse. There needs to be a high index of suspicion of intussusception in presenting patients with a rectal prolapse in order to minimize morbidity.

The purposes of this study were to quantify the mean time to ambulate in a population of pediatric postoperative appendectomy patients at a stand-alone children’s hospital and to identify the associations between mean time to ambulate with admitting floor, patient age, pain medication, occurrence of nausea and vomiting, and length of stay. For decades, it has been suggested that extended immobilization in the postoperative patient should be avoided. Scant literature is available addressing early ambulation for pediatric patients after appendectomy. In practice, we noted that patients are not routinely ambulated early. Data were gathered from a retrospective review of 300 pediatric appendectomy patient charts at a children’s hospital. The mean time to ambulate was 16.05 hours (95% CI [14.14, 17.96]). The mean time to ambulate for patients placed on the surgical specialty unit was 13.48 (95% CI [11.90, 15.07]), compared with 20.36 hours for patients admitted to overflow units (95% CI [16.97, 25.36], p < .0007). Patients who experienced nausea and/or vomiting had a longer mean time to ambulate than those patients who did not (21.17 and 13.49 hours, respectively; p < .0001). Patients who received intravenous narcotics, oral narcotics, and nonnarcotic analgesics had a mean time to ambulate of 17.30, 13.03, and 11.61 hours, respectively (p = .0661). The Spearman’s rank correlation coefficient between length of stay and time to ambulate was .47. The results of this research study suggest that early ambulation has a significant impact on length of stay. Despite ambulation being taught in basic nursing education as a crucial component of postoperative care, this nursing-driven intervention is not routinely practiced. Placing these patients on a surgical specialty unit may lead to improved patient outcomes and will provide a targeted audience for future educational interventions.

Postoperative intussusception is a known yet very uncommon postoperative complication after abdominal surgeries, including ostomy takedown. Early recognition of the symptoms of postoperative intussusception is important for both bedside nurses and nurse practitioners. Understanding clinical features and how to approach diagnosis and management are imperative for the nurse practitioner and the entire surgical team.

Pectus excavatum is a chest wall deformity affecting 1 in 400–1,000 births. There are two surgical correction techniques to repair this chest wall deformity; the Ravitch procedure and the Nuss procedure. Pain issues after the Nuss procedure are potentially more significant than those after the open repair, although minimally invasive. The pain issues have significant impacts on the capacity for deep breathing, early mobilization/ambulation, opioid consumption, and length of hospital stay. CHOP has developed an enhanced multimodal pathway for patients undergoing the procedure. The work group included general surgeons, anesthesiologists, APNs, RNs, physical therapists, and psychologists as well as project and process managers. The goal is to standardize the care of the postoperative pain management, thereby resulting in a decreased length of stay and a 10% decrease in pain scores over a 3-month period.