A parent tells a nurse, "my three-month-old infant recently passed several stools that resembled clumpy red jelly," Based on this information, the nurse should suspect that the infant has developed?

1. A

   Celiac disease

2. B

   Biliary disease

3. C

   Intussusception

4. D

   Ulcerative colitis

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• The description of 'clumpy red jelly' stools is the classic, hallmark sign of intussusception in an infant.
• This appearance is caused by a mixture of mucus, sloughed mucosa, and blood resulting from the compression and ischemia of the telescoped bowel segment.
• Intussusception is the most common cause of intestinal obstruction in children between 6 and 36 months of age and is considered a pediatric emergency.
• Other classic signs include sudden onset of severe, intermittent abdominal pain and a palpable sausage-shaped abdominal mass.

Why Other Options Were Wrong

• Option A: Celiac disease is an autoimmune disorder related to gluten intolerance that causes malabsorption, leading to steatorrhea (pale, fatty, foul-smelling stools), not bloody stools.
• Option B: Biliary disease, such as biliary atresia, involves obstruction of the bile ducts. This prevents bile from reaching the intestine, resulting in acholic (pale, clay-colored) stools and jaundice.
• Option D: Ulcerative colitis is a type of inflammatory bowel disease that causes bloody diarrhea. However, it is extremely rare in a 3-month-old infant and typically presents in adolescence or young adulthood.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of classic signs of intussusception in an infant to guide bedside assessment, documentation, and the next nursing action.
• Prompt recognition of 'red currant jelly' stool is a critical nursing skill, as intussusception is a surgical emergency. Delay in treatment can lead to bowel ischemia, perforation, peritonitis, and sepsis.
• The nurse's primary role is to perform a rapid assessment, notify the healthcare provider immediately, and prepare the infant for emergency diagnostic and therapeutic procedures, such as an air or saline enema.
• What if? If the infant suddenly becomes calm and passes a normal brown stool, it could signify a spontaneous reduction of the intussusception. However, the infant still requires urgent medical evaluation as the condition has a high rate of recurrence.

How to Approach the Question

• First, identify the key elements in the clinical scenario: the patient is a 3-month-old infant.
• Next, focus on the specific description of the presenting symptom: stools that look like 'clumpy red jelly'.
• Recognize this description as a classic, or pathognomonic, sign for a specific pediatric condition.
• Systematically evaluate the given options by recalling the typical stool characteristics associated with each gastrointestinal disorder.
• Eliminate Celiac disease (fatty, pale stools), Biliary disease (clay-colored stools), and Ulcerative colitis (bloody diarrhea, but rare in this age group).
• Conclude that intussusception is the only diagnosis that perfectly matches the hallmark 'red currant jelly' stool in this age group, making it the most likely suspicion.

Concept Tested & Keywords

• Concept Tested: Recognition of classic signs of intussusception in an infant.
• Stem keywords: three-month-old infant, stools, clumpy red jelly
• Lead-in keywords: suspect
• Clinical cues: Age (3-month-old) is within the peak incidence range for intussusception (typically 3-36 months).
• Clinical cues: Stool description ('clumpy red jelly') is a pathognomonic sign for intussusception.

Question ID

Qsbg9Fn2ivlrwdQIBaa18O

Copy ID

Reference Book

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 160-162

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 82-84