Hirschsprung's Disease - Assessment and Nursing Diagnosis

Hirschsprung's disease (HD) is a blockage of the large intestine. Hirschsprung's disease (HD) is a disorder of the abdomen that occurs when part or all of the large intestine or antecedent parts of the gastrointestinal tract have no ganglion cells and therefore cannot function.

Symptoms that may be present in newborns and infants include:
  • Difficulty with bowel movements
  • Failure to pass a first stool within 24 - 48 hours after birth
  • Failure to pass meconium shortly after birth
  • Infrequent but explosive stools
  • Poor feeding
  • Jaundice
  • Vomiting
  • Watery diarrhea (in the newborn)
  • Poor weight gain

Symptoms in older children:
  • Fecal impaction
  • Constipation that gradually gets worse
  • Slow growth
  • Malnutrition
  • Swollen belly

Nursing Assessment for Hirschsprung's Disease

Hirschsprung's Disease is mostly found in term infants and is the sole abnormality. Rarely in premature babies or in conjunction with other congenital abnormalities. At aganglionic segment from the anus to the sigmoid is more common in boys than girls. While abnormalities that exceed even the entire sigmoid colon or small intestine
found as much in boys and girls.

Patient Health History

1. The main complaint
Problems perceived by the client which is very annoying at the time of the assessment, the client Hirschsprung for example, difficult bowel movement, abdominal distension, bloating, vomiting. Obstipasi is a major sign and in newborns. Flatulence and vomiting green. Other symptoms are vomiting and diarrhea.

2. History of present illness
Ask how long the symptoms felt by the client and ask how the client attempts to resolve the issue. Babies often experience constipation, vomiting and dehydration. Mild symptoms of constipation for weeks or months, followed by acute intestinal obstruction.
But there is also a mild constipation, enterocolitis with diarrhea, distension
abdomen, and fever. Foul-smelling diarrhea may occur.

3. Past medical history
History of illness, history of immunization.

4. Family health history
Ask the parents of clients, whether there are other family members who suffered from Hirschsprung.

5. History of growth and development
Presence / absence of abnormalities of growth and development experienced since birth.

6. Nutrition
Maternal nutrition during pregnancy, exclusive breastfeeding.

Physical Examination

1. Cardiovascular system
Presence / absence of abnormality due to Hirschsprung's disease or congenital abnormality.

2. Respiratory system
Shortness of breath, respiratory distress due to abdominal distension.

3. Digestive system
Generally constipation. Abdominal bloating / abdominal strain, vomiting green. In the older children are chronic diarrhea. In the anus plug finger will feel pins and at times withdrawn will be followed by the release of air and spraying meconium or stool.

4. Musculoskeletal system
Impaired sense of comfort.

5. Integumentary System
Skin turgor, capillary refill less than 3 seconds

6. Visual system
Conjunctival pallor / no, jaundice / no.

7. Hearing System
Hearing, ear conditions, presence or absence of wax in the ear.

Nursing Diagnosis for Hirschsprung's Disease
  1. Fluid Volume Deficit related to nausea, vomiting.
  2. Alteration in bowel Elimination: constipation / obstipation related to the absence of intestinal peristalsis, the accumulation of feces.
  3. Imbalanced Nutrition: less than body requirements related to inadequate intake.
  4. Acute pain related to distension of the abdomen.