Nursing Colostomy Checkups And Maintenance (Essay Sample)

NAME
INSTRUCTOR
DATE
INSTITUTION
TASK
1a)Identify the factors that you would need to consider prior to and during an assessment
Prior to assessment of the above-named patient, identification of the intermediate needs should be done first, some of the factors to be considered here are: any possibility of infection risks, manual handling risks to the patient due to his permanent colostomy and the contact details of his son. During the assessment process, the health status, cognitive ability, the tools that are to be used for assessment should be assessed first like pain assessment tool to provide accurate results after assessment. (Ainsworth 2013 pg. 327)
1b)Using the information from the case study, identify and define three (3) physical or psychologically factors that will need to be implemented into Mr. Bott’s care plan
Considering Mr. bott’s conditions during admission and assessment the following factors should be put into consideration when implementing his care plan:
Colostomy checkups and maintenance
* the pouching system should be checked regularly and changed at the appropriate time
* provision of a well-balanced diet to maintain the colostomy state should be provided
for physical care the following factors should be considered:
provision of full range motion to maintain joint mobility to prevent venous stasis
positioning- the patient should be positioned in a good manner to prevent contractures and prevent compressive neuropathies
management of sensory difficulties
frequent assessment of the skin with emphasis on the bony areas and other depended body parts to check for signs of breakdown
establishment of an exercise program to help him recover to his normal condition
preparations for ambulation- as soon as the patient starts to get well, an active rehabilitation to help him maintain balance while suiting and standing should be done. (Sardina 2013 pg. 105)
1(c)
The pulse rate for this patient is beyond the range of a normal person, the correct pulse range lies between 60 to 100
Respiration-the normal range should be 12 to 16
Blood pressure, the normal range should be between 120 over 80 (120/80) to 140 over 90 (140/90).
(Sellier, 2013 pg. 153)
2. I will use the following data to perform neurological observations
* eye opening
* appropriateness of vocalization
* motor activity
* Level of consciousness.
The level of consciousness that may deteriorate if there is a problem in relation to the brain in case of injuries to the brain, space occupying lesion such as brain tumor, increased intracranial pressure which can be determined by checking at the amount of brain tissue, blood and cerebrospinal fluid within the skull cavity.
* Pupillary reaction.
Note if the pupil sizes are equal. A pen torch with a bright narrow beam is recommended. Similarly observe the pupil’s reaction to the beam light. A change in pupil size and subsequent reaction to light indicates increase of the intracranial pressure.
* Vital signs.
-Respirations - Note down the rate, depth and pattern of breathing as the brain controls breathing. Any problem with the brain can affect respiration activity
-Temperature. The temperature should be taken into account since the hypothalamus regulates the body temperature. Therefore, any minor problem with the hypothalamus will result to abnormal temperatures.
-Blood pressure and pulse. A raise in the intracranial pressure will result to increased blood pressure, and a fall in the respiratory rate and the bradycardia
* Motor function.
Assessment of the lower limps can depict the functioning of the spinal. Involuntary movement of the patient’s limp may be a result of cerebral dysfunction.
(Sellier, 2013 pg. 79)
3. considering Mr. bott’s age, his care plan should be planned in such way that he should be treated with respect, and addressed properly
Mr. Bott’s beliefs are important and should be taken into consideration in his plan care. The nurses should be aware on how his spiritual beliefs play a part in health-related decision-making. For example, do they have deep religious convictions, or do they view their religion primarily and try to incorporate them into the care plan
Mr. Bott’s cultural practices should be considered when planning for his care plan in that, the nurses should consider on how the cultural beliefs can affect his healing process and adjust it to suit his cultural beliefs
The care plan should also cover on Mr. Bott practices and how they might affect medical treatment, rehabilitation and their overall health and wellbeing.
How diagnosis may affect their spiritual worldview.
What their needs and wishes are while in hospital, including if they would actively like to see a chaplain.
An environment that is respectful to his beliefs and culture should be created
4. steps involved in changing colostomy bag
* Washing of hands and cleaning of procedure gloves
* Folding of the linens to expose the ostomy site, a clean towel is placed across the abdomen of the patient under the pouch that exists
* The patient is positioned in such a way that skin folds doesn’t occur along the line of the stoma
* The pouch is opened-if openable by removing the clamp and unrolling it at the bottom.
* If the pouch is drainable, the existing ostomy pouch is drained into a bedpan
* Using one hand, the old fastener is removed from the skin gently starting from the top to downward direction. The other hand is used to hold tension on the skin in the opposite direction of the pull. In case of any resistance when removing the fastener, adhesive remover is used
* The stoma and peristomal skin is inspected. The stoma and skin are cleaned using mild soap and the area is allowed to dry.
* The size of the stoma is measured using appropriate method and a clean gauze pad is placed over the stoma
* After removing the glove and washing hands, the size of the opening is traced on a paper that is at the back of the new fastener
* The traced paper is peeled off from the fastener. For those ostomy fasteners that come with an outer ring of tape attached, the backing should not be removed until the fastener is positioned securely. Ostomy skin care products are applied at this stage
* The gauze is removed followed by centering of the fastener opening around the stoma. For a open-ended pouch, the end is folded over the clamp until it “clicks” to ensure it is secured
* Some warmth is applied to the new fastener to warm the adhesive ring-this makes it to stick better
* The patient is returned to a comfortable position as the used ostomy pouch is disposed
Properly
(Sardina 2013 pg. 102)
5a) Outline 3 risk factors associated with immobility, providing a brief explanation of each one chosen.
The risk factors of include;
Urinary system
The stroke patient is prone to developing a urinary tract infection, urinary tract infections, renal calculi, and even urinary stasis because of many potential factors including a preexistent atonic bladder, the change in urogenital flora with hospitalization, possible comorbid conditions, such as malnutrition and prostate enlargement, poor perineal hygiene, and most importantly, the common use of a Foley catheter. Postvoid residual urine is often increased because of incomplete relaxation of perineal muscles during supine voiding. Also, gravitational forces and intra-abdominal pressure have a lessened effect on supine voiding.
The best preventive strategies include;
* Hydration
* Early mobilization
* Investigate for secondary causes of retention
* Prompted voiding
* Intermittent catheterization, as necessary
* Avoid Foley catheter drainage, if possible
Circulatory system
The circulatory system is affected by immobility. The risks associated with may include venous dilation, decreased blood pressure, edema, thrombophlebitis and even orthostatic hypotension. The risks can be minimized by executing leg exercises, use of sequential compression devices and initiation of falls risk prevention measures. The preventive strategies are
* Early mobilization
* Elastic stockings
* Slow deviation from supine to sit to stand
* Daily "leg dangling"
* Adequate fluid intake
For Cardiovascular, Orthostatic hypotension, preventive strategies should be;
* Early mobilization
* Elastic stockings
* Subcutaneous heparin
* Range-of-motion joint exercise
Metabolic and Endocrine Effects such as Osteoporosis
Although usually not recognized as clinically important, there are major metabolic and endocrine changes with bed rest and immobility. These changes occur slowly and insidiously and require a prolonged recovery period for reversal. The risks of decreased rate of metabolism can result to unintended weight gain, negative calcium secondary to the loss of calcium from the bones during immobilization and anorexia are a result of immobility and the best preventive strategies should be
(Ainsworth 2013 pg. 58)
5 b) assessment tool before Mr. Bott is moved
Peristomal skin. The skin around the stoma should be intact without being eroded, rashes and lacerations
Appearance of the stoma, if the stoma is shiny or bloody, superficial bleeding during routine cleaning is normal while one that does not stop may be a sign of stoma complication that might be as a result of inadequate hemostasis during stoma changing or construction process
The shape of the stoma. the shape of a normal stoma should be oval, round or irregular and it can vary with peristaltic movements of the intestines
The size of the stoma and protrusion.
(Sardina; 2013 pg. 45)
5c) Mr. Bott has agreed to sit in his chair for lunch. Identify six (6) factors that the nurse will need to consider before assisting...