Question

The Case:

Mr. Anas sustained a gunshot wound to the abdomen and underwent an exploratory laparotomy and creation of an ileostomy due to damage to the small bowel. You are assigned to care for Mr. Anas on the third postoperative day. He has a nasogastric tube to low intermittent suction, and he is emitting greenish aspirate. IV access is through a triple lumen right subclavian catheter, and he is receiving D5 0.9% NS with 20 mEq K (potassium)/liter. Mr. Anas has a dressing to the left abdomen, and there is moderate amount of fluid draining out of his ileostomy.

Questions

Mr. Anas asks when his bowel output will become more solid and if he will be able to have a continent ostomy. How should the nurse respond?

Answer 1

continent ileostomy is a connection of the end of the small intestine, called the ileum, to the skin of your abdomen. A surgeon makes it so that waste can leave your body, because it can't leave the usual way.

Response of nurse should be to towards caring of Mr, Anas is

POST OPERATIVE CARE

abdominal surgery wound care is required.

The nurse observes the stoma for color and size. It should be pink to bright red and shiny. For the traditional ileostomy, a tempo-rary plastic bag with adhesive facing is placed over the ileostomy and firmly pressed onto surrounding skin.

The nurse monitors the ileostomy for fecal drainage, which should begin about 72 hours after surgery. The drainage is a continuous liq-uid from the small intestine because the stoma does not have a controlling sphincter. The contents drain into the plastic bag and are thus kept from coming into contact with the skin.

They are collected and measured when the bag becomes full. If a continent ileal reservoir was created, as described for the Kock pouch, continuous drainage is provided by an indwelling reservoir catheter for 2 to 3 weeks after surgery. This allows the suture lines to heal.

Mr. Anas having Nasogastric tube so nurse should do Nasogastric suction. It is also a part of immediate postoperative care, with the tube requiring frequent irrigation, as prescribed. The purpose of nasogastric suction is to prevent a buildup of gastric contents. After the tube is removed, the nurse offers sips of clear liquids and gradually progresses the diet. It is important to immediately report nausea and abdominal distention, which may indicate obstruction.

Nurse should promote patient for movement and early ambulation because it will help to patient in a mobilization.

Fluid management is also one of the part of recovering patients with surgery.patient having infusion of D5 and NS with POTESSUIM.There may be 1000 to 2000 mL of fluid lost each day in addition to expected fluid loss through urine, perspiration, respiration, and other sources. With this loss, sodium and potassium are depleted. The nurse monitors labo-ratory values and administers electrolyte replacements as pre-scribed. Intravenous fluids are administered to replace fluid losses for 4 to 5 days.

Emotional and psychological support should be provided to Mr. Anas by nurse is very importanat because due to injury he lost his anatomical part of intestine so it's very helpful after surgery to rehabilitate him to live his normal routine with ileostomy.

this kind of response nurse should give to caring Mr. Anas who having 3rd postoperative day.