Question

dward (Ted) Williams is an 82year old male who is day 4 post-operative following a bowel resection and formation of a temporary colostomy. Ted had previously had a coloscopy and biopsy that confirmed a malignant mass. He has a past medical history of; heart failure, type II diabetes melilites, obesity and gout. (BMI 37.6m2; Height 175cm; weight 115kgs) Ted is a widower and lives alone. His wife died 3 years ago following a bout of pneumonia. One year ago, Ted moved into a retirement village located in a regional area two and a half hours from the city. The retirement village is near where he lived with his wife and children until they left home. Ted has 2 grown up children, a son Christopher who lives overseas with his wife and son, and a daughter Janice who lives with her husband and 3 children in the city. While Ted lives alone, he has a partner Gwen 78, who also lives in the same retirement village as Ted. Current medication: Metformin 500mg Mane Captopril 12.5mg mane Frusemide 40mg mane Allopurinol 100mg Daily Paracetamol 1g QID Ted is now day 4 post op. He was Nil By Mouth (NBM) for the first 48 hours after surgery. Yesterday he commenced on a full fluid diet and has upgraded to a light diet yesterday evening. Today, Ted was given his regular metformin and ate breakfast. Since then Ted has vomited twice and feels nauseous. He has been given ondansetron 4mg for nausea. Teds vital signs at 10am are as follows: T 38.1; HR 98 reg; BP 135/85; RR 26; SpO2 94% on 3L NP. He has right sided inspiratory coarse crackles and he has a moist productive cough. He has PCA morphine in situ for effective pain regulation. Ted has some abdominal pain that he says is at a scale of 4-5/10, he says the pain worsens on palpation to 7/10 and you note that his abdomen is distended. The colostomy bag is intact, and the stoma can be sighted through the bag. The stoma is warm, pink, moist and slightly raised above the skin. There has been no output since his surgery. He has sluggish bowel sounds and has not passed flatus. The abdominal laparotomy has a clear occlusive dressing (opsite) and there is minimal ooze present. He has a redivac drain with 30mls of haemoserous fluid, and a urinary catheter in situ and is passing approx. 60-70mls of urine/hr.

Q1: Use stage one of the clinical reasoning cycle (CRC) ‘Consider the patient situation’ to identify the biopsychosocial, spiritual and cultural impacts of Ted’s surgery for him and his family (250words)

Answer 1

Stoma formation can prolong the lives of patients and help them to return to a healthy life.However this process may cause the individual to experience various problems in terms of psychological ,social ,and physiological aspects.Individuals With stoma experience psychological problems such as depression,anxiety,changes in body image ,low self esteem,sexual problems,denial,loneliness,hopelessness and stigmatization.Social problems are loss of interest and less participation in social activities,avoidance of traveling ,decrease work activities,worsen partner relationship,decrease contact with friends and family relatives.These problems can adversely affect the individual adaptation to stoma and ability to leave with stoma.

Mr.Ted under went bowel resection surgery and had colostomy.Already patient was living alone and no one there to take care . Now this surgery affect Ted in psycho social way. Increase anxiety ,separation from family, causes worsen pain of ted .