Question

A 36-year-old woman was admitted several days ago with a diagnosis of recurrent inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). She is married, and her husband and son are supportive, but she has no other family in the area. She has had IBD for 15 years and has been taking mesalamine for 15 years and prednisone 40 mg/day for the past 5 years. She is very thin; at 5 feet 2 inches she weighs 86 pounds and has lost 40 pounds over the past 10 years. She has an average of 5 to 10 loose stools per day. Her life has gradually become dominated by her disease (anorexia; lactase deficiency; profound fatigue; frequent nausea and diarrhea; frequent hospitalizations for dehydration; and recurring, crippling abdominal pain that often strikes unexpectedly). The pain is incapacitating and relieved only by a small dose of diazepam, oral electrolyte solution, and total bed rest. She is so weak she cannot stand without help.

Her condition deteriorates as she begins experiencing intractable abdominal pain and unrelenting nausea and vomiting. She is taken to the operating room for probable SBO and is readmitted to your unit from the PACU. During surgery, 38 inches of her small bowel was found to be severely stenosed with two areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet of distal ileum and 2 feet of the colon have been removed, and a temporary ileostomy was established. She has a JP drain to bulb suction in her RLQ, and her wound was packed and left open. She has two peripheral IVs, a Salem Sump NGT, and a Foley catheter. Her vital signs (VS) are 112/72, 86, 24, 100.8° F (38.2° C) (tympanic). You attach her NGT to low-continuous wall suction per the postoperative orders.

Questions

1. Per the National patient Safety Goals 2020, name all of the goals that apply to this patient and explain why they apply.

2. What teaching would you include for her about her newly place ostomy?

3. List 3 nursing interventions for her. Give rationales for each. Prioritize them #1, 2, 3.

Answer 1

1. As per The National Patient Safety Goals 2020 the goals that apply to the patient are =

a) Implement evidence based practice to prevent the surgical site infection for the post surgical patients.

As, due to the surgary and illiostomy drainage it may required prolonged hospitalization for the patient and may cause health care associated infection. So, as per assessment findings the care givers need to provide the specific care to the patient.

b) Implement evidence based practice to prevent the urinary tract infections due to indwelling catheter.

As, the patient is on a Foley's catheter for urinary drainage in post operative conditions. UTI is one of the most common hospital associated infection. So, it has to provide more emphasis.

c) Implementation of hand hygiene guidelines for each and every procedures apply on the patient.

As, has hygiene is a basic and easy method to prevent health care associated infection and cross infection. So handn hygiene must has to perform before and after each procedure done on the patient.

2. The health teaching I will provide to the patient for the newly placed ostomy are =

- this is stoma or hole created surgically on your abdomen to allows the bodily waste to pass into a bag placed at the opening of the stoma.

- keep the site clean and intact.

- the ostomy bag has to clear or change at regular intervals.

- to change the ostomy bag first wash the handand empty the pouch in toilet first.

- remove the pouch gently by one hand pulling the pouch and other hand pull the skin backwards.

- clean the skin gently around the stoma by an antiseptic solution.

-use skin barrier products to reduce irritation.

- open the new pouch and provide slight pressure to place the pouch.

- maintain personal hygiene regularly.

3. Nursing interventions =

a) Assessment =

- monitor the vital signs.

- assess the level of pain .

- physical examination of the patient with a special emphasis on abdominal assessment.

Implementation =

I. Vital sings has to be monitor and the finding are BP 112/72 mm of Hg, pluse rate 86 beats/min, respiratory rate 24 breaths/min and temperature 100.8°F to know the baseline data of the patient.

ii. The level of pain, onset of pain, duration and frequency of pain has to measure by pain scale assessment and facial expressions to know the baseline data.

iii. Hot and cold compression has to be given at the surgical site to reduce pain.

iv. Cold sponging has to be done to reduce temperature of the client.

v. Analgesic and antipyratics like Paracetamol has to be administered as per phycian advice to reduce pain and fever.

Expected outcome = pain and fever will reduce and patient become comfortable assessed by facial expressions and body posture.

b) assessment =

- assess the surgical site for any signs of infectt.

- monitor for proper drainage of waste.

Intervention =

I. Regular assessment of the surgical site.

ii. Proper dressing of the incision site has to be done to reduce risk for infection.

iii. Regular removal of ostimy bag when it will fill up has to be done.

Iv. Change the ostomy bag in two weeks intervals has to be done.

v. Antibiotics has to be administered as per phycian recommend to reduce the growth of microbes.

Expected outcome = risks for infection is reduced.

c) assessment =

- monitor the nutritional status.

- check the water and electrolyte balance.

- assess the signs of dehydration.

Intervention =

I. Proper Intravenous fluid has to be administered as oer prescription to maintain Water-electrolite balance.

ii. If peristaltic sound returns then liquid diet has to be administered in proper amount through NG tube.

iii. Gastric lavage ha to dine before administering diet.

iv. Small and frequent diet has to provide.

v. Intake and output chart has to maintain.

Expected outcome= signs of dehydration removed and normal nutrition balance is maintained.