Assessment and care needs of apatient with a colostomy bag in an acute care setting.  The assessment and care planningtook place in a Combine Assessment ward in a general hospital following thepatient’s admission via Day Case Unit.   After consent was taking with the presents of amentor, paperwork was gathered to make sure all that was needed to assess theindividual was available. Entering the patient’s room, i made sure i got theright patient and insure that it was still okay to gather information aboutthem.

I instructor them that to fulfil Caldecott guidelines, their identifiabledata will not be collected for this assignment such as their name, address,postcode, date of birth and i would not be removing  their medical notes  from the NHS premises. This patient hadneither hearing nor vision impairment so they could understand me clearly and wason an eye level where they could see me without struggling, while I was on thechair sitting by their bed side in order to have good eye contact whileassessing them. I also made in mind that they were a day post-surgery, andpainwas registered preoperatively, several times during the first 24 postoperativehours, and daily during the first postoperative week. (https://www.ncbi.nlm.nih.

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gov/pmc/articles/PMC1356141/) Some people experience symptoms similar to thosecaused by gallstones after surgery, including; abdomen pain, indigestion,diarrhoea, jaundice or perhaps a high temperature of 38C or aboveI made sure to assure the patient that they can answerhas such questions as they wish to and if there are in any discomfort, we canstop at any time. Then I was asking the questions, I made sure to give thepatient a little for time to tell their story. At the beginning I wasn’t asconfident as I planned. Although I was well aware of the questions I wasted toask, I was a bit nervous as to how it would all turn out. I didn’t have goodeye contact as I was thinking of what if the information the patient will giveme be able to evaluate them. I also felt that due to the patient being in aroom with other patients, I was a bit restricted to the amount of personalquestions I wanted to ask/ the patient wanted to answer.

The timing of theassessment was not as suitable as I expected due to staff giving out meals/assistingpatients with their meals. After the first five minutes asking a couple ofquestions, I started to get a lot more comfortable. It became more of a conversation   than aninterview.After gathering the information that was needed, Imade sure to gather the patient’s medical notes to compare the notes I got fromthem to their medical/nursing notes. Comparing the notes, there wasn’t muchdifference which is a positive thing. This shows me that the patient that Iassessed was the right patient, was aware of their past and currentcondition/illness on how it has affected them or perhaps may affect them in thefuture. It also shows that the patient was comfortable in talking to me abouttheir condition.

I made sure I had the effects of how I conducted theperson-centred assessment in mind, by gathering accurate information to supportthe clinical care needs of my patient. Based on the event, I came into conclusion that if Iwas to undertake a person-centred assessment again I would first of all gothrough their medical notes so I know what to expect. I would like to assess apatient who has their privacy such as being alone in a room by themselves.///////////////////////////////////Requirementfor education to wound careAs noted above, my patient came for a laparoscopiccholecystectomy which is the surgery to remove the gallbladder.

The gallbladderis removed through a 5 to 8 inch long incision in the abdomen. During an opencholecystectomy, the cut is made just below the ribs on the right side and goesto just below your waist. (https://www.medicinenet.com/cholecystectomy/article.htm)A laparoscope is a small, thin tube that is insertedinto the body through a tiny cut made just below the navel.

The surgeon canthen see the gallbladder on a television screen and do the surgery with toolsinserted in three other small cuts made in the right upper part of the abdomen.The gallbladder is then taken out through one of the incisions. The gallbladder is a small sac that lies under the liver below the right rib cage. Itstores and concentrates bile which brown liquid produced by the liver. The bileis then passed into the small intestine through bile ducts to aid withdigestion. ( https://www.

guysandstthomas.nhs.uk/resources/patient-information/gi/having-a-laparoscopic-cholecystectomy-as-an-inpatient.pdf) The gall bladder is not an essential organ. If it isremoved, bile flows to the intestines directly from the liver and digestioncontinues as normal Following the surgery, there are few things that needto be taking into consideration. While rest is important in the early stages ofhealing, equally important is that you are ambulatory, meaning that you are walkingunder your own strength. 10 minutes every 2 hours engaged in light walking indoorswill promote a speedy recovery. This is because movement will help prevent bloodclots but a nurse must be present before they get up on their feet for thefirst time.

They may need to help them stand up safely and watch how they areon their feet. Keeping in mind that they will feel dizzy or light headed thefirst time. In this case they can sit or lie down.Recline, but avoid lying down completely flat. Thiswill be more comfortable for them, and can reduce swelling. Always keep thehead elevated.  Use extra caution whenleaning forward and if possible try not bend forward or over.

 Eating healthyfoods from all the food groups every day is very important. This Includes whole-grainbread, cereal, rice, and pasta. Eat a variety of fruits and vegetables,including dark green and orange vegetables. Include dairy products such aslow-fat milk, yogurt, and cheese. Choose protein sources, such as lean beef andchicken, fish, beans, eggs, and nuts. Some patients are even told to be on aspecial diet. People are often instructed to go on a low-fat foods for four to sixweeks while their body learns to digest fat without the presents of the gallbladder.Then they would slowly introduce a small amount of fat bit by bit.

Fluids arecritical following surgery. Stick to non-carbonated, non-alcoholic,caffeine-free and green tea-free beverages including fruit juices and water,milk and yogurt drinks.  At least eightounces of fluid must be consumed every two hours. Stick with soft, bland,nutritious food for the first 24 hours.( http://www.laparoscopic.md/concerns/recovery)   Another important issue that need tobe taking to consideration is wound care.

The care for the surgical wounds asdirected. Keep the wounds clean and dry. Patients are instructed that they canstart taking a shower a day post-surgery. (https://www.

drugs.com/cg/laparoscopic-cholecystectomy-discharge-care.html) In many cases, dissolvable stitches will be used toclose the wounds.

These should start to disappear bythemselves within a week or two. If sutures, staples, or glue were used to close the skin,the wound dressings may be taking off and they can take a shower the day aftersurgery.If steri- strips were used to close the skin, thewounds are to be covered with plastic wrap before showering for the first weekafter surgery.

The steri-strips are meant to be left on and they would fall offon their own.( https://medlineplus.gov/ency/patientinstructions/000117.htm) The stitches need to be taken care of by keeping themclean and dry. Any increase in redness swelling or pain need to be watched outfor although it is essential you need pain the first few four but the painshouldn’t be getting worst.

(https://www.nhs.uk/chq/pages/2413.aspx?categoryid=72=727)  The reason behind this is because it woulddecrease the risk of developing any sort of infectionContact sports should be avoid while recovering, suchas football or hockey, to give your wound the best possible chance to heal.

Swimming, hot-tubs and bubble baths are not allowed,until a doctor says so.Signs of infection need to be watched out for near thestitches, such as any swelling, increased redness around the wound, bleedingfrom the wound, the wound feeling warm, an unpleasant odour coming from thewound, increasing pain, having a fever of 38C or above or swollen glands. Ifthis is the case  GP is to be contactedstraight away or a visit to an NHS walk-in centre Importantttttttttttttttttttttttttt http://www.laparoscopic.md/concerns/recovery     Part 4 An outcome focused goal for this clinical care needPrior assessment of wound etiology is critical for properidentification of nursing interventions.Patient reports any altered sensation or pain at site oftissue impairment.

Patient demonstrates understanding of plan to heal tissueand prevent injury.Patient describes measures to protect and heal the tissue,including wound care.Patient’s wound decreases in size and has increasedgranulation tissue.