Assessment and care needs of a
patient with a colostomy bag in an acute care setting.

 

The assessment and care planning
took place in a Combine Assessment ward in a general hospital following the
patient’s admission via Day Case Unit.

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After consent was taking with the presents of a
mentor, paperwork was gathered to make sure all that was needed to assess the
individual was available. Entering the patient’s room, i made sure i got the
right patient and insure that it was still okay to gather information about
them. I instructor them that to fulfil Caldecott guidelines, their identifiable
data 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 had
neither hearing nor vision impairment so they could understand me clearly and was
on an eye level where they could see me without struggling, while I was on the
chair sitting by their bed side in order to have good eye contact while
assessing them. I also made in mind that they were a day post-surgery, and
pain
was registered preoperatively, several times during the first 24 postoperative
hours, and daily during the first postoperative week. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356141/
)

Some people experience symptoms similar to those
caused by gallstones after surgery, including; abdomen pain, indigestion,
diarrhoea, jaundice or perhaps a high temperature of 38C or above

I made sure to assure the patient that they can answer
has such questions as they wish to and if there are in any discomfort, we can
stop at any time. Then I was asking the questions, I made sure to give the
patient a little for time to tell their story. At the beginning I wasn’t as
confident as I planned. Although I was well aware of the questions I wasted to
ask, I was a bit nervous as to how it would all turn out. I didn’t have good
eye contact as I was thinking of what if the information the patient will give
me be able to evaluate them. I also felt that due to the patient being in a
room with other patients, I was a bit restricted to the amount of personal
questions I wanted to ask/ the patient wanted to answer. The timing of the
assessment was not as suitable as I expected due to staff giving out meals/assisting
patients with their meals. After the first five minutes asking a couple of
questions, I started to get a lot more comfortable. It became more of a conversation   than an
interview.

After gathering the information that was needed, I
made sure to gather the patient’s medical notes to compare the notes I got from
them to their medical/nursing notes. Comparing the notes, there wasn’t much
difference which is a positive thing. This shows me that the patient that I
assessed was the right patient, was aware of their past and current
condition/illness on how it has affected them or perhaps may affect them in the
future. It also shows that the patient was comfortable in talking to me about
their condition. I made sure I had the effects of how I conducted the
person-centred assessment in mind, by gathering accurate information to support
the clinical care needs of my patient.

Based on the event, I came into conclusion that if I
was to undertake a person-centred assessment again I would first of all go
through their medical notes so I know what to expect. I would like to assess a
patient who has their privacy such as being alone in a room by themselves.
///////////////////////////////////

Requirement
for education to wound care

As noted above, my patient came for a laparoscopic
cholecystectomy which is the surgery to remove the gallbladder. The gallbladder
is removed through a 5 to 8 inch long incision in the abdomen. During an open
cholecystectomy, the cut is made just below the ribs on the right side and goes
to just below your waist. (https://www.medicinenet.com/cholecystectomy/article.htm
)

A laparoscope is a small, thin tube that is inserted
into the body through a tiny cut made just below the navel. The surgeon can
then see the gallbladder on a television screen and do the surgery with tools
inserted 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 gall
bladder is a small sac that lies under the liver below the right rib cage. It
stores and concentrates bile which brown liquid produced by the liver. The bile
is then passed into the small intestine through bile ducts to aid with
digestion. ( 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 is
removed, bile flows to the intestines directly from the liver and digestion
continues as normal

Following the surgery, there are few things that need
to be taking into consideration.

While rest is important in the early stages of
healing, equally important is that you are ambulatory, meaning that you are walking
under your own strength. 10 minutes every 2 hours engaged in light walking indoors
will promote a speedy recovery. This is because movement will help prevent blood
clots but a nurse must be present before they get up on their feet for the
first time. They may need to help them stand up safely and watch how they are
on their feet. Keeping in mind that they will feel dizzy or light headed the
first time. In this case they can sit or lie down.

Recline, but avoid lying down completely flat. This
will be more comfortable for them, and can reduce swelling. Always keep the
head elevated.  Use extra caution when
leaning forward and if possible try not bend forward or over.

 Eating healthy
foods from all the food groups every day is very important. This Includes whole-grain
bread, cereal, rice, and pasta. Eat a variety of fruits and vegetables,
including dark green and orange vegetables. Include dairy products such as
low-fat milk, yogurt, and cheese. Choose protein sources, such as lean beef and
chicken, fish, beans, eggs, and nuts. Some patients are even told to be on a
special diet. People are often instructed to go on a low-fat foods for four to six
weeks 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 are
critical 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 eight
ounces 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 to
be taking to consideration is wound care. The care for the surgical wounds as
directed. Keep the wounds clean and dry. Patients are instructed that they can
start 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 to
close the wounds. These should start to disappear by
themselves 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 after
surgery.

If steri- strips were used to close the skin, the
wounds are to be covered with plastic wrap before showering for the first week
after surgery. The steri-strips are meant to be left on and they would fall off
on their own.( https://medlineplus.gov/ency/patientinstructions/000117.htm
)

The stitches need to be taken care of by keeping them
clean and dry. Any increase in redness swelling or pain need to be watched out
for although it is essential you need pain the first few four but the pain
shouldn’t be getting worst. (https://www.nhs.uk/chq/pages/2413.aspx?categoryid=72=727)  The reason behind this is because it would
decrease the risk of developing any sort of infection

Contact sports should be avoid while recovering, such
as 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 the
stitches, such as any swelling, increased redness around the wound, bleeding
from the wound, the wound feeling warm, an unpleasant odour coming from the
wound, increasing pain, having a fever of 38C or above or swollen glands. If
this is the case  GP is to be contacted
straight 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 need

Prior assessment of wound etiology is critical for proper
identification of nursing interventions.

Patient reports any altered sensation or pain at site of
tissue impairment.

Patient demonstrates understanding of plan to heal tissue
and prevent injury.

Patient describes measures to protect and heal the tissue,
including wound care.

Patient’s wound decreases in size and has increased
granulation tissue.