Research and Application to Nursing Care Comprehensive Nursing Essay Example
| CARE PLAN Client Name: Mrs. Apolo | |
| Health Priorities Based on Assessment Data Improve the patient’s understanding of the need for the ostomy and adherence to treatment and post-operative care management.(Research and Application to Nursing Care Comprehensive Nursing Essay Example)Improve health management behavior and knowledge Enhance patient self-esteem and body image and encourage continued social interaction after ostomy surgeryReduce the risk of post-operative complications and those associated with pouch management. Maintain role performance(Research and Application to Nursing Care Comprehensive Nursing Essay Example) | |
| Nursing Diagnosis Actual: Disturbed Body Image The ostomy is associated with significant physical change that can cause psychological distress and affect patient self-esteem, self-confidence, and relationships, including social functioning (Ayaz-Alkaya, 2019). The patient, Mrs. Apolo, shows signs of disturbed body image related to alterations in appearance, loss of control over bowel movements, and significant lifestyle changes. The patient is depressed verbalizing that she does not want the Ostomy. (Research and Application to Nursing Care Comprehensive Nursing Essay Example)The patient is upset that she “will never be able to go in the pool.” The verbalization of concerns about lifestyle changes and appearance, negative self-perception, refusal to engage in ostomy care, and chosen isolation from social activities is evidence of potentially disturbed body image and psychological distress. Potential/Risk: Risk of Impaired Skin Integrity The just-placed ostomy is functioning well, and the appliance is intact. However, because the stoma brings waste products via the abdominal walls, the patient is always at a high risk of developing irritation to the surrounding skin (D’Ambrosio et al., 2022). The risk of impaired skin integrity is related to improper pouch emptying, diet changes that might impact output, improper wafer fitting or application, leading to leakage, improper hygiene, and delayed stoma healing. Appropriate nursing interventions are targeted at prevention. Wellness/Health: Deficient Knowledge Patients with an ostomy for the first time might struggle to prepare for, adapt to, and manage the pouch, presenting a significant learning curve (Naseh et al., 2023). (Research and Application to Nursing Care Comprehensive Nursing Essay Example)The nursing diagnosis of deficient knowledge is related to lack of or limited exposure and unfamiliarity with ostomy surgery and ostomy and lack of interest in ostomy operation and care as evidenced by the patient verbalizing lack of knowledge on how she will ever be able to care for the pouch on her side and verbalizing inaccurate statements about having an ostomy like never going to the pool because of the pouch. (Research and Application to Nursing Care Comprehensive Nursing Essay Example) | |
| Planning | |
| Client Goal & Expected Outcomes: (SMART) Actual Goal: Goal: To improve patient self-confidence and self-perception by assessing family and spousal support, vital in helping the patient cope with the physical changes and get comfortable, noting age and lifestyle factors, because the physical change can be traumatic for a busy individual taking care of young children, like the patient in this case, and observing behavior and withdrawal like whether the patient is touching or looking at the pouch and stoma and whether she is seeking for information on managing it, to ensure an appropriate response to the ostomy. Expected Outcomes: (Research and Application to Nursing Care Comprehensive Nursing Essay Example)The patient will start to demonstrate comfort with her body image as evidenced by performing stoma care, touching and viewing her pouch, and maintaining her pool routine. The patient will verbalize being okay or accepting of changes in her body image and physical changes like having a stoma. The patient will seek information regarding how to navigate her life with the ostomy and maintain role function of caring for the grandchildren. Potential/Risk Goal Goal: To reduce the risk of impaired skin integrity by inspecting the stoma and surrounding skin for rashes, redness, or bleeding, assessing diet to ensure a low-residue diet for the first few months and the patient is taking food that cannot cause diarrhea or increase output, and assessing for allergies to pouch systems, adhesives, and barrier pastes. Expected Outcomes: The patient will demonstrate appropriate wafer sizing and applicationThe patient will maintain intact skin surrounding the stoma without swelling or redness.The patient will verbalize various strategies for preventing skin irritation. Wellness/Health Goal Goal: To improve the patient’s knowledge and health management behavior by assessing the patient’s understanding and capability to determine the need for education about the ostomy and ability to perform needed care, and assessing for family assistance because the patient, based on her age, might require family support. Expected Outcomes: The patient will demonstrate the ability to remove, clean, and reapply a new pouch or applianceThe patient will recognize signs of complications and seek prompt medical assistanceThe patient will verbalize correct statements about having the pouch and the ability to continue her swimming routine and the strategies that should be adopted to ensure she protects herself and the pouch during swimming.The patient will verbalize appropriate dietary changes to manage stool output. (Research and Application to Nursing Care Comprehensive Nursing Essay Example) | |
| Interventions | Rationale for Each Intervention: |
| List Two Interventions for Actual Diagnosis: Help the patient visualize a normal life with the pouchRecommend a support group List Two Interventions for Potential/Risk Diagnosis: Clean and keep dry and apply a protective pasteOffer education on the pouch system List Two Interventions for Wellness/Health Diagnosis: Encourage confidence in the patient Educate the patient on ostomy care | Actual Diagnosis It is critical to take a positive approach by offering ostomy care with confidence and a positive attitude and avoiding showing any form of disgust or inappropriate facial expression. This approach helps the patient get comfortable, gain confidence, and visualize a normal life with the pouch. The patient should be made to understand that living with the pouch does not necessarily mean abandoning everyday activities, including caring for the grandchildren and going swimming. (Research and Application to Nursing Care Comprehensive Nursing Essay Example)The patient can be relieved to learn that she can still wear her favorite clothes and engage in her favorite activities, including swimming. According to UOAA (2020), patients with an ostomy can still swim normally. It is also crucial to remind the patient that she can hide her pouch in various ways if she prefers it that way. A support group, especially for Mrs. Apolo, could be necessary to help her cope and adapt to living with the pouch and the associated physical and lifestyle changes (Nam et al., 2019). Talking to others with similar experiences can be empowering and she can learn ways to deal with the difficulties of living with a pouch. A support group can help ease the transition to home care. Support groups can be online or in person, and it is vital to assess the patient’s preferences. Potential/Risk Diagnosis As indicated, anyone with an ostomy is at a high risk of developing impaired skin integrity. Therefore, cleaning, keeping it dry, and applying a protective paste is necessary to maintain skin integrity and prevent irritation (Maria & Lieske, 2021). The caregiver and the patient should keep the area around the stoma free from fecal matter using warm water and a clean washcloth or toilet paper to clean that area. The patient should avoid soap and completely dry the area before applying adhesives (Maria & Lieske, 2021). (Research and Application to Nursing Care Comprehensive Nursing Essay Example)Pastes and powders can help keep the area dry and aid the adhesive in fitting better to the skin, ensuring no leakages. The patient needs education on the pouch system to maintain skin integrity. The patient should be made to understand the frequency by which she should change the pouch to avoid irritation. Changing it too frequently can be irritating to the skin. Also, the patient should be educated on carefully removing the system to avoid pulling on the skin (American Cancer Society, 2019). Wellness/Health Diagnosis The patient in the scenario implies a lack of confidence and knowledge in performing ostomy care. Therefore, it is necessary to encourage confidence in the patient and educate her on ostomy care. The patient can gain more confidence in performing ostomy care by having her participate actively in care and offering positive feedback regarding her participation in and performance of ostomy care (Maria & Lieske, 2021). The patient lacks or has limited knowledge and familiarity with ostomy and ostomy care, which necessitates educating her on ostomy care. It involves ensuring the patient understands how to empty her pouch when it reaches the recommended capacity for emptying (1/3-1/2) to prevent it from loosening. The patient should also learn to bathe properly to avoid any detachments (American Cancer Society, 2019). (Research and Application to Nursing Care Comprehensive Nursing Essay Example)Additionally, the patient should learn the different types of foods to eat and the amounts to avoid gas and odors. It is critical to observe the patient performing the emptying, cleaning, and changing of the appliance to ensure the patient fully understands how to perform ostomy care.(Research and Application to Nursing Care Comprehensive Nursing Essay Example) |
Discharge Planning and Teaching
Discharge planning and patient education are crucial nursing care components after ostomy surgery. The patient requires support and education after surgery to ensure an easy transition to home care, the patient adapts to the new ostomy, and the patient is able to maintain a good quality of life. Discharge would begin early before surgery, involving a multidisciplinary team of nurses, surgeons, enterostomal therapists, and dieticians, who will comprehensively evaluate the patient’s needs and offer comprehensive care. The planning would also involve psychological support to address the emotional aspects of living with the pouch. Offering counseling and support groups would help the patient cope with the psychological effects of the surgery (Ayaz-Alkaya, 2019). The planning would also entail assessing the home environment to ensure it is conducive to prompt recovery and the patient has adequate support at home (Saint Luke’s Health System, 2022). Medical management is also necessary to ensure the patient understands various medications and their effects on bowel function. The patient should be educated on taking prescribed medications and managing side effects or reporting them (Saint Luke’s Health System, 2022). The patient will also receive nutritional counseling, including necessary dietary modifications to avoid foods that can cause gas or odor, increase output, or cause diarrhea. The patient should also understand eating a balanced diet to avoid nutritional deficiencies (Saint Luke’s Health System, 2022). Importantly, the patient should be educated on stoma care, including cleaning, measuring, and applying the pouch. The patient should be able to demonstrate how to change the system and troubleshoot common problems with the system.(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
References
American Cancer Society. (2019, October 16). Caring for a Colostomy. American Cancer Society.(Research and Application to Nursing Care Comprehensive Nursing Essay Example) https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html
Ayaz-Alkaya S. (2019). Overview of psychosocial problems in individuals with stoma: A review of literature. International wound journal, 16(1), 243–249. https://doi.org/10.1111/iwj.13018(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
D’Ambrosio, F., Pappalardo, C., Scardigno, A., Maida, A., Ricciardi, R., & Calabrò, G. E. (2022). Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective. International journal of environmental research and public health, 20(1), 79. https://doi.org/10.3390/ijerph20010079(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
Maria, A., & Lieske, B. (2021). Colostomy Care. In: StatPearls [Internet]. Treasure Island (FL). StatPearls. (Research and Application to Nursing Care Comprehensive Nursing Essay Example)https://www.ncbi.nlm.nih.gov/books/NBK560503/
Nam, K. H., Kim, H. Y., Kim, J. H., Kang, K. N., Na, S. Y., & Han, B. H. (2019). Effects of social support and self-efficacy on the psychosocial adjustment of Korean ostomy patients. International wound journal, 16 Suppl 1(Suppl 1), 13–20. https://doi.org/10.1111/iwj.13038(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
Naseh, L., Shahriari, M., Hayrabedian, A., & Moeini, M. (2023). Nurses’ viewpoints on factors affecting ostomy care: A qualitative content analysis. Nursing open, 10(8), 5261–5270. https://doi.org/10.1002/nop2.1764(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
Saint Luke’s Health System. (2022). Discharge instructions for colostomy. https://www.saintlukeskc.org/health-library/discharge-instructions-colostomy(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
UOAA. (2020, July 17). Swimming with an ostomy. United Ostomy Associations of America. https://www.ostomy.org/swimming-with-an-ostomy/(Research and Application to Nursing Care Comprehensive Nursing Essay Example)
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