Post-Operative Complications in CRC: A Nursing Case Study Analysis

This case study presents a patient, Ted, experiencing post-operative complications following colorectal cancer surgery. The case details the patient's symptoms, including intolerance to oral feeds, abdominal distension, and respiratory distress, indicative of paralytic ileus and right-sided pneumonia. The analysis focuses on the nursing interventions required to manage these complications, such as assessing the colostomy, monitoring skin integrity, and providing appropriate wound care. The study emphasizes the importance of early detection, assessment, and implementation of targeted interventions, including colostomy care, managing fluid and gas stasis, and addressing respiratory issues to improve patient outcomes. The nursing interventions described include assessing the location and type of colostomy, providing skin care, and allowing for the escape of flatus. References to relevant literature support the recommended practices.

Running head: STAGES OF CRC
Stages of CRC
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STAGES OF CRC
Stage 3:
After the fourth day of post-op, Ted is not tolerating oral feeds, though, by the end of
the second day of post-op, he should be able to tolerate oral feeds. His abdomen is distended
with severe pain and a sluggish bowel sound but with no flatus to pass through. After his
surgery, the colostomy bag has been without an output; there might be some destructions
following the bowel content.
From his respiratory rate, he experiences some breathless and productive cough, and
he requires three liters of oxygen and an auscultation with an inspiratory crackle on the right
side. Ted must have developed some forms of lung infections. The infection is secondary to
stasis of fluid in the lungs during the operative period, and it is clear that Ted has a
colostomy, meaning that there has been some surgery on the colorectal region.
Stage 4
After the colorectal surgery, Ted has developed postoperative paralytic ileus and
right-sided pneumonia. The reduction in his bowel motility is a result of the paralytic ileus
due to mechanical intestinal obstruction being absent in the Teds case. The condition occurs
typically after the colonic surgeries with the patient being able to get an oral feed at the end
of the third day, which in the case of Ted is not.
For alteration in electric activities within Ted's body, the release of inflammatory
mediators as a result of the surgical stress is observed, which brings spinal and local neuronal
dysfunction together. They result in the paralyzation of the bowel segments and the
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disorganization of his electric activities. The bowel content is not going to be pushed forward,
leading to fluid and gas stasis.
Problems
 Intolerance to oral feed
 Nausea and vomiting
 Not passing flatus
 Reduced bowel sounds
 Abdominal distension
 Tympanic node on percussion
Nursing interventions
Nurse should be able to assess the location of the stomach and the type of colostomy
which have been performed. For the correct prediction and location of the type of the fecal
drainage, the location of the stomach will, therefore, act as an indicator of the bowel section.
Frequent assess to the skin surrounding and the appearance of the stomach to be done
frequently with the help of a qualified nurse (Feldman-Winter et al, 2018). The assessment of
the skin condition regularly will, in turn, be of great importance during the early stages of the
postoperative period as at this period is when complications can easily occur and can be
treatable.
By allowing the nurse to place drainage pouch over the stomach, when they start to
drain, they will observe the first collection, which will contain mostly serosanguineous and
the mucus as the fluid rather than the fecal material. The continuity of the drainage will
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depend on the location of the stomach in the bowel. It will be apparent that the drainage is
going to be fecal in nature whenever the bowel begins to function.
For the colostomy to be cleaned, water is allowed to get in to stimulate the colon for it
to get emptied within the shortest time possible (Toth, 2006). A digital assessment of the
bowel direction will be required whenever the client has a loop colostomy, as the digital
bowel will carry the contents without the fecal in it, and no irrigation of the stomach will
therefore be required (Butcher et al, 2018). The nurse in charge may carry an irrigation for
stomach cleaning purposes before the re-anastomosis process began.
Provision of both the skin and stomach care will be crucial for a client with a
colostomy. The proper care of the client's skin and stomach will help in maintaining the
integrity of the skin and other functions as in the direction of skin mechanical defense in
fighting off the infections (Feldman-Winter et al, 2018).
The application of the caulking agents to Ted, such as the karaya or the stomahesive
paste and recommended skin barriers will be of great importance as it will help in holding the
ostomy pouch on position. It clear that the method will only be of more importance to those
with the loop colostomy, and for those with the transverse loop colostomy, it will be
disadvantageous for the ostomy pouch to be maintained over a plastic bridge.
For the escape of the flatus to be allowed, a needle hole that is small in size will be
required on the colostomy pouch. The hole may be closed by the use of a Band-Aid and be
opened while the patient is only in the bathroom, as this will assist in the control of the odor.
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Therefore, for the disruption of the skin seal to be achieved, the Ostomy bag can be balloon
out, whenever excess gas has been collected (Ambe et al, 2018).
References
Ambe, P. C., Kurz, N. R., Nitschke, C., Odeh, S. F., Möslein, G., & Zirngibl, H. (2018).
Intestinal ostomy: classification, indications, ostomy care and complication
management. Deutsches Arzteblatt International.
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. M. (2018). Nursing
Interventions classification.
Feldman-Winter, L., Goodstein, M. H., Hauck, F. R., Darnall, R. A., & Moon, R. Y. (2018).
Proposed guidelines for skin-to-skin care and rooming-in should be more
inclusive. Journal of Perinatology, 38(9), 1277-1278.
Toth, P. E. (2006, August). Ostomy care and rehabilitation in colorectal cancer. In Seminars
in oncology nursing (Vol. 22, No. 3, pp. 174-177).
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