Nursing Questions 2: Case Study of Post-Operative Patient Care

This nursing report addresses a case study of an 82-year-old male, Ted Williams, who is four days post-operative following a bowel resection and colostomy formation. The report analyzes Ted's situation, considering his medical history of heart failure, diabetes, obesity, and gout, along with his social context as a widower living alone in a retirement village. The report applies the clinical reasoning cycle to assess Ted's needs, process information, establish goals, and evaluate interventions. It includes a detailed examination of the patient's physical condition, vital signs, and current treatment plan, including medications like Metformin, Frusemide, and Captopril. The report highlights potential complications like infection, abdominal distention, and pain management, and provides treatment plans for stoma care, pain control, and emotional support. It also discusses the use of miscellaneous coagulation modifiers and ACE inhibitors, along with their side effects, and provides a comprehensive list of relevant references.

Running Head: NURSING QUESTIONS 1
Nursing questions
Name of Student
Name of Institution
Date
Author’s note

NURSING QUESTIONS 2
Nursing questions
Question 1
Clinical reasoning cycle is particularly important in assessing the needs of the patient the first
stage of the clinical reasoning cycle is considering the patient situation. This involves analyzing
the spiritual cultural and biopsychosocial impact of the patient. In the case study provided, the
patient has undergone a bowel resection surgery. He is currently in the post-operative phase.
The patient is living alone in a retirement village. His wife died three years ago but he has a
partner who lives in the same retirement village. The patient, Ted, has two grown up children
who live far away from him. One child is overseas with a wife and a son, while the other child
lives in the city with a husband and three children. With his family far away, the patient has no
emotional support from his family. This could affect the overall healing process. In addition, the
patient is 82 years and may require assistance in living with a pouch after being discharged from
hospital
The patient has had a history of heart failure, obesity, type II diabetes, gout, and heart failure.
This indicates that the patient’s lifestyle is a contributor to his illness. In addition, the patient is
82 years and his immune system is compromised. The patient has a BMI of 37.6 which is
extremely high. This could result in complications.
The surgery that was conducted has a significant impact of Ted’s family. Due to his age, he has
no source of income. His family will have to cater for any medical costs that he will incur. The
surgery has also had an impact on his emotional state. Having a colostomy is embarrassing and
could severely affect the emotional state of the patient. The patient will require education on how

NURSING QUESTIONS 3
to care for the collection bag. He will also require education on dietary changes that will help to
reduce odor and gas.
Question 2
The second stage of the clinical reasoning cycle is processing the information. In this phase, the
past medical history of patient is analyzed. In addition, other presenting complications are also
analyzed. other findings are also analyzed based on the pathology, pharmacology, physiology,
and ethics. This helps to establish cues that will help in drawing information (Race, 2017).
The patient has had a history of heart failure, obesity, gout, and type II diabetes. He previously
underwent a colonoscopy which confirmed the presence of a malignant mass. This led to a
surgery which involved bowel section and formation of a temporary colostomy. The current
treatment plan involves, Metformin 500 mg Mane, Frusemide 40 mg mane, Captopril 12.5 mg
mane, Paracetamol 1 g QID and Allopurinol 100 mg Daily. As of today, the patient is 4 days
post-operative. After the first 48 hours of surgery, the patient was nil by mouth. He then begun a
full diet yesterday before upgrading to a light diet.
Today, the patient is feeling nauseous and has vomited twice. He was administered ondansetron
4 mg Ted also has right sided inspiratory coarse cranes and a most productive cough. The patient
has an abdominal pain which rated on a scale of 1-10, the patient reports a 4-5. He complains
that the pain worsens to 7 when there is palpitation. The patient has a distended abdomen. He
was administered PCA morphine in site to help in the pain regulation. the colostomy bag is
intact. The stoma is warm, moist, and pink it is slightly raised above the skin and can be sighted
easily. The adnominal laparotomy has a clear oppose dressing and there is minimal ooze from
the site. The patient has had no output since the surgery was conducted but he has experienced

NURSING QUESTIONS 4
sluggish bowel sounds. Ted also reports that he has not passed flatus. He has a redivac drain that
has a haemoserous fluid of 30 mls. The urinary catheter is in position and is passing urine at the
rate of 60-70 mls in an hour.
The patient has a height of 175 cm and a weight of 111 kgs. His BMI is 37.6 m2. His vital signs
as of 10 am today were temperature of 38.1, heart rate was 98, blood pressure was 135/85,
respiratory rate was 26, and the Sp O2 was 94% on 3 L NP.
Based on this information, it is possible to process the gathered information. Procession of
information is the third stage of the clinical reasoning cycle. Based on the information collected
it is possible that the patient is experiencing an infection. His abdomen is distended it is possible
that an infection has occurred (van Gils, Cornelissen, & Tan, 2018). It is also possible that the
colostomy opening has narrowed which could result in pain
The stoma appears to be progressing well. It is pink, moist, and warm which indicates that it is
healthy (Franklyn et al., 2017). The abdominal laparotomy has very minimal ooze. This shows
that the wound is healing well, and the laparotomy was successful. The redicav drain also
appears to be functioning properly and there is proper passage of urine
Question 3
The fifth stage of the clinical reasoning cycle is establishing goals. during this stage, the
treatment goals are assessed depending on the patient’s situation. The goas should be goal
oriented to help achieve the health outcomes in addition, the treatment plans should be open
ended to allow flexibility (Odensten et al. 2019). Below is a treatment plan for Ted
- The first treatment plan is to inspect the stoma an the peristomal skin area with each
pouch change the rationale behind this is to monitor the healing process. Inspection also

NURSING QUESTIONS 5
helps to monitor the effectiveness of the appliance and identify possible areas of concern
routine examination of the stoma helps in the identification of stomal necrosis or fungal
infection a healthy stoma should be warm, moist, and pink in color (Race, 2017).
- Another treatment plan is verifying that the opening on the adhesive backing of the pouch
is lager that the base of the stoma. According to evidence-based research, a large opening
helps in the prevention of trauma to the stoma tissue and prevents trauma to the
peristomal skin. An adequate adhesive should be applied the adhesive should not be too
tight (Hamooddi, Ibrahim, & Eriby, 2018).
- The patient should also be provided with a transparent pouch that is odor proof and
drainable. A transparent appliance helps in the observation of the stoma without
removing the pouch and irritating the skin (Race, 2017).
- The ostomy pouch should be emptied and disinfected on a routine basis. According to
evidence-based research, frequent pouch changes can result in skin irritation instead, the
pouch should be emptied at a regular time emptying should be accompanied by bacterial
disinfection and deodorization of the pouch (Atthaphinan & Lueboonthavatchai, 2017).
- The pain level, intensity, location, and characterizing should be assessed. The degree of
pain often indicates the presence of an underlying condition abdominal pain form a
surgery usually subsidies by the third day. Evidence suggest that increased pained is an
indication of delayed healing or a possible infection
- Encourage he patient to use relaxation techniques or provide diversional activities.
Evidence suggest that refocusing the attention of the patient either be guided imagery or
visualization help to refocus their attention thus reducing pain levels

NURSING QUESTIONS 6
- Administer the patient with medications either opioids, narcotics, or patient controlled
analgesia. Medication ahs proven to be effective in relieving pain and enhancing comfort.
PCA is the most recommended for patient who have undergone a colostomy because it
helps in quick anal perineal repair (Race, 2017).
- Investigate and report cases of abdominal distention, or abdominal muscle rigidity. These
are possible indicators or a peritoneal inflammation which should be treated promptly.
- Review anatomical, physiological, and possible implication of the surgery. It is important
to discuss with the patient future expectations and anticipated changes in the character of
the effluent. This initiative will help in proper management of the pouch bag (Campos,
Bot, Petroianu, Rebelo, Souza, & Panhoca, 2017).
- Educate the patient on stomal care and pouch cleaning. The patient may require patient
information on how to properly handle the pouch bag and how to conduct the cleaning
process to prevent infection and bad odor. Due to his age, the patient may require
assistance of the nurse during this process (Race, 2017).
- Provide emotional and mental support. The surgery may have a significant impact of the
normal activities of the patient. it is important to provide the patient with emotional
support to help in proper transition into the new routine. According to past works of
literature, patients who had a strong emotional support reported a faster healing rate.
Question 4
To help in the treatment, a miscellaneous coagulation modifier can be used. These are drugs
which affect the blood coagulation process they can either induce clotting, break down clots or

NURSING QUESTIONS 7
prevent clotting. In patient who have recently undergone a colostomy, this class of drugs is
recommended to help control bleeding. It is used to prevent bleeding when a close wound
incision cannot be used. The medicines in this class can also help to prevent any leaks into the
stomach tissue after a surgery (Chan et al., 2020).
Drugs from this class are either dripped or sprayed on the affected area. The most common side
effects are itching and inflammation at the site of application. Other possible side effects include
fever, chills, runny nose (Neri, 2019). Adverse side effects are chest pain, cough, difficulty
breathing, headaches, slurred speech, problems with vision, change of color in the extremities,
nausea, and lightheaded feeling. It is important to seek medical advice if adverse side effects
occur.
Another class of drugs is ACE inhibitor (angiotensin converting enzyme inhibitor). These are
drugs that are used to treat high blood pressure. These class of drugs are recommended for
patients suffering from high blood pressure or recent heart failure (Hu, Lee, Tsai, & Chen, 2018).
It is not recommended for breastfeeding or nursing mothers. The most common side effects of
this drug are coughing, warmth tingly feeling in the body, numbness in the hands and limbs, loss
of taste and mild skin rash. Adverse side effects of this drug are dizziness and lightheadedness,
little urination, shortness of breath, chest pain, rapid weight gain, swelling, nausea, slow heart
rate, weakness, fever, chills, painful mouth sources, difficulty swallowing and possible skin
sores. It is important to seek medical attention if any of the adverse side effects occur.

NURSING QUESTIONS 8
References
Atthaphinan, C., & Lueboonthavatchai, P. (2017). Quality of life and associated factors in
colorectal cancer patients with colostomy at King Chulalongkorn Memorial
Hospital. Chulalongkorn Medical Journal, 61(3), 387-400.
Campos, K. D., Bot, L. H. B., Petroianu, A., Rebelo, P. A., Souza, A. A. C. D., & Panhoca, I.
(2017). The impact of colostomy on the patient's life. Journal of Coloproctology (Rio de
Janeiro), 37(3), 205-210.
Chan, E. Y., Borzych-Duzalka, D., Alparslan, C., Harvey, E., Munarriz, R. L., Runowski, D., ...
& Serdaroglu, E. (2020). Colostomy in children on chronic peritoneal dialysis. Pediatric
Nephrology, 35(1), 119-126.
Franklyn, J., Varghese, G., Mittal, R., Rebekah, G., Jesudason, M. R., & Perakath, B. (2017). A
prospective randomized controlled trial comparing early postoperative complications in
patients undergoing loop colostomy with and without a stoma rod. Colorectal
Disease, 19(7), 675-680.
Hamooddi, S. A. K., Ibrahim, A. W., & Eriby, Q. H. (2018). Complications of colostomy
closure.
Hu, W. H., Lee, K. C., Tsai, K. L., & Chen, H. H. (2018). Temporary closure of colostomy with
suture before colostomy takedown improves the postoperative outcomes. International
journal of colorectal disease, 33(1), 47-52.
Neri, V. (2019). Introductory Chapter: Role of Colostomy in the Colorectal Pathologies.
In Gastrointestinal Stomas. IntechOpen.

NURSING QUESTIONS 9
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U., & Näsvall, P.
(2019). Use of prophylactic mesh when creating a colostomy does not prevent parastomal
hernia: a randomized controlled trial—STOMAMESH. Annals of surgery, 269(3), 427.
Race, E. (2017). Acute Care Physical Therapy Status Post Colostomy For A Patient With
Colorectal Cancer: A Case Report.
van Gils, N. A., Cornelissen, J. G., & Tan, A. C. (2018). A Metal Stent in a Colostomy
Obstruction. GE-Portuguese Journal of Gastroenterology, 25(4), 214-215.