SB508 Integrative Health care Practice Assignment Sample
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Introduction
An ileostomy can be used in the case of having problems in the colon or rectum in order to move waste out of the body. An ileostomy is needed in the case of having medical histories with the surgery like abdominal colectomy, bowel resection, and many more. Sometimes ileostomy can be needed for a short time or temporary basis as the colon needs some time like 3 to 6 months to heal. Sometimes having an ileostomy may result from different changes to life like a sex life, physical activities, and future pregnancies as well. This essay has a discussion on nursing interventions like wound assessment and care for recovering from the wound. Moreover, the importance of assessing wounds in order to make life secure in the future has also been discussed in this essay.
Case scenario
In the given scenario it can be said that an 84 years old woman had a temporary ileostomy for Bowel cancer. Now she needs to have a reversed ileostomy because her health can be found to improve with the treatment of cancer. The importance of having assessments including color, smell, tissue loss, oedema have been discussed in this essay. Moreover, nursing care that is needed in order to manage or recover wounds resulting from ileostomy has also been discussed in this essay. Nursing care includes infection prevention, mobilization, nutrition, and many more that are discussed in this essay. However, this essay aims to make an idea on the wounds related to ileostomy and nursing assessments and care in order to recover the wound.
2. Intervention 1: Wound assessment
An ileostomy can be defined as the opening constructed in the terminal ileum in order to treat ulcerative colitis. As per the view of BENBOW (2016), in order to do ileostomy and the assessment of the wound nurses can be the key factor. Nursing care in the case of managing wounds in ileostomy includes assessment, preventing complications most importantly providing information about ileostomy.
The peristomal skin can look bluish-purple, pale pink, or black in color if infected due to having an ileostomy. Moreover, an abnormal bulge can also be found underneath the stoma, and sometimes red or dark rashes can be found in the wounded area. According to the view of BOGA (2019), skins around the wound can be turned into red and weepy in the case of having an ileostomy. Besides this, there can be recurrent pouch leakage after having an ileostomy as in the place of colon opening. There can be found a swelling in the place of ileostomy after reversed. The stoma may have a very large increase after having the ileostomy in the colonial space. In the case of having touch, the region can feel moist after ileostomy. In the view of GOUDY-EGGER and DUNN (2018), a big issue that can be noticed in most of the patients who had ileostomy is the odor that can come from the region of ileostomy. Patients who have an ileostomy can be noticed to experience offensive smells of their body fluids that can only be assessed by the nurses.
Patients can have experience of having pain after reversing ileostomy as well as blood clots and infections. As per the view of EDWARDS and MCCORMACK (2018), most importantly the risk of Hernia can be considered as the major concern after having a reverse operation of ileostomy. In order to assess this type of complication like the color of a wound, leakage, and many more nurses should have more concern about the assessment. For example, at the place of a wound after ileostomy reversal mucus can be produced at the lining of the bowel. It can act as a lubricant that can play an important role in helping the passage of stools. As stated by VASILOPOULOS et al. (2020), the mucus produced at the place of a wound can vary from egg white to sticky glue-like consistency.
Patients can also experience blood or pus at the place of the wound or there can be found a sign of tissue damage or infections. According to STANKIEWICZ et al. (2019), some patients can be found to have experienced irritation as well as inflammation around the stoma. In order to assess the patients after having reverse ileostomy nurses should have proper communication with the patients so that they can know their complications. On the other hand, nurses should be concerned about the factors that can happen after having an ileostomy like wound color, leakage, smell, and many more (Nice.org.uk, 2020).
Evidence can be presented by having a study on the case of a patient who has acute rectosigmoid resection due to sigmoid perforation. The patient had been discharged after doing an ileostomy and can be found to have skin irritation at the place of the wound. This situation can be found to be managed by the nurses of the hospitals (Nmc.org.uk, 2020). In order to manage problems first of all they assess their wound in order to understand the needed care for the patient (Eakin. eu, 2020).
From another case, it can be found that a 65-year-old female came to the hospital with perforated large bowel resulting from Crohn’s disease (Eakin.eu, 2020). This patient has a medical history of having an ileostomy before (Nice.org.uk, 2020). Nurses can be found to have practice on the assessment of their patients and found to have the gap of education in the case of taking self-care for having an ileostomy. After the assessment, proper education, as well as proper care to the patient, has been provided.
Another case study can be mentioned as an 83-year-old male patient came to the hospital with rectal cancer. He can be found to have a previous history with prostate cancer also treated with radiotherapy. Most importantly this patient came to the hospital with the moisture feeling at the place of a stoma (Eakin.eu, 2020). The main problem with the patient was ileostomy leakage that can lead to abdominal contours. After an assessment, it can be noticed that the stoma was watery as well as corrosive to the peristomal region. In order to assess these problems, the role of nurses was significant. Having concern on deep assessment of the problem of patient nurses had succeeded to assess the problem with the wound (Eakin.eu, 2020).
Apart from this pouchitis can be found after having an ileostomy in the region of the colon. As per the view of PINTO et al. (2017), it can be considered as a common complication in patients with ileoanal pouch. The pouchitis may include symptoms like diarrhea, abdominal pain, high temperatures, and many more. However, patients with an ileostomy can experience a lot of gas or smell after having an ileostomy. Although this gas is harmless but can be embarrassing as well as uncomfortable for the patients (Eakin.eu, 2020).
As stated in the given case study an 84-year-old woman having Bowel cancer leading her to have an ileostomy at the region of the colon. After the recovery from the disease, she needs to reverse that can lead her to have complications with the wound. She is supposed to have an assessment from the nurses that can be helpful for her in recovering from the post reversed operation of the ileostomy. Nurses should have a concern on the assessment of the clinical appearance like pain, oedema, any changes in color, and many more. The type of wound should be assessed properly in order to serve her best care for the recovery.
3. Intervention 2: Wound care including dressing
Condition of the body system
In the given case, the 84y/o female had colon surgery lately. The closure surgery is to be done next to reverse the process of ileostomy so that the bowel movements can become normal like it was before the occurrence of ileostomy. After the surgery, there will be a “small wound” where the operated ileostomy had been before the operation. There can be frequent bleeding from that portion that would require bandaging every day (Behuria et al. 2020). As the rectum and colon are removed via operation, wastes will now directly pass through the stoma before excretion. The additional incisions made take almost 4 to 6 weeks to recover. The body becomes weak and easily dehydrated which can result in the formation of kidney stones. Rectal discharge, Vitamin B12 deficiency, phantom rectum, pouch inflammation, and irritable bowel are some problems that the body faces after this surgery.
Explanation of proposed intervention
The intervention proposed for taking care of the wound after surgery is NESTOR (“Negative Pressure Wound Therapy for Wound Healing After Stoma Reversal”). Stoma reversal is followed by severe complications in the body among which the most common one is “wound infection” (Berti and Elliott, 2019). “Surgical site infection” (SSI) can end up in long-term complications like hernia, enhanced outpatient visits, long duration in hospital, and excess medical charges. In the NESTOR technique, a vacuum dressing is used to augment the process of healing. According to Oliveira et al. (2018), the process is safe and efficient in promoting healing soon after stoma closure. Generally, a device named PICO™ 7 with a “small portable pump”, two fixation and dressing strips, and two lithium batteries are used for an adhesive and simple wound dressing.
Need for the intervention
The wounds from stoma surgery can take a long time to heal. In order to speed up the healing process safely and efficiently, Pico 7 is used. Pico 7 is canister free, can be easily applied on different locations or wound types, and even on closed incisions. The device has a simple operating system so there are few chances of error. It is needed for this patient as it promotes the healing process by exudating infectious materials acutely (Goztok et al. 2018). Furthermore, it can easily deal with the wounds situated in proximity to blood vessels. However, the nurse must be cautious about the usage of vacuum as misuse of the suction valve can result in severe bleeding.
Process of intervention
- Types of dressing
Initially, a bandage or gauze is applied to the wound. Two types of dressings are most preferred for dressing stoma wounds next. Foam dressings are slightly adhesive so that they do not get stuck to delicate wounds and are non-occlusive. They are made with hydrophilic gel or polyurethane material. According to Malik et al. (2020), they are highly absorbent so frequent dressing changes are not required. Hydrocolloid dressings too are great absorbents containing colloidal particles like methylcellulose, pectin, or gel particles that attract the exudates. They are impermeable to urine or bacteria thus with this dressing patients can bath without the risk of affecting the wound.
- clips, stitches
Metal clips and single “non-resorbable stitches” are used for linear closure of stoma wounds on SSI. Skin closure is done using “purse-string approximation” (PSA).
- infection prevention
The infection is treated using antibiotics and some fluids which are either discharged from wounds or reabsorbed by the patient’s body (Poehnert et al. 2017). After a week of operation, the wound must be kept clean and dry to prevent infections.
- Nutrition
Being an extremely aged patient, oral “liquid diets” are suggested for at least five days after the completion of surgery. Foods like milk and cereals which are rich in vitamin B12 are also referred to. A diet including cooking in olive oil, mashed potatoes with butter and milk cream, or pudding is suggested for this patient.
- Mobilisation
Mobilisation includes the reduction of complications post operations. It is achieved by abdominal distension, acceleration of recovery of “abdominal wounds” and reducing surgical pain (Vasilopoulos et al. 2020).
- support wound
Wounds are supported by vacuum dressing as per the standards of NMC and NICE guidelines for UK based nurses.
- Shower
Showering is allowed during stoma reversal as exposure to humidity or air does not harm the stoma wound. However, it can be suggested that if the patient is showering without a pouching system then she should remove the “skin barrier” as well.
Outcome
The first SSI rate is to be compared within seven postoperative days. Through medical examination, infections on subcutaneous tissue and muscles are assessed. The second SSI rate comparison is done within 30 post operating days. Other outcomes include a complete restoration of tissues, removal of resected tissues, and scar formation which is also done within 30 days of operation (Ignatavicius et al. 2017). Quality of life is assessed next and the dimensions range from no problems to severe problems. Pin, discomfort, depression, speech differentiation are some other aspects of quality of life that are examined in 30 days. Furthermore, pain is analysed under different components like sensory, affective, and miscellaneous.
Role of patient and nurse
The patient has a simple yet important role to play in the entire process and that is coordinating with the nurse. The nurse has to provide support to the patient so that they are genuinely interested in coordinating with them and other surgical members of the “multidisciplinary team”. Nurses need to have a vivid understanding of different surgical procedures involved in stoma formation (Evidence.nhs.uk, 2020). Nurses must analyse the injuries and wounds to investigate what sorts of infections can arise from them. Other illness factors and the effects of medications on those factors are also needed to be analysed. Then they are required to counsel or educate patients and their caretakers on “wound care processes” and issues (Rch.org, 2020). They can demonstrate certain care processes to enlighten them with such steps. They must obtain cultures of infectious tissues from time to time to check if any new implications are arising.
4. Conclusion
An ileostomy can be used in the case of having problems in the colon or rectum in order to move waste out of the body. There can be several complications after having an ileostomy in the region of the colon. This complication includes obstruction, rectal discharge, vitamin deficiency especially vitamin B12, pouchitis, stoma problem, and many more. Generally, ileostomy helps in making an artificial but temporary, or in some cases permanent opening that is called a stoma. A stoma can be defined as the pathway of the lowest part of the intestine called the ileum, situated outside the abdomen. This can play an important role in making a path for waste and gas exit instead of passing through the rectum.
In this essay, a discussion on the importance of having ileostomy especially for patients with colon cancer has been provided. Along with this a discussion on the post complications that can be experienced by the patient has also been discussed in this essay. A discussion on the nursing management needed for the assessment of the problems after having reversed operation of ileostomy has also been provided in this essay. Moreover, the importance of having knowledge on the ileostomy as well as post ileostomy complications has been discussed in this essay. Besides this, nursing care management in order to recover patients from post ileostomy complications has been provided. However, the major steps like the assessment of color, smell, and many more, that should be followed for the assessment of the problems of having wound at the region of ileostomy has also been mentioned. It can be concluded that a proper nursing assessment and care should be provided to the patient as mentioned in the given case study of the 84-year-old woman should be taken.
Reference list
Book
Ignatavicius, D.D., Workman, M.L. and Rebar, C., 2017. Medical-Surgical Nursing-E-Book: Concepts for Interprofessional Collaborative Care. Amsterdam: Elsevier Health Sciences.
Journals
Behuria, N., Banerjee, J.K., Ghosh, S.R., Kulkarni, S.V. and Bharathi, R.S., 2020. Evidence-based adoption of purse-string skin closure for stoma wounds. Medical Journal Armed Forces India, 76(2), pp.185-191.
BENBOW, M., 2016. Best practice in wound assessment. Nursing Standard (2014+), 30(27), pp. 40.
Berti-Hearn, L. and Elliott, B., 2019. Ileostomy Care: A Guide for Home Care Clinicians. Home healthcare now, 37(3), pp.136-144.
BOGA, S.M., PHD., 2019. Nursing Practices in the Prevention of Post-Operative Wound Infection in Accordance with Evidence-Based Approach. International Journal of Caring Sciences, 12(2), pp. 1-8.
CHLAN, LINDA L, PHD, RN,A.T.S.F., F.A.A.N., TOFTHAGEN, CINDY, PHD, ARNP,F.A.A.N.P., F.A.A.N. and TERZIC, ANDRE,M.D., PHD., 2019. The Regenerative Horizon: Opportunities for Nursing Research and Practice. Journal of Nursing Scholarship, 51(6), pp. 651-660.
de Oliveira, A.L., Boroni Moreira, A.P., Pereira Netto, M. and Goncalves Leite, I.C., 2018. A cross-sectional study of nutritional status, diet, and dietary restrictions among persons with an ileostomy or colostomy. Ostomy Wound Manage, 64(5), pp.18-29.
Eakin.eu, 2020, Stoma case studies for nurses, Available at: https://www.eakin.eu/stoma-case-studies/[Accessed on: 21st December, 2020].
EDWARDS , S. and MCCORMACK , S., 2018. Simulation using ‘live’ adult service users and moulage in a variety of settings. Nursing Management (2014+), 24(9), pp. 33.
GOUDY-EGGER, L. and DUNN, K.S., 2018. Use of Continuing Education to Increase Nurses’ Knowledge of Chronic Wound Care Management. The Journal of Continuing Education in Nursing, 49(10), pp. 454-459.
Goztok, M., Terzi, M.C., Egeli, T., Arslan, N.C. and Canda, A.E., 2018. Does wound irrigation with clorhexidine gluconate reduce the surgical site infection rate in closure of temporary loop ileostomy? A prospective clinical study. Surgical infections, 19(6), pp.634-639.
LI, W., STOCCHI, L., CHERLA, D., LIU, G., AGOSTINELLI, A., DELANEY, C.P., STEELE, S.R. and GORGUN, E., 2017. Factors associated with hospital readmission following diverting ileostomy creation. Techniques in Coloproctology, 21(8), pp. 641-648.
LOTFI, M., AHMAD, M.A., DAVAMI, B., KHAJEHGOODARI, M., HANIEH, A.K. and MOHAMMAD, A.K., 2020. Development of nursing care guideline for burned hands. Nursing Open, 7(4), pp. 907-927.
Malik, R.N., Quddus, A., Ahmad, S., Ullah, H., Shafi, A. and Asim, I., 2020. Comparison between Primary Repair Versus Loop ileostomy in ileal Perforation. National Editorial Advisory Board, 31(8), p.46.
Nice.org.uk, 2020, NICE guidelines, Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines [Accessed on: 21st December, 2020].
Nmc.org.uk, 2020, Professional standards of practice and behaviour for nurses, midwives and nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 21st December, 2020].
PINTO, I.E.S., QUEIRÓS, S.,MARIA MOREIRA, QUEIRÓS, C.,DOLORES RIBEIRO, DA SILVA, C.,REGINA RODRIGUES, SANTOS, C. and DE BRITO, M.,ALICE CORREIA, 2017. Risk factors associated with the development of elimination stoma and peristomal skin complications. Revista de EnfermagemReferência, 4(15), pp. 155-165.
Poehnert, D., Hadeler, N., Schrem, H., Kaltenborn, A., Klempnauer, J. and Winny, M., 2017. Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy. Wound Repair and Regeneration, 25(6), pp.994-1001.
Prevention and management of moisture-associated skin damage. 2019. Nursing Standard (2014+), 34(2), pp. 77-82.
STANKIEWICZ, MONICA, MNSC (NP), MAPPSCI, GRAD DIP WM,GRAD CERT S.T.N., B.N., GORDON, JODIE, M HEALTH ADMIN, M CLIN SPEC (WM),GRAD CERT S.T.N., B.N., RIVERA, JENNY, MCLINLEAD, GRAD CERT STN,GRAD CERT I.C.U., R.N., KHOO, ANTHONY, B NUT DIET,E.N.G.AEROAV, NESSEN, A.,B.NUT DIET and GOODWIN, M.,B.NURS, 2019. Clinical management of ileostomy high-output stomas to prevent electrolyte disturbance, dehydration and acute kidney injury: a quality improvement activity. Journal of Stomal Therapy Australia, 39(1), pp. 8-10.
SUKKARIEH-HARATY, O. and HOFFART, N., 2017. Integrating Evidence-Based Practice into a Lebanese Nursing Baccalaureate Program: Challenges and Successes. International Journal of Nursing Education Scholarship, 14(1), pp. 441-442.
VASILOPOULOS, G., MAKRIGIANNI, P., POLIKANDRIOTI, M., TSIAMPOURIS, I., KARAYIANNIS, D., MARGARI, N., AVRAMOPOULOU, L., TOULIA, G. and FASOI, G., 2020. Pre- and Post-Operative Nutrition Assessment in Patients with Colon Cancer Undergoing Ileostomy. International Journal of Environmental Research and Public Health, 17(17), pp. 6124.
Vasilopoulos, G., Makrigianni, P., Polikandrioti, M., Tsiampouris, I., Karayiannis, D., Margari, N., Avramopoulou, L., Toulia, G. and Fasoi, G., 2020. Pre-and Post-Operative Nutrition Assessment in Patients with Colon Cancer Undergoing Ileostomy. International Journal of Environmental Research and Public Health, 17(17), p.6124.
Websites
Evidence.nhs.uk (2020), NICE National Institute for Health and Care Excellence, https://www.evidence.nhs.uk/search?q=nmc+guidelines [Accessed on: 23/12/2020]
Rch.org (2020), Wound assessment and management, https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Wound_assessment_and_management/ [Accessed on: 23/12/2020]
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