QUESTION THREE

Madam Ama Serwah, aged 64 years, is admitted to the female surgical ward with intestinal

obstruction. She is scheduled to have an emergency laparotomy. Colostomy was done for her

subsequently.

i. Mention FOUR indications for colostomy (2 marks)

Cancer of colon or rectum

An injury to the small or large intestine

Inflammatory bowel diseases such as crohn’s diseases and ulcerative Collis that

causes irritation or sore in the GIT.

Obstruction- a blockage in the bowel that prevents the flow of fluid or solid.

Diviticulitis

Malformation present at birth

Facael inconvenience

½ mark * 4 points = 2 marks

ii. What physiological preparation would be carried out prior to the surgery? (4 marks)

Laboratory investigations to rule out any abnormality

Cleansing enema

Nil per os

Administration of IV fluids

Skin preparation

Correcting of anemia

Serving prescribed medication

Administer replacement fluid, as ordered, before surgery due to possible

increased output during the postoperative phase

Provide low-residue diet before NPO status

iii. discuss the nursing care that would be given to her within the first 48 hours under

a. Observations (4 marks)

i. Stoma is observed for position of the bag, whether well fixed or not

I. Amankwaa

ii. It is also observed for its nature, whether pinkish, pale or necrotic

iii. Stools are observed for color, consistency and rate of flow

iv. Watch for profuse bleeding

v. Inspect stoma and peristomal skin area with each pouch change.

Note irritation, bruises (dark, bluish color), rashes

vi. Observe wounds, note characteristics of drainage.

b. Care of the stoma and colostomy (6marks)

i. After surgery, odour-proof pouch is placed over the patient’s ostomy.

ii. The wafer is attached to the patient abdomen to be fitted over and around

the stoma to collect stool and gas.

iii. The wafer protects the skin around the stoma form getting irritated by

stool leakage.

iv. Best pouching system should be chosen for the patient.

v. Empty the pouch when its 1/3 or 1/2 full.

vi. The pouch should not become over full.

vii. Every bit of air should not be squeezed, as this can cause the sides to stick

together making it more difficult to collect stool

viii. Generally, appliance should be changed every 3-5days.

ix. If leakage occurs, change it immediately; this is to protect the skin around

the stoma from getting irritated from stool leakage.

c. what education would you give to Ama before discharge? (4 marks)

i. Instruct the patient to inspect peristomal skin with each pouching system change.

ii. Review techniques for treating peristomal skin problems.iii. Recommend alternative products if patient develops allergic reaction to an

ostomy product.iv. Teach the patient to notify health care provider when skin care problems

do not resolve by usual methodsv. Encourage pouch hygiene through rinsing, keeping pouch tail free of stool,

airing of reusable pouches, discarding odor-impregnated pouches.vi. Recommend the use of pouch deodorants, room deodorizers, and oral

deodorizers, such as bismuth subgallate (Devrom) or parsley.vii. Avoid use of pinholes in pouch

viii. Suggest avoidance of straws, excessive talking while eating, chewing gum, and smoking to reduce swallowed air.

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ix. Instruct about gas-forming foods, such as beans and cabbage, and eliminate when appropriate. It takes about 6 hours for gas to travel from mouth to colostomy.

x. Recommend using arm over stoma to muffle gas sounds when appropriate.xi. Patient should be taught on dietary guidelines to follow after surgery.

xii. Patient should be advised to stay well hydrated by drinking 8-10 glasses

of liquids daily, limit intake of caffeine and alcohol as they can

dehydrates, limit foods high in fibre and simple sugar, they also

dehydrates.

xiii. Advice patient to identify and remove any food that makes him feel pain

after eating from his diet.

xiv. Regulate the intake of gas forming diet such as; cabbage, carbonate

beverages, drinking through straw, chewing gum etc.

1 mark * 4 points = 4 marks

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