Develop a care plan and answer the questions in this specific template. A colect

Question

Develop a care plan and answer the questions in this specific template. A colectomy is either an elective or emergent major surgery where the entire colon or part of the colon is removed, generally because of severe inflammation or malignancy. Based on the extent of the surgery, the patient may or may not end up having a colostomy as well.
History: You are the nurse receiving report on your patient who was admitted as an emergency earlier in the day. A 64-year-old female underwent a right colectomy. The right side of her colon was removed due to cancer and the ends of the remaining colon were anastomosed together. She has a history of smoking & no other health problems. She is currently being transferred to you in PACU (Postoperative Anesthesia Care Unit). Assessment: She is alert, oriented, and able to move all 4 extremities. Vital Signs: Temp. is 98.7, BP is 110/68, Heart rate is 86, Respiratory rate is 14, 02 sats are at 93% on 2L of oxygen given via nasal cannula. She has a midline incision with a Penrose drain, and a surgical cut with a Jackson Pratt drain next to the incision. There is minimal sanguineous drainage on the abdominal dressing. She also has a NG tube, attached to low intermittent suction (LIS) and a Foley catheter. The NGT output is 50 ml so far. The Foley output is 50 mL for the past hour She has absent bowel sounds on auscultation in all four quadrants. She does not complain of any nausea. She describes her pain as a dull ache around the incision area, exacerbated by moving and relieved by rest. No associated symptoms. She rates her pain 7/10. All labs are normal Orders: Keep patient NPO VS Q 15 min for one hour, then Q 30 min. x 2, then hourly .IVF 0.9% NS at 125 ml/hr Maintain NGT to LIS s Change dressing daily and document drainage Morphine 2 mg IV q lhr prn pain> 4 Notify physician if any change in patient's status. i You are asked to change the dressings daily and document the drainage. What precautions will you take to prevent this patient from obtaining a nosocomial infection? (Cite references for scientific rationale

Explanation / Answer

1.

Sterile dressing

Sterile patient care equipment

Proper hand hygiene

Other personal protective equipment’s like gloving and mask

Restrict the number of personnel handling the patient

Environmental cleanliness

Isolation

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK2683/

2. https://pmj.bmj.com/content/77/903/16

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963198/

2.

Nursing diagnosis:

1. Pain r/t surgical intervention as evidenced by patient’s verbalization, pain scale reading of 7/10

3.Goal: Patient will experience the decrease of pain/discomfort

Outcome: patient felt discomfort and used pain medication, other coping mechanisms

Assess the characters of pain: to plan further

Provide comfortable position: to minimize the discomfort

Divert the attention by reading to the patient: helps to change the patient’s concentration from pain

Administer analgesics: reduces fever by its pharmacological action

2. The risk for post-op infection r/t abdominal surgical incision as evidenced by loss of integrity of skin

Goal: patient will remain free of infection

Outcome: Patient is free from the increase in temperature, wound stayed clean dry and urine was clear to yellow w/out odour, no elevation of WBC.

Assess the surgical site for redness, infectious drainage, pain, and swelling: these are the signs of inflammation

Change dressings every day: to clean the wound and promote healing

Use sterile technique while caring for the wound: to minimize infection

Prophylactic antibiotics: to prevent infection

3. Alteration in GI function r/t pacing gas and altered bowel movement as evidenced by lack of bowel sounds

Goal: the patient will have a return of normal bowel function: check abdomen for sounds, swelling and pain

Outcome: a patient has remained free of nausea, vomiting, and abdominal distention

4. Alteration in fluid and electrolyte balance r/t NPO status as evidence by has no passing gas or bowel movement yet and absence of bowel sounds

5.Anxiety r/t disease process as evidence patients concerns about the future outcome

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