Surgery Among Chine Rectal Cancer Patients â€Myassignmenthelp.Com

Question: Discuss About The Surgery Among Chine Rectal Cancer Patients? Answer: Introducation Laparotomy is a type of incision in the abdominal cavity. This type of operation is generally for the examination of the abdominal organs and for the diagnosis of any type of problem which includes abdominal pain. After the laparotomy had been done it can cause to various problems. Here in this care plan there has been described the top three priority problems are risk of constipation, heathcare pain and skin/tissue integrity, impaired(Ackley Makic, 2016). Learning triggers. Rationale/clinical reasoning relating to the IBL scenario What is intestinal obstruction? What are the types of intestinal obstruction? What is the difference in the clinical manifestations of small or large intestinal obstruction? It is a type of blockage in the intestine may be partial or complete which prevents the passing of the contents of the intestine. Types of obstruction are small bowel obstruction and large bowel obstruction (Cobb et al, 2105). Clinical manifestations of small bowel obstruction adhesions (previous operation) external hernia small bowel volvulus (primary) neoplasms Clinical manifestations of large bowel obstruction carcinoma of colon volvulus (sigmoid) diverticular disease ) What are some of the presenting complaints of Mr Jones that is indicative of bowel obstruction? Mr. Jones is noticing some blood with his stool; he was also suffering from abdominal pain and constipation. What are the surgical goals and the pre-operative preparation for a patient going for colorectal surgery? The patient starts preparing for the surgery few days before the surgery(Doenges Murr, 2014). The doctor may prescribe the oral antibiotics to start days before the surgery. The patient is asked to keep the colon as empty as possible to keep the risk of infection at bay. 2) The operation has a stoma and a large dressing covering his laparotomy wound. The basic principle of the surgery is to remove the vascular pedicle along with the lymphatics which feeds the tumor. This procedure is done to obtain a tumor free margin. What type of surgery does Mr Jones need for his recto sigmoid tumour? Why is a colostomy performed in Mr Jones case? An emergency laparotomy was done on Mr. Jones for the resection of the recto-sigmoid tumor. After the surgery he has a stoma and a large dressing covering his laparotomy wound (Lambrecht et al., 2015). 4) What are the types of ostomies? What are the specific nursing management after ostomy surgery? Two types of ostomies are ilieostomy and colostomy. Nursing care management plan after surgery are: Assessment on the stoma location and the colostomy. Position a collection bag or drainable pouch over the stoma. Empty a drainable pouch or replace the colostomy bag according to the need or when it is one-third full. Provide stomal and skin care for the client with a colostomy(Zhang Zheng, 2017). How long will it take for Mr Joness colostomy to be active? What are some of the possible areas of concerns of Mr Jones going home with a colostomy? Post operative care for Mr. Jones are: Mr. Jones has to strictly follow a balanced diet which comprises a lot of fresh fruits ans vegetables. Eating yogurt or drinking buttermilk may help reduce gas. Mr Jones must change his pouch. Empty the pouch when it is one-third full. Mr Jones must stop eating such foods like cabbage, broccoli, onions, garlic and fish in to reduce the odour of the bowel. Every time while emptying the pouch, very carefully clean the pouch opening. Never forget to clean both inside and outside of the pouch with a wet toilet paper. He must rinse his pouch 1 or 2 times daily after you empty it (Di Gesaro, 2012) 5) Identify some of the general post-operative nursing care concerns after a laparotomy? A small tube may have been passed through your nose and into your stomach to help drain stomach secretions for a day or two(Doenges Murr, 2014). A urinary catheter may be inserted to drain off urine. Pain relief should be given regularly, as ordered by the doctor. 5) Prepare a patient family teaching guide for Mr Jones Mrs Jones on ostomy self care. What are the effects on food on stoma output? Eat meals regularly. This means eating small meals every 2 to 3 hours or 6 to 8 times a day. At each meal and snack try to eat a starchy food and protein food. Starchy foods include bread, cereal, rice, pasta and potatoes(Doenges Murr, 2014). Protein foods include meat, fish, cheese, peanut butter and eggs. Table 2 Nursing diagnosis (from NANDA-I) Goal Nursing interventions Rationale Evaluation/ expected outcome Risk of constipation To reduce the risk of constipation this generally causes after the laparotomy or the newly created colostomy(Vierimaa, 2015). Monitor the intake of food and the output of the body very carefully; monitoring the hydration status of the patients(Vierimaa, 2015). To assess the signs and symptoms for constipation; to analyze the pattern of the decreasing bowel sounds and to implement some measures for preventing constipation (Wright et al, 2014). The stool produced and passed was normal. The abdominal Pain is relieved; frequency of the bowel movements; passage of the normal stools; reduced feeling the pressure of rectal fullness and no blood during defecation (Wrigh et al, 2014). Acute pain to reduce the degree of discomfort Assess pain of some specific location; encourage the patients to say their concern; providing comfort; encouraging relaxation techniques and provide sitz baths (Grant et al, 2013). Helps for the evaluation of degree of discomfort; to reduce anxiety and fear; reduction in muscle tension; advice the patient to rest more; relieves the discomfort, reduces edema and helps in promoting healing (Grant et al., 2013). After the intervention, the treatment started according to the patients concerned. The pain is relieved. The patient is able to sleep and rest; and comfort to the individuals. Skin/Tissue Integrity, impaired To achieve healing of wound on time. Observe wounds; change the dressings on time; encouraging the patient to lie on side lying position. Postoperative hemorrhage occurs at the early stage but infection develops at any time. Much amount of bleeding requires dressing which is to be changed frequently. Prolonged sitting increases perineal pressure, reducing circulation to wound, and may delay healing (Zanella Di Leo, 2016). The skin of the patient would heal over time. The stoma would be painless. The pain would be relieved, enhances comfort, and promotes rest. PCA may be more beneficial, especially following anal-perineal repair (Grant et al., 2013). References: Ackley, L. G., Makic, . (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. . Elsevier Health Sciences. Cobb, M. D., Grant, M., Tallman, N. J., Wendel, C. S., Colwell, J., McCorkle, R., Krouse, R. S. (2015). Colostomy irrigation: current knowledge and practice of WOC nurses.Journal of Wound Ostomy Continence Nursing,42(1), 65-70. doi: 10.1097/WON.0000000000000075 Doenges, M. M., Murr, . (2014). Nursing care plans: Guidelines for individualizing client care across the life span. . FA Davis. Lambrecht, J. R., Larsen, S. G., Reiertsen, O., Vaktskjold, A., Julsrud, L., Flatmark, K. (2015). Prophylactic mesh at end?colostomy construction reduces parastomal hernia rate: a randomized trial.Colorectal Disease,17(10).. Di Gesaro, A. (2012). Self-care and patient empowerment in stoma management.Gastrointestinal Nursing,10(2). Vierimaa, e. a. (2015). Prospective, randomized study on the use of a prosthetic mesh for prevention of parastomal hernia of permanent colostomy. . Diseases of the colon rectum, 58(10), 943-949. Wright, Davis, Koehler, Scheeres, . (2014). Cost-efficiency and outcomes in the treatment of perforated peptic ulcer disease: laparoscopic versus open approach. Surgery, 156(4), 1003-1008. Grant, M., McCorkle, R., Hornbrook, M. C., Wendel, C. S., Krouse, R. (2013). Development of a chronic care ostomy self-management program.Journal of Cancer Education,28(1), 70-78. Zanella, S., Di Leo, A. (2016). Use of Vacuum-Assisted Closure in the Management of Colostomy.Surgical Infections Case Reports,1(1), 165-168. https://doi.org/10.1089/crsi.2016.0043 Zhang, W. F., Zheng, . (2017). The preoperative reaction and decision-making process regarding colostomy surgery among Chinese rectal cancer patients. European Journal of Oncology Nursing, 28, 107-113.