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FECAL DIVERSIONS - FECAL DIVERSIONS POSTOPERATIVE CARE OF...

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FECAL DIVERSIONS: POSTOPERATIVE CARE OF ILEOSTOMY AND COLOSTOMY Within the past 50 years major advances have occurred in ostomy surgery, including continent diversions such as the Kock pouch and the ileoanal reservoir. However, each year in the United States, 100,000 people still undergo surgery to create ostomies. These so-called incontinent diversions are the primary focus of this plan of care. An ileostomy is an opening constructed in the terminal ileum to treat regional and ulcerative colitis and to divert intestinal contents in colon cancer, polyps, and trauma. It is usually done when the entire colon, rectum, and anus must be removed, in which case the ileostomy is permanent. A temporary ileostomy is done to provide complete bowel rest in conditions such as chronic colitis and in some trauma cases. A colostomy is a diversion of the effluent of the colon and may be temporary or permanent. Ascending, transverse, and sigmoid colostomies may be performed. Transverse colostomy is usually temporary. A sigmoid colostomy is the most common permanent stoma, usually performed for cancer treatment. CARE SETTING Inpatient acute care surgical unit. RELATED CONCERNS Cancer Fluid and electrolyte imbalances, see Nurse Care Plan CD-ROM Inflammatory bowel disease: ulcerative colitis, regional enteritis Psychosocial aspects of care Surgical intervention Total nutritional support: parenteral/enteral feeding Patient Assessment Database Data depend on the underlying problem, duration, and severity (e.g., obstruction, perforation, inflammation, congenital defects). TEACHING/LEARNING Discharge plan DRG projected mean length of inpatient stay: 9.4 days considerations: Assistance with dietary concerns, management of ostomy, and acquisition of supplies may be required Refer to section at end of plan for postdischarge considerations. NURSING PRIORITIES 1. Assist patient/SO in psychosocial adjustment. 2. Prevent complications. 3. Support independence in self-care. 4. Provide information about procedure/prognosis, treatment needs, potential complications, and community resources. DISCHARGE GOALS 1. Adjusting to perceived/actual changes. 2. Complications prevented/minimized. 3. Self-care needs met by self/with assistance depending on specific situation. 4. Procedure/prognosis, therapeutic regimen, potential complications understood and sources of support identified. 5. Plan in place to meet needs after discharge.
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NURSING DIAGNOSIS: Skin Integrity, risk for impaired Risk factors may include Absence of sphincter at stoma Character/flow of effluent and flatus from stoma Reaction to product/chemicals; improper fitting/care of appliance/skin Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Bowel Elimination (NOC) Maintain skin integrity around stoma.
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