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tracts to skin, elevated WBC count, elevated sed rate, soft tissue edema of surrounding areaNursing interventions/TeachingMonitor VS, monitor IV or oral antibiotic therapy, assess pain level frequently, use gentle handling and supportwhen moving extremity, monitor the prescribed immobilization device and maintain patient’s body in correctalignment, teach patient to use assistive devices if able to ambulate, elevate extremity, teach patient about usingdistraction relaxation and breathing, teach patient about proper diet and physical rehabilitation, ROM on extremity,monitor for footdrop,ComplicationsSepticemia, septic arthritis, pathologic fractures, squamous cell carcinoma, amyloidosis
140Ostomy care (continent diversion)DefinitionAssessment- inspect stoma with pouch change (should be moist and red), measure stoma (shrinkage), VS, pain,body image/altered feelings of self,I&O, lab values, electrolytes, weight, bowel soundsS/SN/ANursing interventions/TeachingImplement- clean with warm water and dry, adhesive backing 1/16 to 1/8 inch larger than stoma base,transparent/odor proof pouch, irrigate and cleanse periodically, consult with ostomy nurse, aseptic technique withbandaged wounds Education- future expectations, changing ostomy bag, signs/Sx of infection and skin breakdown, increase fluid intakeComplicationsSkin breakdown, infection, disturbed body image
141Ostomy – Ileostomy (Lippincott 590-94 & lewis1085-6)Definition: A surgical procedure in which an opening is made to allow passage of intestinal contents from the bowelto the incision/stoma. The stoma (opening surface of abd) is created when the intestine is brought through the abdwall and sutured to the skin, where fecal matter is diverted through. It may be permanent or temporary. There arevarious types:1.Ileostomy – opening from ileum to through abd wall. ( aka conventional or Brooke Ileostomy)2.Cecostomy – opening from cecum to abd wall. (uncommon, as well as ascending colon) areusually temporary.3.Colostomy- opening between colon and abd wall. Proximal end of colon sutured to the skin.Ileostomy:Stool consistency – liquid to semi liquidFluid requirement – increasedBowel regulation– noPouch and skin barriers – yesIrrigation– noIndications for surgery:– ulcerative colitis, Cohn’s, diseased colon, birth defect, familial polypsis,Complications:stomal ischemia, stricture, or stenosisstomal prolapseperistomal herniaperistomal skin breakdownmucocutanious separation ( between skin and stoma)Nursing Interventions:educating patient – surgical procedure, Ostomy teaching, include fam, clarify misunderstandingpromote positive self imagereduce anxiety – gradual steps toward independent caremaintain skin integrity – emptying 1/3 to ½ fullmaximize nutritional intake – avoid foods stimulate elimination, consistent moderate diet habits, nutritionistconsult, weigh QDachieving sexual well being – discuss ways to conceal pouch, diff positions, counselingCharacteristics of stomas:- pink, red, moist, bleeds slightly when rubbed, no felling to touch, stool functions involuntary, post opswelling decreased over several months.