Question

Mr. Jacobs is a 55-year-old college-educated male recently diagnosed with colon cancer. He is scheduled for surgery with formation of a colostomy. Prior to meeting the patient, the nurse reviews the health record and notes that Mr. Jacobs is able to read English, has family support, and is currently not working. Mr. Jacobs’ wife works in retail.

Mr. Jacobs is very health conscious, and his goals are to go back to “normal” life. The nurse notes a comment made by Mr. Jacobs that “a colostomy is the one thing I said I would never live with.” Based on the information gathered, the nurse develops a teaching plan for Mr. Jacobs. The plan includes the provision of written material about colon cancer, anatomy and physiology of the gastrointestinal tract, and alterations presented by having a stoma. Options for care of the stoma are also provided in writing. A second visit to demonstrate how the ostomy appliance is fitted, emptied, and changed is planned. A manikin abdomen will be used to demonstrate and practice stoma care with the patient. Mr. Jacobs is in the developmental stage of generativity versus stagnation. When planning for his learning needs, the nurse also uses multiple sources of information to teach Mr. Jacobs according to his level of education but also attends to the fact that psychomotor learning is required. To evaluate the outcome of the educational intervention conducted, the nurse follows up with Mr. Jacobs to determine his competency (both actual and perceived) in performing the necessary skills of care and Mr. Jacobs’ emotional and attitudinal changes related to the ostomy and his illness. Plans are changed and adjusted according to Mr. Jacobs’ progress toward his goals, incorporating family members while Mr. Jacobs becomes ready for this step.

Case Analysis

In this case, the nurse attended carefully to assessment before beginning the educational process. Because the patient was well educated, the nurse could rely on multiple forms of education, including written materials. The nurse used hands-on practice to incorporate psychomotor skill. By asking about goals and listening to Mr. Jacobs’ feelings about living with an ostomy before initiating the educational plan, the nurse gathers valuable information about perceptions and attitudes. With this information, the nurse is able to incorporate strategies for addressing the affective domain that will be most effective. Including the family members before the patient is ready may hamper education efforts by limiting trust in the nurse–patient relationship. The patient’s desire to return to his normal life tells the nurse that this patient, in Erickson’s stage of generativity versus stagnation, wants to resume a productive life as soon as possible, lending to motivation to learn. This could have been further enhanced by incorporating frank discussions about the impact on Mr. Jacobs’ sexuality into the teaching plan.

Failing to attend to the patient during assessment would have resulted in failure of the patient’s educational experience. For example, if the nurse assumed that the patient would want his wife included from the beginning and arranged the educational sessions with Mrs. Jacobs rather than the patient alone, the nurse would have limited the patient’s ability to express his own needs in the educational encounter.

1. How would the nurse best plan to evaluate Mr. Jacobs’ ability to change his colostomy bag?

2. What is another way in which Mr. Jacobs could be assisted in learning to care for his colostomy?

Answer 1

1.The Following measure to be followed to change Mr.Jacob's colostomy bag:

• Initial the nurse should build confidence to the patient.
• Teach the patient about the colostomy management as simple as possible.
• Perform hand hygiene to prevent the spread of microorganism.Apply gloves before removing the old existing pouch
• With the gathered all the information ,Gently remove existing pouch in front of shower or use adhesive removers to decrease skin and hair stripping. it is the best way for easy removal of old existing pouch. and using a warm, moistened paper towel gently push down on the skin by lifting the corner of the pouch.
• Begin at the top edge and capture any stool or urine that can removed remained din the old pouch.
• Once the pouch was removed ,the pouch can be discarded in the trash bag.Don't tie the bag untill the pouch change so you can additional items in the bag.
• Examine the stoma and surrounded skin. Stoma should be pink that should be raised above skin level and moist. If the new stoma will have visible sutures at the junction of the base of the stoma and the skin edge.
• Aggressive cleaning can cause bleeding,if removing the stoma adhesive paste from the skin use a dry cloth.Urinary stoma will have small stents that will remain in place of 7-10 days.
• Stoma should be free from wounds and should be take off about peristomal skin.Measure the stoma diameter and cut off stoma hole.Stoma adhesive powder should be used to create a skin sealant to adhesive pouching system to prevent leaking.
• Remove flange over stoma and leave the border tape and apply pressure and remove outer border backing and press gently to create seal.
• Dispose the used pouch in to the trash and wash your hands with sanitizer.
• Pouch should be changed for every 4 to 7 days Encourage the patient to empty the pouch when if is one half full of urine and feces.

2.Teaching to Mr.Jacob about colostomy care:

• Educate the patient by using leaflets,video counselling.
• Wash your hands and put on medical gloves to prevent from the spread of microorganisms.
• Empty the pouch when if is half full with stools and urine.Don't wait untill the pouch is completely filled and dont' keep pressure on pouch that the pouch should spill out.
• Hold the pouch up by the bottom of the bag if it has a clamp system.
• Drain the pouch by squeezing the content into the toilet by placing the toilet paper before emptying the pouch to reduce the splash back.
• Clean the pouch by using toilet paper.
• Close the end of the pouch with clamp.
• Mr.Jacob should make change in his diet that some food may cause gas beacuse colon is the mixture of hydrogen , methane and carbondioxide.Complex carbohydrate cannot be broken down normal digestive processes.Limit asparagus,banana,beans,Cabbage,Carbonated drinks,Onions.