Question

John had a gunshot wound to the abdomen and underwent an exploratory laparotomy and creation of an ileostomy due to damage to the small bowel. You are assigned to care for John on the third postoperative day. He has a nasogastric tube to low intermittent suction, and he is emitting greenish aspirate. IV access is through a triple lumen right subclavian catheter, and he is receiving D5 0.9% NS with 20mEq K(potassium)/liter. John has a dressing to the left abdomen, and there is moderate amount of fluid draining out of his ileostomy.

A-what is the rationale for the nasogastric tube to low intermittent suction?

B-John is at risk for which kinds of electrolyte imbalances?

C-Upon assessment of the stoma, what findings substantiate a healing stoma?

D-John asks when his bowel output will become more solid and if he will be able to have a continent ostomy. How should the nurse respond?

E-what is the rationale for a low residue diet in the patient with an ileostomy?

Answer 1

A.The rationale for low intermittent nasogastric suction are

• To remove gastric contents
• To prevent nausea and vomiting in post op cases
• To observe the gastric secretion

B.A patient who has stoma is at risk of sodium loss due to exclusion of colonic content

Certain patient has decreased level of magnesium due to poor dietary intake in later days

In case of dehydration patient tend to have loss of sodium, potassium, chloride and magnesium

C.A healing stoma will be reddish pink and shiny .This observation is a good sign that there is adequate blood supply to the operated site which makes the are bright red which are shiny

D.The initial bowel content will be of gas and in liquid form.When the patient gradually starts on soft to solid diet ,the stool content also turns solid.It is expected in about 6 to 8 weeks.

E.A low residual dietwill help wound healing and also prevent blockage of wound which may occur due to inflammation. This also prevents constipation and discomfort in patient.