NURSING3009 Leadership and Transition to Practice Assignment

NURSING3009 Leadership and Transition to Practice Assignment

NURSING3009 Leadership and Transition to Practice Assignment

Workbook addressing stoma care management

Learning needs to be enjoyable and a challenging process which the learners are able to understand each other’s roles differently. Various research methodology is effective in enhancing this; these methods include student participation, group discussion, workbook assessments, and practice opportunities.

Nurses are paramedics who have appropriate qualifications and the needed technical expertise who can be able to provide both normal and emergency care services, (Metcalf, 2017). The expected learning outcomes for this task entail ;

registered nurse students being able to identify different kinds of stoma and

Identification of different kinds of stoma abnormalities.

to describe the role of stoma care nurse for patients with stoma condition, care offered during the postoperative period,

description of patient support needs for enhancing independence

understanding an overview of general dietary needs for stoma care patient

description of the process of safe hospital discharge (Barnwell, 2015)

Participation statement

Statement of participation will be offered upon successful completion and achievement of the assessment task.

Course evaluation

Student feedback will be issued to the learner in relation to the course input and output.

Expected learning topics covered towards stoma care management

Contents

1. What is stoma?

2. Digestive system process

3. Stoma operations

4. Ileostomy

5. Colostomy

6. Urostomy

7. Role and function of stoma nurse

8. Effective communication

9. Postoperative care

10. Stoma management and related abnormalities

11. Patient self-care

12. Safe discharge protocol (Harrison & Howlett, 2016 pp 37-38)

At the end of the learning sessions, the registered nurse will be able to identify various stomas affecting patients. In this way will gain an overview of various aspects which are needed on patient management practices. The students will be able to identify various stoma care management process and be able to identify various types of stoma. Further issues surrounding stoma care will be enhanced. This is geared to offer learners an in-depth understanding prior to their practicum session, (McGee, 2016 pp 2032).

The workbook is geared in providing learners with adequate knowledge and skill in handling stoma patients. The workbook will be able to provide illustration and key case study illustrations which enhanced registered nurse students in their first year of study, (Burch, 2017 pp 44). Further, the workbook will offer the learner some of the challenges which often occur when managing stoma among the patients. Further, an illustration of coping mechanism to enhance patients with is thoroughly and adequately covered in the workbook.

Hence this workbook is geared towards equipping registered nurse students inadequate skills which will help them in coping with nursing skills as they prepare themselves for clinical nursing practice, (Zimnicki & Pieper, 2018).

Expected learning outcome

Learning will be expected to provide nursing care for the following case study;

End learning case study

Patient history

74-year-old male

Undergone cystoprostatectomy and lead to the formation of ileal conduit for transitional purpose and cell carcinoma disease in 2009.

The patient is a lifelong smoker suffering angina, hypertension and mild COPD.

The patient is married and despite the medical challenges he still experiences a full life.

Learners to document complete patient management and document various nursing care protocols for the patient and be able to illustrate the highlighted patient case management pictorials above.

Workbook

The word stoma originate from Greek word referring to mouth and is an opening created in the body. The three main types of stoma refer to –

Colostomy; this is the stoma formed from the large intestines

Ileostomy; this is the stoma formed from the small intestines or the ileum

Urostomy; this is formed in the urinary system process

Reasons why stoma is necessary

Blockage or obstruction formed in the bowel

Bowel perforation

Severely removed bowel or the bladder

Conditions which require stoma include;

Bladder or bowel cancer

Ulcerative disease

Chrohns disease

Diverticular disease

Abnormalities during birth

Colostomy and ileostomy occur as a temporary measure, while urostomy occurs as a permanent measure. End stoma is where one end of the stoma is formed into the stoma

Loop stoma is brought out as abdomen which the edges are sutured on the skin, (Porrett & McGrath, 2005).

The digestive system begins its lining from the mouth with food being swallowed from the esophagus (1) into the stomach area (2). The stomach mixes the food and churns them into digestive juices and passed into ileum (3),

(Wildman & Meedeiros, 2014).

The small intestine is 6 meters long. The food is able to go through the walls and being scrubbed through the expansion and contraction process. This matter is able to pass the large intestines in the colon, (4) which is estimated to be 1.5 meters. The colon s tasked with taking back the water through absorption into the body, thus leaving the undigested and indigestible matter to go through the semi-solid phase and passed as feces, (Svhius, 2015 pp 307-312).

This occurs when part of the colon is removed temporarily to act as a bypass. This forces the faeces from the body not to pass the normal process.

Formation

A colostomy is formed surgically through the creation of the opening of the larger intestines. The colon is directed towards the abdominal wall and later sutured in the skin. A colostomy can occur anywhere however it is commonly placed at the left-hand side, (Zanella & Dileo, 2016).

Appearance

The colostomy appears as a small spout having a deep pink color similar to the inside walls. It poses no feeling. Waste matter comes out of the stoma and is collected using a stoma pouch.

Normal output

The function of the colon is to initiate absorption of the waste. This is done by the movement through the stoma. This signifies that the further the stoma is situated in the colon, the more the waste matter is more formed and appears thick.

Managing Colon stoma

In managing the stoma, there is a need for a pouch which is used to cover the stoma hole. This pouch is usually changed twice or up to thrice per day, (Swan, 2011).

Procedures done for ileostomy are similar to that of colostomy, with the only exception being that the stoma is usually created in the ileum rather than the colon side. An ileostomy can occur both on the temporal process or permanent basis depending on the patient status.

Ileostomy formation

Ileum stoma is formed through the process of surgery, whereby the hole is opened in the small section of the bowel, which is the ileum. Ileum ends is adjusted into the abdomen right side. The spout is usually longer than in the colostomy process, (Poggioli, Gentilini, Cosca, Boschi & Ugolini, 2018 pp 124-130).

Appearance

The stoma appears like a spout having a deep pink colour which looks similar to the outside mouth. It has no feeling of touch. It releases waste and collected through the special pouch which is fixed on it.

The normal output of stoma

Due to the waste not able to travel through the section well, a small volume of water is absorbed and the faeces released from the ileostomy usually in liquid form. The average output of an abnormal stoma is estimated to be around 500-800 MLS in a period of 24 hours, with more content of the liquid form.

Mucous fistula

This occurs when the rectum has not been completely been removed but is left on the side need, this can be brought to the surface through small opening referred to as mucous fistula. Normally after surgery, the excess is drained through the mucous fistula and this can be mitigated through the emergency procedure.

Normally it is can be mitigated using a small pouch, which allows for dressing after a few weeks.

Management appliance

An opening of the ileum is usually managed using a drainable pouch, which can be emptied between 4-6 times in a day. The pouch can be changed any day every time with the patient.

(Ashburn & Hull, 2018)

Working of the urinary system

The urinary carries out various functions. The body function is engaged with the process of producing waste chemicals which are channeled through the blood. The kidneys in the body continue to filter the blood in order to purify it. The urine content formed is passed through the kidneys and goes to the uterus and filled into the bladder, where storage occurs. This is then passed through the ureter and it goes to the urethra.

Working of the urinary system

The urinary carries out various functions. The body function is engaged with the process of producing waste chemicals which are channeled through the blood. The kidneys in the body continue to filter the blood in order to purify it. The urine content formed is passed through the kidneys and goes to the uterus and filled into the bladder, where storage occurs. This is then passed through the ureter and it goes to the urethra.

Occurrence of urostomy

During the urostomy process, the urine is channelled through other ways. Instead of the bladder process and urethra, the urine is passed to the uterus and is diverted to the surface through the opening in the abdomen. Normally the stoma is placed on the right-hand side facing the abdomen, (Arolfo et al., 2018).

Formation of stoma

Creation of the stoma which cuts through the abdomen, small pieces of the ileum is removed and used to fashion the tube in the ileal conduit. The two formed ureters are then channelled through to the ileal conduit which is open as a stoma.

Normal output occurrence                        

The normal output process occurs as an occurrence of continuous urine flow which has mucus.

Management appliance

Its management is undertaken using a pouch which requires emptying several times a day. Urostomy has been made to have continuous drainable bag during night times. The pouch needs changing every day.

Patients with stoma need constant attention of a specialist nurse with adequate skills and to offer technical and special support to the patient. Nurses offer the following component of care to the patients with astoma.

Clinical care

1. The nurse provides patient care and guides stoma management

Education

1. The nurse provides assessment and teaching the patient and develop health education based resources for the patient to enhance self-care

Management

1. Facilitates management both at the ward and administration stoma care services for the patients.(Bhargava, Chasen & Feldstain, 2018 pp 640-650)
2. Stoma has a great impact on a nurse image and patient self-image and self-esteem

3. Incorporating practical and emotional needs of the patient while communicating stoma care. Emotional needs entail how the patient is feeling while the practical needs entail how the stoma is managed

4. Being sensitive in communicating using the right language and being in cognisant with facial expression.

5. Supporting the patient in enhancing stoma care management and assisting the patients enhancing independence.

6. Incorporating effective communication for the patient and notifying stoma care upon the admission of a stoma patient.

relies on the nurses to offer care for the patient. This will be enhanced through two processes which entail monitoring and redoing stoma conditions. This entails the color, size and skin touch.

Secondly entails monitoring and measuring the stoma output of the patient. This is done through regular emptying of the stoma output. (Gibson & Hardy, 2007)

Recognizing stoma care abnormalities is very crucial for stoma care. Notices on the skin, oedema and bleeding stoma are the key factors to assess common complications of the stoma.

Other abnormalities include;

  1. Relapse,
  2. Retraction
  3. Skin creases
  4. Stenosis

Mucocutaneous separation process

A parastomal hernia

It is important to teach the patient on self-care process. This details to;

Good hygiene

Pouch emptying process

Enabling safe discharge process.

References

1. Arolfo, S., Borgiotto, C., Bosio, G., Mistrangelo, M., Allaix, M.E. and Morino, M., 2018. Preoperative stoma site marking: a simple practice to reduce stoma-related complications. Techniques in Coloproctology, pp.1-5.
2. Ashburn, J.H. and Hull, T.L., 2018. Management of Ileal Pouch Strictures and Anal Stricturing Disease: A Clinical Challenge. In Fibrostenotic Inflammatory Bowel Disease (pp. 253-266). Springer, Cham.
3. Barnwell, A., 2015. Advanced nursing practice in colorectal and stoma care. Gastrointestinal Nursing, 13(1), pp.42-48.
4. Bhargava, R., Chasen, M.R. and Feldstain, A., 2018. Rehabilitation and Survivorship. In The MASCC Textbook of Cancer Supportive Care and Survivorship (pp. 635-651). Springer, Cham.
5. Burch, J., 2017. Care of patients undergoing stoma formation: what the nurse needs to know. Nursing standard (Royal College of Nursing (Great Britain): 1987), 31(41), pp.40-45.
6. Gibson, P. & Hardy, L (007. Cumbria Competence and Training: Assisting clients with stoma management. Cumbria Changing Workforce Project, 64(8), pp.35-42.
7. Harrison, P. and Howlett, K., 2016. Developing a stoma care training programme through a unique university-industry collaboration. Gastrointestinal Nursing, 14(1), pp.36-42.
8. McGee, M.F., 2016. Stomas. Jama, 315(18), pp.2032-2032.
9. Metcalf, C., 2017. Evaluating nursing standards in a stoma care service: results of an internal audit. Gastrointestinal Nursing, 15(4), pp.35-41.
10. Poggioli, G., Gentilini, L., Coscia, M., Boschi, L. and Ugolini, F., 2018. Surgical Treatment of Ulcerative Colitis: Indications and Techniques. In Ulcerative Colitis (pp. 123-138). Springer, Milano.
11. Porrett, T. & McGrath, A. eds. 2005. Stoma Care. Blackwell Publishing, Oxford
12. Stephenson, N 2008. Self-directed learning: communication. British Journal of Healthcare Assistants, 2(6), p301-303
13. Svihus, B., 2014. Function of the digestive system. Journal of Applied Poultry Research, 23(2), pp.306-314.
14. Swan, E., 2011. Colostomy, management and quality of life for the patient. British Journal of Nursing, 20(1), pp.22-28.
15. Wildman, R.E. and Medeiros, D.M., 2014. Advanced human nutrition. CRC press.
16. Zanella, S. and Di Leo, A., 2016. Use of Vacuum-Assisted Closure in the Management of Colostomy. Surgical Infections Case Reports, 1(1), pp.165-168.
17. Zimnicki, K. and Pieper, B., 2018. Assessment of Prelicensure Undergraduate Baccalaureate Nursing Students: Ostomy Knowledge, Skill Experiences, and Confidence in Care. Ostomy/wound management, 64(8), pp.35-42