Hey nurses! 👋
Last week we looked after Mary Byrne, a 75 year old patient admitted after a fall at home, an increase in her confusion and a decrease in her ability to perform her ADLs. The answers to our critical thinking questions are below!
Name, DOB: Linda Brown, 05/03/1979
Allergies: None Known
Admission Reason: Partial Bowel resection D3 today. Formation of a stoma, patient has a colostomy bag in situ.
PMH: Bowel cancer, chemotherapy, anxiety, depression post cancer diagnosis. Family have a hx of Bowel cancer.
Diet: Tolerating clear fluids, to transition to light diet today
Social: Lives at home with husband and 2 daughters in a ground floor apartment.
- Height 160cm, weight 50kg. Average BMI
- Linda received chemotherapy for her cancer last year, and since then has become more anxious and suffers from depression since her diagnosis. Linda has been very emotional and distressed since the surgery requiring a lot of reassurance and time with the nursing staff.
- Alert and Oriented.
- Independent with ADLs.
- Patient is being reviewed daily by stoma nurse for support and education. Patient needs assistance with stoma care as not confident with stoma management yet.
Observations completed this AM by AIN:
Temp 36.9, RR 16, HR 90 and regular, BP 135/75, 02 Sats 99%
Critical Thinking Questions:
- What are the main concerns or issues arising in this scenario?
The patient’s ability to learn and manage her stoma independently, and to improve and focus on her coping strategies.
- What are possible issues that may arise with the formation of a new stoma?
Dehydration, electrolyte imbalance, issues arising with new stoma, we want to pay close attention to colour, description and output. Patients also can develop emotional responses to the formation that require attention as this is a huge change in life.
- Identify and explain what you are including in a stoma assessment.
Colour: pink, pale, dusky, black
Description: Oedema, Shape, sprouted, flush, retracted, prolapsed.
Output: Nil, Flatus, Serous, haemoserous, Bile, Faecal Fluid, soft faeces, hard faeces.
- What would you include in your patient education today?
Reassurance to the patient
Offer support services, if patient would like to have access to support or debrief services.
Education in relation to assess patients stoma
Education to assess surrounding skin
Could include training of family members as extra support
- Linda is taking Endone PRN for pain, what are some side effects of taking this medication?
Side effects: constipation, RR depression, sleepy, nausea, drowsy, itchiness, rash, dependence.
- What are the requirements of a PRN medication order? (hint...what exactly does the doctor have to include in the order)
The order must include: patient name, patient MRN, patient DOB, drug name, drug dose, dosing time (ie q4h, q30mins), max dose in 24 hours, reason for medication, and doctor's signature.
Thanks for joining in our case study! You can award yourself CPD Hours for the time that you took researching and reflecting on Linda's case. We hope that you will join us again next month for our next case study!