The nurse is seeing a patient at home with a new colostomy. In ...

[stephzh]

The nurse is seeing a patient at home with a new colostomy. In formulating the plan of care, what is the priority long-term goal for this patient? The patient will:
 
  a. Adjust emotionally to the colostomy and lifestyle change
  b. Verbalize appropriate steps in caring for his colostomy
  c. Assume self-care in colostomy management
  d. Experience soft stool with minimal flatus

Question 2

The nurse is obtaining a bowel elimination history from her 80-year-old patient. The patient states, Sometimes when I go to the bathroom I push real hard, hold my breath, and plug my nose. Which action should the nurse take first?
 
  a. Warn the patient, You should not hold your breath while straining.
  b. Assure the patient, This does seem to help some people to have a bowel movement.
  c. Check the patient's medical history for heart disease, glaucoma, increased intracranial pressure, or a new surgical wound.
  d. Notify the primary care provider that the patient has reported performing this action.

[allisonblackmore]

Answer to Question 1

C
Patients experience a variety of reactions to a bowel diversion, and each person has unique physical and psychological needs. Initially, the nurse will care for the colostomy and teach the patient how to care for it. The ultimate, priority goal is for the patient to assume self-care and a normal life. Although patient acceptance of his or her colostomy is important, the nurse cannot assume any patient will accept the lifestyle change. Some patients may never feel comfortable with a bowel diversion. However, if the patient has been sick before surgery and the ostomy leads to less pain or discomfort, the transition and acceptance may be easier. Verbalizing the steps of colostomy care and passing soft stool with minimal flatus are important short-term goals. However, they are merely small steps toward the long-term goal of self-care and management.

Answer to Question 2

C
A person can increase the pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway (e.g., holding breath). This is called the Valsalva maneuver and it is what the patient is describing. Although it assists with the passage of stool, you should caution patients with heart disease, glaucoma, increased intracranial pressure, or a new surgical wound to avoid this maneuver because it increases pressure with the abdominal cavity, raises blood pressure, decreases heart rate, and is associated with an increased risk for cardiac dysrhythmias. For that reason, before deciding how to respond, the nurse should check the chart to see whether the patient has any medical conditions that contraindicate the Valsalva maneuver. Only then would it be necessary to warn the patient against the maneuver. The nurse should not reassure the patient or further encourage the action without additional information. It is not necessary at this time to inform the primary care provider, although a notation should be made in the patient record.

[stephzh]

Excellent

[pratush dev]

TYSM