Question

he client presents with loss of appetite, nausea, vomiting and no bowel movement for 5 days. He is diagnosed with a bowel obstruction. Patient states, "I feel so bloated...". He vital signs are BP 164/80, RR 28, P 96, T 99, pain is 3/10. He is scheduled for surgery for lysis of adhesions with potential ileostomy placement and a nasogastric tube.

• Discuss specific teaching the nurse will provide to the client regarding his ileostomy including: stoma care, stoma health and how to assess stools.
• An area of teaching post-ileostomy is that of sexual health; describe the content that the nurse needs to include in their discharge teaching.

Answer 1

Stoma Care

Actually stoma is very delicate so it needs to be protected very carefully. Always keep the skin around the stoma dry and clean.The feces that come out of the stoma ican be irritating to the skin so take special attention to avoid any damage to the skin. To protect skin you can use a bag or pouch with correct size opening to avoid waste leakage. more than that wash your skin with warm water and dry it well before you attach the pouch and avoid any skin cleaning products, that can cause skin irritation such as alcohol or cosmetic skincare items. Moreover, if you have hair on the skin around the stoma, you should remove it completely for that you can seek help from your nurse, otherwise, your puch may not stick.

Stoma health

Carefully look at your stoma and the skin around it every time you change your pouch or barrier. If the skin around your stoma is red or wet, your pouch may not be sealed well on your stoma.Sometimes the adhesive, skin barrier, paste, tape, or pouch may damage the skin. This may happen when you first start using a stoma, or it may happen after you have been using it for months, or even years.If something like this happens immedialtely contact your physician for remedial measures. Please note, other than this should also seek help from your physician when

1. Your stoma is pulling in, below the skin level.
2. Your stoma is bleeding more than normal.
3. Your stoma has turned purple, black, or white.
4. Your stoma is leaking often or draining fluid.
5. Your stoma does not seem to fit as well as it did before.
6. You have to change the appliance once every day or two.
7. You have a discharge from the stoma that smells bad.
8. You have any signs of being dehydrated.
9. If you have frequent incidence of diarrhea.

Assessment of stools

initially, after surgery stool may look thinner and at the same time quantity of stool may also be higher and it will gradually thicken up as the body adapts and the small intestine starts to absorb more water.