Question

Case Study Chapter 48: Caring for Clients With Ostomies

James Smith, a 44-year-old male client with a history of ulcerative colitis, had a total colectomy and a continent ileostomy (Kock pouch). The client is postoperative day 1, and the stoma is bright red and shiny in appearance. The retention catheter inserted into the nipple valve is in place to continuous drainage to the collection bag, and the nurse monitors the intake and output closely and the lab values for any electrolyte imbalances. The client asks the LPN/LVN if the ileostomy drainage will always be around a liter a day, or will it decrease eventually. a. What postoperative nursing management pertaining to the Kock pouch does the client need? b. What client education does the nurse need to provide regarding management of the Kock continent ileostomy?

Answer 1

a.The postoperative nursing management required for the patient are

• Administration of antibiotics, analgesics as per order to prevent infection and pain
• Aseptic procedure
• Monitor the patient's intake and output
• Observe for bleeding and leakage from the surgical site
• Wound care

b.The client education which has to be given to the patient are

• Take liquid diet
• If there is sensation of bloating or gas formation,solid food can be taken
• Empty every second hourly for first few weeks and it will gradually reduce to a time of 4_6 hours in a day
• A continuous catheter can be applied in the night time for drainage
• It had to be emptied strictly before bed time and also after getting up in the morning