THE SIMULATIONS IN... Clinical Simulations for Nursing Education
have been validated through their use in the NCSBN National Simulation Study and meet the current INACSL Standards of Best Practice: Simulation.
Don’t forget to take a look at the Table of Contents on page 3 to see how these 53 simulations span the curriculum.
Fundamental Skills 2
All of these Standard Forms , Patient Charts , and activities are included online.
2-3 Care of the Patient with a Colostomy
FUNDAMENTALS LEVEL: Beginner ROLES Participating ■ Primary nurse ■ Enterostomal nurse/wound ostomy continence nurse (WOCN). ■ Surgeon Supporting ■ Husband LEARNING OUTCOMES These outcomes were designed so that the Educator/Facilitator can select the learning objectives that best fit his or her needs for that simulation experience.The Facilitator may opt to select objectives based on the amount of time available to devote to the simulation experience. Cognitive The participant will be able to: 1. Describe signs and symptoms of a healthy stoma. 2. Correlate signs and symptoms of infection to the physiology of wound healing. 3. Identify factors in a patient’s history that increase the risk of colon cancer. 4. Identify factors in a patient’s current condition that increase the risk of complications with the colostomy. 5. Identify the appropriate interventions for a patient with a colostomy. 6. Differentiate the roles of team members in response to a patient with a colostomy. Psychomotor The participant will be able to: 1. Perform an appropriate assessment for a patient with a colostomy. 2. Initiate appropriate interventions including stoma assess- ment, cleansing the stoma, applying the appliance, and
STANDARD FORMS These templates are included in the Appendix which appears in the Participant Volume and also on DavisPlus. They can be used to make a simulated patient chart. ■ Interdisciplinary Progress Notes ■ Vital Sign and Pain Assessment Record
Learning outcomes meet INACSL Standards of Best Practice: Simulation Outcomes and Objectives and are tied to each simulation so that your students know exactly what they will be learning. 3. Demonstrate attention to standard precautions. Includes hand washing, infection control measures, and use of personal protective equipment (PPE) as needed. Leadership and Management/Delegation The participant will be able to: 27
■ Intake and Output Record ■ Standardized Flow Sheet ■ MAR
26
Fundamental Skills
25 ■ Continent ileostomy: A pouch is created inside the wall of the intestine.The pouch serves as a reservoir similar to the rectum.The pouch is emptied on a regular basis with a small tube. ■ Ileoanal anstamosis:The large intestine is removed and the small intestine is inserted into the rectum and attached just above the anus. Pathophysiology OVERVIEW OF THE PROBLEM Definition Colostomies and their care. Fecal diversion procedures create stomas, which may be temporary or permanent. Types of stomas include: ■ Temporary:The fecal stream is rerouted to allow the GI tract to heal or provide an outlet in obstruction. ■ Permanent:The intestine cannot be reconnected, often performed for cancer of the colon and/or rectum. 3. Use SBAR when communicating with team members in the care of a patient with a colostomy. 4. Practice Transparent Thinking (thinking out loud) to facilitate group problem solving. 5. Use Directed Communication (directing a message to specific individual) when delegating tasks. 6. Employ Closed-Loop Communication (acknowledgment of receipt of the message and status) to acknowledge communications from others. Safety The participant will be able to: Administer and maintain specific protecting interven- tions with attention to safety of the client and healthcare professional. 1. Demonstrate a safe environment with attention to haz- ards to healthcare providers, visitors, and the client. Includes body mechanics, tripping hazards, and equip- ment issues. 2. Demonstrate attention to national patient safety goals. Includes patient identification standards, effective communication among healthcare providers, and safe medication administration. 4. What does a normal stoma look like? Answer: Pink, red, moist, free of blood. Stomas are performed because of disease or trauma. ■ An ileostomy may be performed for unresponsive or complicated ulcerative colitis or suspected carcinoma. ■ A colostomy may be performed for colon or rectal cancer or to relieve an obstruction. Risk Factors Risk factors vary according to the disease process resulting in the need for a stoma. Risk factors for colonrectal cancer
Care of the Patient with a Colostomy
teaching self-care management for a patient with a colostomy. 3. Work collaboratively as part of the healthcare team in the care of a patient with a colostomy. Affective The participant will be able to: 1. Reflect upon performance in the care of a patient with a colostomy. 2. Express personal feelings in delivering care to a patient with a colostomy. 3. Discuss feelings related to working as a member of a team in the care of a patient with a colostomy. 4. Identify factors that worked well during the simulation of care of a patient with a colostomy. 5. Identify factors that needed improvement during the simulation of care of a patient with a colostomy. 6. Develop self-confidence in the care of a patient with a colostomy. Communication The participant will be able to: 1. Communicate effectively with healthcare team members in the care of a patient with a colostomy. 2. Communicate effectively with the patient and family in the care of a patient with a colostomy.
1. Identify tasks that can be legally, ethically, and safely delegated to unlicensed assistive personnel (UAP) or licensed practical nurse (LPN) in the care of a patient with a colostomy. 2. Identify and prioritize patient’s needs in the care of a colostomy. Teaching and Learning The participant will be able to: 1. Demonstrate to the patient how to change the colostomy appliance. 2. Describe the signs and symptoms of a functional colostomy to the patient. 3. Include the family in the teaching session with the patient’s consent. 4. Evaluate the teaching session and assess the patient’s knowledge. ■ Personal or family history of polyps or cancer ■ Ulcerative colitis ■ High-fat low-fiber diet ■ Gardner’s syndrome (autosomal dominant disease, familial adenomatous polyposis) Assessment Subjective ■ Assess client response to stoma and stoma care Objective ■ Observe appearance of stoma—should be pink, moist ■ Monitor for signs of bowel obstruction ■ Check skin around stoma for signs of breakdown Diagnostic Tests Not applicable Treatment ■ Administer medications and IV fluids as ordered ■ Irrigate if ordered Nursing Management Goal: Maintain fluid balance. ■ Monitor I & O ■ Administer IV fluids Goal: Prevent other postoperative complications. ■ Monitor for signs of intestinal obstruction ■ Use aseptic technique ■ Observe stoma appearance
Goal: Initiate ostomy care. ■ Prevent skin breakdown ■ Change appliance appropriately ■ Use deodorizing drops Goal: Promote psychological comfort. ■ Support patient and family ■ Assess grieving process Goal: Initiate Health teaching. ■ Self-care management ■ Diet adjustments ■ Signs of complications ■ Community referral and follow-up care Evaluation/Outcome Criteria ■ Demonstrates self-care for independent living ■ Makes dietary adjustments ■ Ostomy functions well ■ Adjusts to alterations in bowel elimination patterns REVIEW QUESTIONS 1. What are the key nursing interventions for the care of a patient with a colostomy? Answer: Stoma assessment, bowel care, pain management, and teaching colostomy care. 2. What are the complications of a colostomy? Answer: Bleeding at the stoma site, skin irritation and break- down, stoma infection, constipation and obstruction, stoma retraction. 3. What electrolyte imbalances or conditions would you observe in a patient who has had a colostomy? Answer: Hypokalemia, dehydration, constipation, and diarrhea.
5. What are the parts of a colostomy appliance? Answer: Face plate, bag/pouch, and clip (if applicable). Related Evidence-Based Practice Guidelines National Guideline Clearinghouse. Practice parameters for rectal cancer. Retrieved from https://www.guideline .gov/summaries/summary/46238/practice-parameters- for-the-management-of-rectal-cancer-revised?q=colon+ cancer+colostomy National Patient Safety Goals. Retrieved from https://www .jointcommission.org/standards_information/npsgs.aspx SBAR Technique for Communication: A situational briefing model. The Institute for Healthcare. Retrieved from http:// www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/ Tools/SBARTechniqueforCommunicationASituational BriefingModel.htm Wound, Ostomy, and Continence Nurses Society. Basic ostomy skin care. Retrieved from http://www.wocn.org/ ?page=BasicOstomySkinCare Topics to Review Prior to the Simulation ■ Medical/surgical nursing ■ Ostomy care ■ Skin and abdominal assessment ■ Colon cancer ■ Nutrition ■ Fluid balance
Your students have all the key background information they need to prepare for the simulation and review questions that check their understanding. Students will see the questions. You will have the answers.
Copyright © 2018 by F.A. Davis Company. All rights reserved.
Copyright © 2018 by F.A. Davis Company. All rights reserved. .fadavis.com Equipment ■ ID band with name and birth date ■ Telephone ■ Mannequin or simulator ■ Ostomy equipment (bag, face plate, paste, scissors, and measuring tool) ■ Face cloths 11 years. She requires teaching regarding her colostomy care. Mannekin with abdominal insert containing a stoma. Ostomy appliance bag filled with chocolate or butterscotch pudding to simulate stool. For a comprehensive collection of recipes for simulator effects, see Merica, B. J. (2011). Medical moulage: How to make your simulation come alive. Philadelphia: F. A. Davis at www
SIMULATION Prerequisites ■ Acute medical-surgical nursing ■ Anatomy and physiology ■ Nutrition ■ Ostomy care ■ Fluid balance Setting Hospital room, Surgical Unit Environment and Simulator
We help you set the scene for your simulation—from the patient’s background information to the specific equipment and meds you need to have on hand.
include: ■ Male ■ Middle aged
Mrs. Jones is a 42-year-old woman who was diagnosed with colon cancer. She has undergone a resection of her large bowel and required a permanent colostomy. It is postop day 4. She is married and has four children, aged 4 to
4
Powered by FlippingBook