Nursing Report You arrive on the unit at 0700 and have been assigned Mrs. Jones. She will require colostomy care teaching and her appliance needs to be changed. She has requested morphine
2 mg IV twice in the last 12 hr. Her husband and children are present in the room. She met with the enterostomal therapist yesterday and feels well enough to begin independent care of her colostomy.
Simulation Prep Assignments
Care of the Patient with a Colostomy
31
This is the ticket to lab —identifying all of the prep work students must complete to be fully prepared to participate in the simulation. Note: Only the Facilitator Version includes the answers! Assessment Priority Problem Data
1. Identify items and their purpose in the care of a patient with a colostomy.
7. Nursing Problems/Diagnoses Identify three priority nursing problems/diagnoses.
Item
Purpose
Stethoscope
Detect bowel sounds To change appliance Not a sterile procedure Could Be Delegated to Unlicensed Personnel?
Colostomy equipment
Intervention
Expected Patient Which Interventions
Outcome
Clean gloves
2. Identify team members and their specific roles in the care of a patient with a colostomy.
1. Colostomy
Alteration in bowel functioning related to the colostomy Potential for alteration in skin integrity related to creation of a stoma Potential for altered body image related to the colosto- my and loss
Team Member Primary nurse Teach patient about a healthy balanced diet. Monitor for signs and symptoms of constipation or diarrhea Assess for chemical/ mechanical, bacterial, fungal, and thermal irritants Type of procedure Encourage patient to express feelings. Acknowledge feel- ings and encourage patient to ask questions from Report
Patient will have regular bowel move-
Role
Teach and change colostomy appliance Resource for patients with colostomies
WOCN or enterostomal nurse
ments prior to discharge
Family members
Support
Physician/surgeon
Treatment plan
2. Colostomy
Patient will achieve/ maintain skin integrity
3. Relevant Data Exercise: Fill in the columns below. Relevant Data Relevant Data from
Sources for Missing Data
Data Requiring
Other Sources
Data Missing
Follow-up
Response to morphine Current pain level
Surgical date Type of appliance
Current diet plan Patient and family
3. Colostomy
The patient will implement new coping patterns
Changing of the colostomy could be delegated to a caregiver or unli- censed personnel following discharge
and verbalize acceptance of appearance
of bowel function Simulator Settings provide the information you need to preprogram your high-fidelity manikin according to each scene/frame in the simulation.
4. Initial Focused Assessment After reviewing the client background and nursing report, you are ready to assess your client’s current status. Under each cat- egory, identify how you would target your assessment and what you would expect to find for the patient with a colostomy.
History Are there any questions you need to ask the patient or family to obtain additional relevant data? ■ Do they require an interpreter for the teaching session? ■ Are they able to pay for the supplies? ■ What is the client’s normal diet?
Other Nursing Diagnoses ■ Altered health maintenance related to knowledge of ostomy care. ■ Fear related to medical condition requiring stoma. ■ Risk for fluid volume deficit related to increased output through stoma.
Copyright © 2018 by F.A. Davis Company. All rights reserved.
Simulator Settings
Frame (timed)
Settings
Additional Findings Participant Action/Correct Participant Action/Incorrect
Completes a bowel auscultation, identifying correct assessment
128/82 Bowel
Stoma site with a colostomy appliance
Identifies incorrect bowel sounds
0–15 min
sounds— can be hypo, hyper, or normal
It’s easy to find the simulation script —these steps will always appear in landscape format and include facilitator cues, timing, correct participant actions and other possible responses.
Scene 1: Health Teaching—Colostomy Care Facilitator Role Check To
Copyright © 2018 by F.A. Davis Company. All rights reserved.
Assessment/
Patient Event/
Check Assessment/
Patient Event/
Comments
Cues/Time Progression
be Used by
Participant Action
Response
Participant
Facilitator as Correct
Patient
Action
Response
Check List
Assessment Data Patient denies pain and agrees to teaching session
Incorrect
Participant will introduce self, identify patient by 2 means, and
If participant just brings supplies to bed side and doesn’t ask permission or explain his/her actions, then stop the sce- nario. Also a pain assessment
Patient is over- whelmed, refusing the teach- ing and complains of pain
0–15 min Primary nurse
explain the teaching plan and complete a pain assessment
must be included
Participant then asks the patient if she wants all her family members present. The nurse should
Family decides which family members can remain in the room
If a language barrier is not identified, patient and family under-
Patient
doesn’t understand directions
5
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