fundamental procedures

Colostomy is the opening of some portion of the colon onto the abdominal face

Reasons for Performing a Colostomy

▪When feces cannot progress naturally from the colon to the anus

▪When it is more desirable or manageable to divert the feces, as for paraplegics

▪In any condition where the rectum or anus is nonfunctional because of disease, a birth defect or a traumatic condition.

▪It is performed to divert the fecal flow away from an area of inflammation or around an operative area General Procedure for Changing an Ostomy Pouch

Assessment

1. Identify the type of ostomy the patient has and its location (Bowel Urinary Diversion)

2. Assess the skin integrity around the stoma and as general appearance

3. Note the amount and character of any fecal material or urine in the pouch

4. Determine whether the patient is being taught self-care at the moment

Planning

1. Wash your hands

2. Gather the equipment needed in changing a pouch or dressing

▪Cleansing supplies including tissues, warm water, mild soap, wash cloth and a towel

▪Clean pouch of the type currently being used

▪Seal or use tape to prevent leakage

▪Clean belt

▪Dressing materials

▪Receptacle for the soiled pouch or dressing (bedpan, paper bag/newspaper for wrapping)

▪Protective spray

▪Clean gloves

1. Determine whether the patient is to participate actively

2. Choose the appropriate location in performing the procedure (bathroom/ bedside)

Implementation

1. Identify the patient

2. Explain the procedure to the patient

3. Put on clean gloves for infection

4. Assist the patient to the bathroom or provide privacy

5. Remove the soiled dressing

6. Using warm water and a mild soap, cleanse the skin around the stoma thoroughly. Inspect the skin for

redness or irritation.

7. Cover the stoma with a tissue to prevent feces or urine from contacting. Change tissues as necessary during

the procedure

8. Dry the skin around the stoma carefully, patting gently

9. Apply a skin protective spray if needed

10. Allow the skin to dry thoroughly so the pouch will adhere firmly (a hair dryer on a low setting at least 18

inches from the skin may be used)

11. Remove the tissue from the stoma and apply the clean pouch or dressing

12. Remove gloves and wash hands

Evaluation

1. Evaluate using the following criteria

▪Pouch or dressing secure

▪Area clean

▪Odor free

▪Patient comfortable

▪If the patient is being taught the procedure, add the following criteria:

▪Patient is able to change pouch using correct technique

▪Patient verbalizes understanding of key points in care

Documentation

1. Record the following information:

▪The amount, color, and consistency of the fecal material or urine in the pouch

▪The application of the clean pouch and dressing change

▪The knowledge and ability of the patient t participate in the procedure or ability to change independently.

Chest Tube Care and Monitoring

TERMINAL LEARNING OBJECTIVE

Given a scenario in a holding or ward setting, involving a patient with a chest tube, identify procedures for chest tube care and monitoring IAW the Textbook of Basic Nursing, Lippincott Introduction

Trauma, disease, or surgery can interrupt the closed negative-pressure system of the lungs, causing the lung to collapse. Air or fluid may leak into the pleural cavity. A chest tube is inserted and a closed chest drainage system is attached to promote drainage of air and fluid. Chest tubes are used after chest surgery and chest trauma and for pnuemothorax or hemothorax to promote lung re-expansion

Terms and definitions

a. Pneumothorax – collection of air in the pleura space

b. Hemothorax – an accumulation of blood and fluid in the pleural cavity between the

parietal and visceral pleurae, usually as the result of trauma

c. Chest tubes – a catheter inserted through the thorax to remove air and fluids from the

pleural space and to reestablish normal intrapleural and intrapulmonic pressures

Chest Tube Systems

a. Pleur-Evac chest drainage system

(1) One-piece molded plastic unit that duplicates the three-chambered system

(2) Cost effective

(3) There must be bubbles flowing in the suction control portion of the unit to provide

suction to the patient

b. Pleur-Evac Set Up

(1) Fill water seal chamber

(2) Fill suction control chamber

(3) Attach tube to suction source

(4) Tape all the connections

(5) Provide sterile tube for connection to patient

c. Procedure for Proper Usage of the Heimlich Valve