NCM 118L/ 119L (Related Learning Experience)

Day 3- ACTIVITY

October 11-13, 2021 Rotation

Name: Villanueva, Nicole P.

Year/Section/Group No.: N4A/Group 4

Clinical Instructor: Ma’am Precy Lantin, RN, MAN

Case Analysis

CASE STUDY PROGRESS

You are a nurse working on a surgical unit and take the following report from the registered
nurse in the emergency department. “We are sending you a direct admit with rule out small
bowel obstruction (R/O SBO) and/or food blockage. Dr. N., the gastrointestinal specialist is
on his way in to see the patient. D.S. is a 78-year-old obese man with complaints of sudden
onset of severe abdominal cramping, distention, and nausea and vomiting; he denies
passing of flatus or stool within the past 12 hours. Past medical history includes heart failure,
hypertension, colon cancer, and ulcerative colitis. He underwent a total colectomy 16 years
ago and had an enterocutaneous fistula 12 years ago. Lab samples have been drawn, and
the results will be sent to your floor. We started an IV and placed a Salem Sump

1. Given that D.S. had had a total colectomy, would he have a colostomy or an
ileostomy? Explain your answer.

A colectomy is a type of surgery used to treat colon diseases and after a

colectomy the patient may have a colostomy or ileostomy. Both of these terms describe a
procedure in which the end of the remaining colon is brought to the surface of the skin. This
allows gastrointestinal contents, like bile and waste, to leave the body through this hole. A bag,
called a colostomy or ileostomy pouch, is then attached to the skin to collect the waste. The only
difference between the procedure is the location of the stoma. Based to the patient’s history he
had total colectomy 16 years ago, his entire colon was removed, therefore the small
intestine would have to be brought through the abdomen to create the stoma, resulting in
an ileostomy. It is due to his current anatomy the ileum must be used for emptying. The
green tinged stool in the ileostomy should be clean if had a withdrawn.

2. What would you expect to see if D.S.'s ostomy had normal function?

We would expect the liquid brown stool draining from the stoma (or green
unformed stool). And also, the stoma is pink or beefy red color, viable, and moist if it is
normal in control should inspect always if has infection that’s why we need to check the
stoma of the patient. Normal, passive, passing of gas/stool (1200mL/day). After D.S. is
settled into his room, the NGT and IV line are functioning well, and he receives pain
medication, the nurse will begin admission assessment. His abdomen is extremely large,
firm to touch, with multiple scars and an ileostomy pouching system in his right lower
quadrant.

3. What stoma changes would you report immediately to the physician?

a. If the stoma appears pales, bluish or black, that may mean blood flow to the
stoma is impaired.
b. Increased pulse, respirations and temp, rigid abdomen and abdominal pain
could be a sign of infection.
c. The stoma is no longer moist in appearance or seems dry.
d. The stoma appears to be discharging pus and the discharge smells bad.
e. If the stoma retracts or separates.
f. If the stoma is swollen and is more than a ½ inch (1cm) larger than normal
and the swelling does not decrease weeks after the surgery.
g. The stoma is pulling in, below the skin level.
h. The stoma is bleeding than normal.
i. If the stoma has a rash or it hurts or burns.
4. Why are transparent ostomy pouches recommended postoperatively or when
patients are hospitalized?

Transparent ostomy pouches are recommended for post-op patients because they
allow the new stoma to be seen. It is critical to visually monitor the stoma to determine its
viability. The nurses and doctors can easily assess the contents being eliminated and if
the stoma is healing properly.

5. Will the stoma present visual clues of D.S.'s bowel blockage or obstruction?

If there is a blockage or obstruction, the stoma will change. The color and
appearance of the stoma will change, it may appear a darker red or cyanotic color if there
is an inadequate blood flow. A swollen stoma indicates a potential blockage. Skin around
the stoma may swell or become enlarged. A hernia may form due to the weakened
abdominal wall, swollen stoma, and watery output.