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Evidence-Based Justification of the three problems
Nursing care planning and management for Mr. Peter Jones will incorporate assisting him during adjustment; prevention of complications; autonomic self-care support; provision of information about the prognosis; therapeutic needs; and possible complications. However, based on the patient’s conditions, the three problems that will be used in care plan include danger for Impaired Skin Integrity; acute Pain; and deficient fluid Volume (Gulanick & Myers, 2013).
Impaired Skin Integrity Risk
Mr. Jones is in danger of impaired tissue integrity because of the stoma, and it was important to me to include this in the care plan. As Doenges, Moorhouse and Murr (2014) outline, persons with an injury to the skin, like in the cases of colostomy procedure, remain at risk of having impaired skin integrity. This is due to difficulties in moving and incapability of changing positions easily while on the bed or when seated (Lewis et al., 2014). Since Mr. Jones needs to recover from laparatomy and colostomy, he needs bed rest, and this may compromise his skin integrity.
Acute Abdominal Pain
The second problem is that the patient will experience acute abdominal pain on the laparatomy site and areas surrounding the stoma. In most cases, post-operative patients experience acute and severe pain on the incision site. However, it is very important for healthcare providers to manage this pain to make the patient comfortable. The efficient pain relief on Mr. Jones will remain the utmost significant intervention. Pain relief has momentous physiological advantages; therefore, pain relief monitoring is increasingly turning out to be a vital postoperative quality measure (Dirksen, 2011).
Risk of Nutritional Imbalance
The third problem that Mr. Jones will develop will be a risk of nutritional imbalance. According to McKay et al. (2012), patients with a colostomy in most cases are limited to certain type of foods. Generally, these patients after operation, they are subjected to nil per oral for quite sometimes. Most of them use NG tubes in feeding and IV fluids. Due to these, these patients like Mr. Jones are subject to the risk of nutritional imbalance. With reduced oral intake linked to prescribed dietary changes; weakness; pain; nausea; fatigue; as well as fear of excessive colostomy output, gas, and odor, there is interference of the patient’s mode of eating. Consistent with Mishra (2016), these patients stand at risk of nutritional imbalance due to loss of nutrients linked to vomiting and extreme colostomy output; reduced nutrient absorption due to loss of absorption surface of the colon as a result of incision of a portion of the colon; and enhanced nutritional needs linked to the enhanced metabolic rate, which takes place during wound healing.
Nursing Interventions
| Diagnosis | Goal | Interventions | Rationale | Expected Outcomes |
| -Impaired skin integrity risk, which is as a result of colostomy bag | -After 72 hours following complete nursing intervention, Mr. Jones will be free from skin irritations and rashes of the stoma and the surrounding region | -Inspect the skin/stoma after changing the bag -Clean the stoma and the surrounding area with normal saline solution (NSS) or warm water -Apply or instruct the patient to apply skin barriers to the region around the stoma. -Apply antifungal to the area per the prescription -In cases of any complication, consult nurse specialist in charge of stomas. | -To monitor the healing process of stoma/skin. -To uphold cleanliness in the surrounding region and preventing skin damage. – To uphold cleanliness in the surrounding region and preventing skin damage. -To assist in healing -To enhance management of the patient. | -Mr. Jones will be expected to manifest the following: -Uphold skin integrity -Find out risk factors -Disappearance of skin irritation and skin rashes -Uphold behaviors that improves healing ……. |
