. List special considerations when changing an ostomy appliance. State rationales.
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Additionally, the patient's overall health and skin condition must be considered to ensure the appliance is suitable and does not cause complications. Show more…
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Discuss best practices in relation to stoma care (4 Marks)
Breanna O.
89. The doctor has ordered a timed urine specimen be collected from Mr. Lewis, a non-catheterized, independent patient in a long-term care facility. The equipment the nurse assistant should use to collect the initial sample from the resident is a: a) Paper cup b) Catheter c) Urine bag d) Bedpan or urinal 90. Mrs. Stuart is a resident with an ileostomy bag. The nurse assistant has been instructed to change Mrs. Stuart's ostomy pouch. Why is it important that the nurse assistant wear gloves? a) To avoid skin irritation to the nurse assistant's hands b) To avoid contact with potentially infectious body fluids c) To keep the nurse assistant from having to wash his/her hands often d) To avoid sensual contact with the resident's skin 91. Mr. Michaels has a respiratory disorder and his doctor has asked for a sputum specimen. Prior to collecting a sputum specimen from Mr. Michaels, the nurse assistant may ask the resident to: a) Rinse his mouth out with clear water b) Rinse his mouth out with mouth wash c) Expectorate onto sterile pad d) Expectorate into a tissue
Madhur L.
Interactive Activity: With a partner, do the following: (1) select the one nursing diagnosis that is of priority at this time, (2) provide a rationale for your selection, and (3) list three nursing interventions that assist to meet the needs of the patient: All of the following Nursing Diagnoses may apply to Mrs. Potts. Risk for infection, Risk for impaired skin integrity, Pain, Anxiety, Ineffective airway clearance, Fatigue, Impaired physical mobility, Altered nutrition: Less than body requirements, Body image disturbance, Risk for fluid volume deficit, Fear. Nursing Diagnosis | Rationale | Nursing Interventions On the morning of the third postop day, the N/G tube was removed per physician order and Mrs. Potts was started on a clear liquid diet. In the afternoon the assessment findings included: Stoma edematous and pale, abdomen distended, c/o of pain. Instructions: Based on the third postop day assessment, identify and write the priority problem in the box below. Then, starting with the small box labeled #1, prioritize the nursing interventions listed and identify your action plan for the follow-up care of Mrs. Potts. NURSING INTERVENTIONS A. Take the vital signs B. Prepare to insert N/G tube C. Assess colostomy bag and stoma D. Notify physician stat E. Place on NPO F. Check IV patency DECISION-MAKING DIAGRAM Prepare Mrs. Potts for surgery New Action Plan Signs and symptoms of stomal ischemia Priority Problem NOTES
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