About
Surgical excision of portions of the colon with reconnection to existing colon or colostomy
Assess
Medical and surgical history, knowledge of procedure
Complications
Cholelithiasis, diarrhea, general post-operative complications ( DVT, pneumonia, atelectasis, paralytic ileus, pain, infection), body image disturbance, adhesions
Diagnosis
- Pain related to surgical procedure.
- Knowledge deficit related to surgical procedure.
- Body image disturbance related to possible bowel diversion.
- Ineffective airway clearance related to anesthesia and abdominal pain and guarding.
- Impaired skin integrity related to actual surgical incision and/ or ostomy.
Goals
- The client will be able to state pre-operative and post-operative expectations.
- The client will be able to perform incentive spirometry and splinting exercises pre and post-operatively several times an hour.
- The client will be able to tolerate oral intake.
- The client will state a pain level less than 4 after medication intervention.
- The client will ambulate at least three times daily after post-op day 1.
- The client will be free from signs and symptoms of infection.
- The client will be able to verbalize feelings related to bowel diversions and caring for an ostomy.
Interventions
- Assess vital signs post operatively every 15 minutes X's 2, every 30 minutes X's 2, every 1 hour X's 2, than every four hours.
- Assess incision for signs and symptoms of infection including redness, swelling, drainage, fever, elevated white blood cells.
- Monitor pain levels, lung sounds, bowel sounds, and pulse-oximetry.
- Teach client how to perform incentive spirometry and splinting exercises.
- Encourage early ambulation to avoid complications.
- Monitor NG tube output and the presence of bowel sounds and flatus.
- Administer analgesics for pain as ordered.
- Encourage opportunities for client to discuss feelings regarding surgical procedure and any bowel diversions.
- Encourage client participation in ostomy appliance changes and skin care.
- Monitor stoma for signs of infection, drainage, and circulation.
- Monitor fluid and electrolytes ( especially potassium) and administer replacement meds and fluids as ordered.
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