• Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

A case study of a 68 year old patient admitted to undego a bowel resection resulting in the formation of a colostomy

Extracts from this document...


BSc/BSc Honours in Nursing Tayside Institute for Health Studies Module HE0808A - Adult Nursing Case Study - "Mr. Jones is a 68 year old gentleman who has been diagnosed as suffering from colorectal cancer. He has been admitted to your surgical ward to undergo a bowel resection, which will also result in the formation of a colostomy" Matriculation Number: - 0605304 * Introduction Background Colorectal cancer is the second most common cause of cancer-related deaths in the UK (Brooker, 2005); and this paper aims to discuss the treatment and care of a 68 year old gentleman who has been admitted for colostomy forming surgery. Consideration will be given to both the pre-operative and post-operative care that Mr Jones will receive; and we will discuss the factors surrounding his physical and emotional well being. Aetiology & Pathophysiology The lumen of the colon is lined with many cells which are subject to constant turnover. Adenocarcinomas form when too many dysfunctional cells lining the colon create a tumour (Whittaker, 2005). The exact cause of colorectal cancer is unclear (Alexander et al, 2006); however diet is thought to be the most important factor (Waugh & Grant, 2006). The symptoms of colorectal cancer vary depending on the area of the bowel affected (Brooker, 2005). The symptoms of right sided tumours usually include: anaemia, weight loss, abdominal mass, ill-defined abdominal pain, and changes in bowel habit (Borwell, 2005). Left sided tumours usually present with symptoms such as: colicky abdominal pain, abdominal distension, alternating bowel habits, plus mucus and/or blood in the patients' stool (Borwell, 2005). Treatment of Colorectal Cancer Treatment depends on the stage of the cancer and the prognosis of the disease (Whittaker, 2005). ...read more.


The level of Mr Jones' comprehension with regards to his procedure and prognosis should be constantly monitored by the nurse to ensure he knows what to expect (Dougherty & Lister, 2004). All too often the patient and their family are so emotionally overcome that they do not grasp all that has been said. The nurse can determine what information has been given, then, in simple terms; can repeat any necessary information (Walsh, 2002). Usually, surgeons will prescribe a bowel preparation 1-2 days before the operation to reduce the risk of infection from faecal contamination (Borwell, 2005). These preparations can include Fleet, Picolax or Klean-prep and ensure the bowel is free of any solid contents (BNF, 2007). In addition, Mr Jones will be not be allowed any food or fluids 4-6 hours prior to surgery, in order to avoid the risk of regurgitation and inhalation of gastric contents whilst under the anaesthetic (Jamieson, 2002). However the undesirable results of prolonged fasting are dehydration and electrolyte imbalance, particularly in older patients; which may potentially render them unfit for surgery. To prevent this; intravenous fluids may be prescribed if Mr Jones displays any signs of dehydration (Alexander et al, 2006). If Mr Jones is particularly anxious the anaesthetist may prescribe a "premed". This is a drug such as diazepam which constitutes to part of the anaesthetic. It is used to relax and relieve anxiety; and will be given just before Mr Jones leaves the ward for theatre (Alexander et al, 2006). In addition to the previous information, most hospitals also employ a standardised checklist which is completed on the morning of surgery and includes the following criteria: - * Ensure Mr Jones is wearing an identification band with the correct information (Dougherty & Lister, 2004). ...read more.


Once Mr Jones is able to meet this criteria the nurse can then organise the appropriate support for his discharge such as transport and community services (Brooker & Nicol, 2003). * Conclusion This paper has endeavoured to provide a broad but brief insight into the holistic care provided for Mr Jones during his colostomy forming surgery. However, there are numerous factors to consider and due to the word allowance of this assignment it was not possible to mention them all in detail. The main aspects for a nurse to remember are that pre-operatively the focus must be on the psychological welfare of Mr Jones; and his understanding and acceptance of the stoma is required to enhance a speedy recovery (Porrett & McGrath, 2005). To ensure this, the nurse must educate, reassure and more importantly listen to Mr Jones as he expresses his fears, and asks questions (Dougherty & Lister, 2004). One of the most important aspects of care to remember is that of therapeutic relationships. By being supportive, listening to, and acknowledging the patients fears, by offering good clear explanations, and building trust; nurses can make a positive difference to the patients experience (Walsh, 2002). Post operatively the nurse must shift their focus to the physical care of Mr Jones, ensuring that his vital signs and wounds are monitored regularly; and any problems reported immediately (Porrett & McGrath, 2005). The complications with regards to Mr Jones' acceptance of the stoma should be minimal, as long as the training and support he received pre-operatively was adequate (Alexander et al, 2006). However, constant assessment of Mr Jones' psychological state should be made to ensure he is coping. And finally; to ensure adequate rehabilitation occurs at home, the nurse must make the appropriate referrals and supply the correct level of community support to Mr Jones' upon his discharge. ...read more.

The above preview is unformatted text

This student written piece of work is one of many that can be found in our University Degree Nursing section.

Found what you're looking for?

  • Start learning 29% faster today
  • 150,000+ documents available
  • Just £6.99 a month

Not the one? Search for your essay title...
  • Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

See related essaysSee related essays

Related University Degree Nursing essays

  1. Teamwork is an integral part of Accident and Emergency care and if it is ...

    (Mallett,& Dougherty, 2000) Patients are individuals with unique needs that should be addressed through careful assessment and with the use of therapeutic communication. (Mallett, J & Dougherty, 2000) The essence of nursing care is the relationship between the nurse, the patient and their loved ones, and the way in which they form a true partnership to negotiate care.

  2. The aim of this assignment is to analyse a critical incident in the care ...

    Joe was commenced on oxygen therapy; which relieved the symptoms of breathlessness. Administrating oxygen reduces or corrects hypoxia by compensating for the reduced minute volume (Bennett 2003). Bennett et al (2003) state that oxygen can be delivered in a number of ways, it was important to ensure the method chosen was the appropriate device.

  1. This assignment intends to demonstrate the use of the Roper, Logan and Tierney model ...

    The assessment highlighted several health care needs: sexuality was not initially noted as a problem. Problems relating to sexuality were recognized by the writer through subsequent discussions with the patient. The nursing care needs identified pre-operatively for Stacy were; the impact psychologically of the loss of pregnancy (actual)

  2. Burns Case Study. The pathophysiology involves both local and systemic responses which Klein ...

    Doenges et al. (2010) goes on to explain that in almost all burns patients will present with tachycardia, tissue edema formation, decreased urinary output, decreased or absent bowel sounds, nausea, vomiting, facial mask, changes in blood pressure, pulse, and increased respiratory rate.

  1. Chronic obstructive pulmonary disease (COPD)

    This results in the loss of support for the airways and early closure on expiration (Fehrenbach, 2002). Most COPD patients have a history of cigarette smoking of at least 20 pack-years (one pack year = one pack of 20 per day for one year (Brewin, 1997).

  2. Reflective writing, I have decided to reflect upon the development of my confidence and ...

    After preparing all the equipment and repositioning the patient in long supported sitting, my C.E. told me to say what I was doing as I was doing it and I found it did help to calm me down. I managed to get the suction catheter down after two attempts, which

  1. Case Study. This essay will examine the nursing process involved in managing chronic venous ...

    O?Meara et al. (2009) found that multicomponent systems are currently the most effective treatment for CVLU with a simple primary dressing. Under Agnes? compression, a non-adherent dressing was used as recommended in SIGN (2010). Hess (2011) suggests a moist wound environment as optimal however wound healing maintains a balance between over-hydration and too dry.

  2. The importance of effective communication between doctors and nurses and its impact on patient ...

    Having reflected on this clinical incident, I have come to the conclusion that inter-professional learning and effective communication are a paramount for patients? care. Inter-professional relationships are not always smooth and it takes a lot of effort from the professionals involved to make them successful.

  • Over 160,000 pieces
    of student written work
  • Annotated by
    experienced teachers
  • Ideas and feedback to
    improve your own work