Question

The nurse is caring for a client three days after a bowel resection and colostomy due to acute diverticulitis. Which postoperative assessment finding necessitates physician notification? A. Stoma protrudes above the abdominal wall B. Absence of feces in the colostomy bag C. Gray dusky color of the stoma D. Mucus oozing from the stoma opening

Short answer

Answer: Gray dusky color of the stoma.

Step-by-step solution

Option A: Stoma protrudes above the abdominal wall

A stoma protruding above the abdominal wall is a normal and expected finding. This allows the stoma to drain properly and does not indicate a problem that would require physician notification.

Option B: Absence of feces in the colostomy bag

A lack of feces in the colostomy bag at three days postoperative may or may not be a cause for concern. In the first few days after surgery, it is normal for the output to be minimal, and it may take a few days for bowel function to return to normal. However, it is important to monitor the client closely and report any changes, such as abdominal pain or distention. For this exercise, the absence of feces in the colostomy bag is not considered urgent enough to necessitate physician notification.

Option C: Gray dusky color of the stoma

A healthy stoma should appear pink or red, and a gray or dusky color may indicate poor blood supply to the stoma. This is a cause for concern as it can lead to stoma necrosis or infection. This finding necessitates physician notification.

Option D: Mucus oozing from the stoma opening

It is normal for some mucus to be produced by the lining of the intestines and to be present in the colostomy bag. Mucus oozing from the stoma does not indicate a problem that would require physician notification. Based on the analysis of each option, the correct answer is: C. Gray dusky color of the stoma

Key concepts

Postoperative Nursing Assessment

After a bowel resection and colostomy, thorough postoperative nursing assessment is critical. It involves regular checks to ensure recovery is progressing without complication. Nurses focus on evaluating the patient's vital signs, stoma condition, and abdominal status.

Vital signs such as temperature, pulse, and blood pressure are monitored closely because changes might indicate an infection or a problem with the surgery area. Pain levels are also assessed to ensure they are within acceptable limits and that pain management techniques are effective.

Additionally, the nurse must assess the abdominal area for signs of distention, which could signal issues with bowel function. A lack of bowel sounds or excessive abdominal pain might suggest complications like ileus, which would require immediate attention.

Colostomy Care

Caring for a colostomy involves regular monitoring and management to ensure physiological and psychological well-being. Post-surgery, the nurse instructs the patient on how to maintain and care for their colostomy site.

It is important that the stoma and surrounding skin remain clean to prevent irritation or infection. Daily washing of the stoma area with water and mild soap is recommended, and it's crucial to thoroughly dry it to prevent skin issues.

The colostomy pouch should be monitored for proper seal and emptiness. A weighty or full pouch tends to loosen the seal, which can cause leaks and skin irritation. Properly fitted appliances prevent leaks, protect skin, and may need to be resized as swelling decreases post-surgery.

• Empty the pouch when it is one-third full to avoid spills and weight issues.
• Change the entire system every 3 to 7 days or sooner, if needed.
• Inspect the skin around the stoma regularly for any signs of irritation or infection.

Acute Diverticulitis Management

Acute diverticulitis often requires a multifaceted approach for recovery and management. Postoperative care is crucial for patients who had surgery due to severe acute diverticulitis.

Patients are typically advised to gradually resume diet, starting with clear liquids and progressing to more solid foods as tolerated. It is essential to monitor for signs of infection, such as fever or increased pain, and report these immediately.

Pain management is typically addressed with medications appropriate for the patient's level of discomfort. Activity level is also monitored and adjusted, with a focus on avoiding strain while healing.

• Avoidance of heavy lifting and strenuous activity is recommended during the recovery period.
• Follow-up appointments are crucial for monitoring recovery and addressing any complications early.
• Education on dietary modifications to prevent future episodes is essential, focusing on high-fiber foods.

Stoma Evaluation

A critical component of post-surgical care is stoma evaluation. The stoma should generally be red or pink, wet, and moist, similar to the inside of the mouth.

A gray or dusky stoma, as noted in the original problem, could signal a reduction in blood flow, which is a serious concern. This could significantly affect the patient’s recovery, as necrosis might occur if not rapidly addressed.

Regular observation is essential. The stoma's color, size, and texture should be documented consistently. Any changes should be reported to the physician immediately.

• Look for any unusual bleeding or discharge; this could indicate infection.
• Note any significant swelling, which could point to complications that need evaluation.
• Patient education should include recognizing signs that indicate problems, promoting proactive management.