Fistula Assessment and Care Paper
Purpose of Assignment: The purpose of this assignment is for the student to become aware of the challenges of fistula care and, using best practice resources, explore assessment & management options. In addition, you will develop an appreciation for the work around the transfer of care when patients transition from hospital to home.
Length and Value: This assignment is marked out of 100% and worth 15% of total mark. The length should be 10-12 pages excluding the cover page and the reference list. Assignments longer than 13 pages may be returned unmarked and given a 0%. Assignments must use APA formatting or risk a mark reduction. The assignment must be submitted in Microsoft word or equivalent format (the file should end with .doc, or .docx).
Case Study Part A Tom Jones is a 62-year-old self-employed electrician. Eight weeks ago he underwent an abdominal incisional hernia repair with a Surgical Mesh. He began experiencing serous drainage from the incision a few days post op. On Day 10 post op he returned to the surgeon who removed staples and a 10 centimeter section of his midline incision opened up. The wound was packed with saline soaked gauze and Tom went home. Two days later he started draining large amounts of liquid stool from this opening and the visiting Home Care Nurse sent him to the hospital. Mr. Jones was admitted late Friday night over the Labour Day weekend and the NSWOC was asked to see him on Tuesday.
Part B Mr Jones has been in hospital for 7 weeks and he is now well enough to go home to continue his recovery. He’s been off TPN for a week and is tolerating a GI diet but must be encouraged to drink enough fluids. He’s on Imodium 1/2 hr ac meals & hs which helps to keep the fistula output 700-850mls/ day. The wound is 5.4 cm L x 3.7 cm W x 2.3 cm D and a fistula pseudostoma is visible in the base. Tom, while happy to go home, is admittedly nervous about how he will manage everything.
Knowledge Acquisition Focus: Gain knowledge about the diagnostic tests and assessment parameters used in the presence of a fistula.
- Briefly define an ECF. (2 marks)
- Identify 3 diagnostic tests that may have been completed on Mr Jones upon admission with stool draining from his wound. Briefly describe the test highlighting what information it provides about an ECF. (3 marks each x 3 =9 marks)
- Describe 5 fistula assessment parameters that the NSWOC must consider. These are the components you are going to assess when seeing a patient with a fistula. (25 marks)
- Briefly explain the significance of the presence of mesh when one has an ECF. (2 marks) Knowledge to Practice Focus: Determine management options and communicate care needs.
- a) Describe 3 nursing methods of fistula management to protect the skin and contain the effluent. Identify the advantages and disadvantages for each. Use a table for this answer, point form, single spaced for this table. (1 mark for method, 3 marks for advantages, 3 marks for disadvantages = 21 marks)
- b) Select a nursing management method from the list above that is most appropriate for Mr. Jones and explain why you chose it. (6 marks)
- As an NSWOC you will be involved with the transfer of care of patients with complex care needs from hospital to home or another care setting. Identify 6-8 things that should be included in the transfer of care information for Tom as he is discharged from hospital to home care. This section must have detailed clinical information of how the Home Care nurse would care for this man on discharge in his home setting. Include your rationale for including each (brief comment). Please answer this question using the layout you would use when creating a transfer of care sheet. It should be no more than 2 pages long and may be as creative as you like. (30 marks)
- Presentation : Style and Clarity. Grammar, spelling, format (cover page, introduction, conclusion, citations, reference list). (5 marks)