| Scenario preparation: Proposed theme: “Nursing care for the colostomized patient” Medicaldiagnostic: Rectal neoplasia. Reason for the current hospitalization: Post-operative segmental colectomy with left stoma. Loyalty to the scenario: high Fidelity. Clinical situation/case: Patient João Alves Bandeira, male, 68 years old in the 12th postoperative period of segmental colectomy with definitive colostomy on the left. He is conscious, oriented, calm, communicative, with venous access in the back of the hand of the right upper limb with flexible short catheter No. 22, without phlogistic signs. Low distended abdomen, with operative wound in the middle abdominal area with a clean and dry appearance, with no phlogistic signs and a functioning colostomy on the left (semi-pasty feces in great quantity). Information for the student: You are a nurse at the general surgical clinic and were called in room 2236 to care of a 68-year-old patient on the 12th postoperative day of colectomy surgery with left colostomy. He is in the bed in supine position with peripheral venous access in the back of the hand of the upper right limb with saline solution 0.9% 500ml. Vital signs: blood pressure= 140/90mmHg; pulse= 80bpm, temperature= 36.5 °C, respiration= 18irpm. Colostomy bag in the left functional intestine, with elimination of semi-pasty effluents in large quantity. In this scenario, perform patient care. Consider have already performed hand hygiene. Script for simulated patient training: Your name is João Alves Bandeira, 68 years old, married to Juliana Alves. You have three (3) children, being two (2) men and one woman, aged 22, 25 and 28, respectively. Your wife is a housewife. You work as a bricklayer. In the last four months she has been showing a change in the intestinal habit, alternating periods of diarrhea and constipation. At the beginning of the condition, you did not notice abnormalities, but you began to notice that the feces were darker and sharper (stringy type). Even so, you did not seek medical care. In the last 30 days you began to present blood in the feces and subsequently rectal bleeding, in addition to persistent abdominal discomfort, accompanied by cramps, excessive gas elimination and a feeling that your intestine was not completely empty. Since you haven't improved, communicated to your wife and she immediately scheduled a medical appointment. After performing several blood and imaging tests (computed tomography), the biopsy-colonoscopy diagnosed a tumor. You underwent surgery and is now in the 12th postoperative period of colectomy, with a colostomy on the left. Try to answer the questions in a low-key voice, appropriate for the environment, and if the student asks for some information that has not been commented on your illness, answer “I do not have this information” (“not relevant to the case”). Characterization of the actor: the actor was featured in clothing appropriate to the hospital environment, peripheral venous access on the back of the right upper limb hand. The artistic make-up for aging was latex in two layers; covered with compact powder and base with coloration close to the skin color of the simulated patient. Talc powder was used for the hair. For the manufacture of the abdominal surgical wound, was used artistic makeup mass, latex, compact powder for cover and surgical suture. For the preparation of the intestinal stoma located in the left lateral region of the abdomen, close to the transumbelical line (figure 1), the following were used: latex for fixation; mass of artistic makeup in stoma format; Red paint; and false blood. The feces, inside the colostomy pouch, with their characteristic odor were prepared using beaten bovine liver and kept outside the refrigerator for two days. Material resources:drainable colostomy bag of the following types: one-piece cut-out colostomy bag and two-piece, opaque and transparent colostomy bag in adult and child sizes. Stoma measure, straight and curved scissors, gauze, tray, procedure glove box, goggles/protective visor, mask, disposable apron, sterile glove, 500 and 250ml saline, 10ml and 20ml syringe, 40x12 needle, short catheter flexible number 22, saline infusion set, saline identification label, plaster, micropore, towel, paper towel, compress, dressing pack, bedpan, urine bottles, jar, bucket, skin protection materials (powders, skin protection paste ) and antiseptics (alcohol gel, anti-germ chlorhexidine, alcoholic). Documentation: patient's medical record containing medical prescription, medical evolution, nursing evolution, nursing prescription, laboratory and anatomical-pathological exams. Physical space of the environment properly characterized as general surgery ward with two beds. |
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