Nursing of patient with transverse colon cancer, ruptured inflammatory colon and sepsis operated left half colostomy with Hartmann’s operation : Case study

Abstract

A 38 – year - old Thai woman admitted in the female surgical ward, Singburi Hospital, on 6th November 2015, presented with severe left lower abdominal pain with nausea and vomiting 4 hours before to admission. At ward, she had extreme abdominal pain with fever, nausea and vomiting. Abdominal ultrasound was performed and showed fluid collection and inflammation of the peritoneum.Emergency whole abdominal CT scanning was reported: mass or abscess of the transverse colon and ruptured colon with acute inflammation. The physicians considered to set an operation of operating emergency Exploratory laparotomy following left half colostomy with Hartmann’s operation. After the surgery, she was transferred to ICU. For 24-hour post- operative risks in this patient who septic shock and hypovolemic shock, treated by fluid replacement and inotropic drug administration until safe. She was the plan to wean mechanical ventilation via weaning protocol and was extubated successfully. She had wound pain and a risk of developing surgical wound infection, so pain control and proper wound care were done, therefore no infection was found. Discharge planning included colostomy care were teaching to the patient and her relatives. The admission time was 13 days. There was no complication at follow-up. After that, she was transferred to Lopburi Cancer Hospital for chemotherapy. She had been appointed monthly for 6 times of chemotherapy. At this moment, she keeps getting better and is able to do activities of daily living with very good mind and spirit in treatment.

The purpose of this study is to check knowledge and understanding as well as education in clinical courses and nursing plans. The role of the critical care nurse is very important in caring critical care patients from sepsis including before, during and after shocks, because each phase can be fatal. Morever common complications consist of acute kidney injury, ventilator-associated pneumonia and wound infection, so nurses need to have knowledge, ability and developed skills in caring for effective nursing according to with patient’s problem individually for the purpose of patient’s safety and satisfaction along with mortality rate reduction.