Don Mariano Marcos Memorial State University

South La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union
Tel. 072.682.0663/ichams.dmmmsu-sluc.com
Embracing World Class Standards NURSING DEPARTMENT Care to learn, Learn to care

Name: JOSELYN M. LACHICA Program and Course: BSN IV

CASE 2 – USE OF CRITICAL THINKING IN

CARING FOR CLIENTS WITH GASTRO
INTESTINAL DISORDERS
TASK 1: Make a step by step procedure on how to administer enteral feeding.

ADMINISTERING A TUBE FEEDING

PROCEDURE
1. Explain procedure to patient. Use a stethoscope to assess bowel sounds.
2. Assemble equipment needed. Check the amount concentration, type, and
frequency of tube feeding on patient’s chart. Check expiration date of formula.
3. Perform hand hygiene. Don disposable gloves.
4. Position patient with the head of bed elevated at least 30 degrees or as near
normal position for eating as possible.
5. Unpin tube from patient’s gown and check to see that the nasogastric tube is
properly located in the stomach.
6. Aspirate gastric contents with syringe and measure. Return immediately through
tube, saving small amounts to measure gastric pH. Flush tube with 30 mL of sterile
water for irrigation. Proceed with feeding if amount of residual does not exceed
policy agency or physician’s guideline.
7. When using a large syringe (open system):
a. Remove the plunger from 30-60mL syringe.
b. Attach syringe to feeding tube, pour pre-measured amount of tube feeding to
enter tube. Regulate the rate by raising or lowering the height of the syringe.
Do not push formula with syringe plunger.
c. Add 30-60mL of water for irrigation to syringe when feeding is almost
completed and allow to run through the tube.
d. When syringe has emptied, hold the syringe high and disconnect from the tube.
Clamp the tube and over end with sterile gauze secured with a rubber band or
apply cap.
8. Observe patient’s response before and after tube feeding.
9. Have patient remain in upright position for at least 30-60 minutes after feeding.
10. Wash and clean equipment or replace according to agency policy. Remove gloves
and perform hand hygiene.
11. Document procedure. Record type and amount of feeding residual amount,
verification of placement, and patient’s response.

TASK 2: Make a step by step procedure on the care of colostomy.

CARE OF COLOSTOMY
PROCEDURE
1. Assess the appearance of the stoma and condition of the bag.
2. Assess the characteristics of fecal waste.
3. Determine the client`s knowledge and understanding of colostomy care.
4. Perform hand hygiene.
5. Assemble the equipment needed. Supplies include flange, ostomy bag and clip,
scissors, stoma measuring guide, waterproof pad, pencil, adhesive remover for
skin, skin prep, stomahesive paste or powder, wet cloth, non-sterile gloves, and
additional cloths.
 6. Identify the patient and review the procedure. Encourage the patient to participate
as much as possible or observe/assist patient as they complete the procedure.
7. Provide Privacy. Place waterproof pad under pouch to prevents the spilling of
effluent on patient and bed sheets.
8. Apply gloves. Remove ostomy bag, and measure and empty contents. Place old
pouching system in garbage bag.
9. Remove flange by gently pulling it toward the stoma. Support the skin with your
other hand. An adhesive remover may be used. If a rod is in situ, do not remove.
10. Clean stoma gently by wiping with warm water. Do not use soap.
11. Assess stoma and peristomal skin. A stoma should be pink to red in color, raised
above skin level, and moist. Skin surrounding the stoma should be intact and free
from wounds, rashes, or skin breakdown. Notify wound care nurse if you are
concerned about peristomal skin.
12. Measure the stoma diameter using the measuring guide (tracing template) and cut
out stoma hole. Trace diameter of the measuring guide onto the flange, and cut on
the outside of the pen marking. The opening should be 2 mm larger than the stoma
size.
 Trace template
 Once size is traced onto back of flange, cut out size to fit stoma
 Assess flange for proper fit to stoma
13. Prepare skin and apply accessory products as required or according to agency
policy. Accessory products may include stomahesive paste, stomahesive powder,
or products used to create a skin sealant to adhere pouching system to skin to
prevent leaking.
14. Remove inner backing on flange and apply flange over stoma. Leave the border
tape on. Apply pressure. Hold in place for 1 minute to warm the flange to meld to
patient’s body. Then remove outer border backing and press gently to create seal.
If rod is in situ, carefully move rod back and forth but do not pull up on rod.
 Remove backing from flange
 Apply flange around stoma
 Press gently to create seal
15. Apply the ostomy bag. Attach the clip to the bottom of the bag to prevent the
effluent from soiling the patient or bed.
16. Hold palm of hand over ostomy pouch for 2 minutes to assist with appliance
adhering to skin.
17. Clean up supplies, and place patient in a comfortable position. Remove garbage
from patient’s room.
18. Perform hand hygiene.
19. Document procedure. Record the color, consistency and amount of feces. Record
also the condition of the stoma and the response and client responsiveness to
perform self-care.

TASK 3: Make a Home Care Plan for the patient to be instructed to the mother as a primary
care provider.

COLOSTOMY
Inform the mother to support and understand the patient’s ostomy transition especially in his
behavior and emotional state. Instruct her also on how to change an ostomy pouch:

 Gather the necessary supplies like measuring guide, moistened paper towels, wash
cloths or appropriate ostomy wipes, a way of drying the surrounding skin and the
pouching system to be used. In addition, scissors may be needed to cut an opening
that matches the size of their stoma or if they are using a moldable system, scissors
will not be necessary.
 Ostomy Pouch Removal. Using a warm, moistened paper towel or washcloth, gently
push down on the skin while lifting on the corner of the pouch. Begin at the top edge
and work down to capture any stool or urine that can be captured in the old pouch.
Once removed, the pouch can be discarded in one of the disposal bags that some
companies provide or in any small trash bag. Do not tie the bag closed until you
 complete the pouch change so that you can add any additional items to be
discarded. Now that the abdomen is bare, examine the stoma and surrounding skin.
 Stoma Cleansing. Cleansing is done with plain tap water. Soap, baby wipes, or those
popular bathroom wipes are not necessary and can actually interfere with pouch
adherence. Once clean, the skin surrounding the stoma should be completely dry.
Fanning or a hair dryer on cool will help dry the skin quickly.
 Ostomy Pouch Application: After the stoma has been measured, you will need to cut
an opening that matches the measurement on the back of the barrier. If a one-piece
pouch is being used, be sure to pull the pouch away to prevent cutting into the
plastic. The opening should match the size of the stoma leaving no exposed skin.
 Frequency of Pouch Changes: When a drainable pouch is being used, changes
should be scheduled every 3-7 days depending on patient preference, the type of
stoma, characteristic of the effluent, and type of pouch that is being used. Patients
with a low colostomy and regular, formed stools may opt for a closed end pouch that
can be changed with each bowel movement- normally once or twice a day.
Inform the mother that lifting more than five to ten pounds may increase patient’s risk of
complications such as the development of a hernia. If the patient also ride in a car for more than
short trips, stop often to stretch the legs. Advice also to increase patient’s activity gradually like
taking short walks on a level surface. Take patient’s medicines exactly as directed. Don’t skip
doses. Inform also the mother to call healthcare provider immediately if she has observed any of
the following:
● Excessive bleeding from the stoma
● Blood in the stool
● Stool that is very hard
● No gas or stool
● Change in the color of the stoma
● Bulging skin around the stoma
● A stoma that looks like it’s getting longer
● Fever of 100.4°F (38°C) or higher, or chills, or as advised by the healthcare provider 
● Redness, swelling, bleeding, or drainage from the incision
● Constipation
● Diarrhea
● Nausea or vomiting
● Increased pain in the belly or around the stoma

NGT
Instruct the mother the following:
 Wash your hands and warm the feed as necessary. Patient should be positioned
with their head above the level of their stomach.
 Always check the tube position before giving a feed.
 Connect the feeding syringe without the plunger and pour the feed into the syringe.
 Put the syringe plunger into the top of the syringe and push gently with the plunger to
start the feed. Then, remove the plunger and let the feed run in by gravity.
 The height of the syringe will alter the pace of the feed. If the syringe is high the feed
will speed up, if it is held low it will slow down.
 Watch the patient during the feed in case he tries to pull the tube out.
 After feeding or giving medicines, flush the tube with 1-2ml of water. This helps
ensure the patient gets all his feeds and prevents the tube from blocking.