11 year old male patients with ulcerative colitis since 9 years old Colectomy done @ age 10 with a (temporary)

colostomy

Comes to clinic with worried parents, who complained of child's bad diet choices (fast food) and sugary drinks resulting in constipation (last
bowel being 3 days ago) & reddened and swollen stoma related to his noncompliance and mild pain

Patient states "I hate this hole in my stomach; when do I get to have it removed?"

Risk of Malnutrition related to

Non-compliance

Constipation related
to hard and round
stool and 3 day lack
of BM
1. I will educate
patient on MDs
prescribed
treatment for the
constipation
2. To review dietary
pattern/ amount &
type of fluid
3. To encourage
patient and family
to increase fluids
4. I will recommend
foods used to
manage / prevent
constipation based
on Canada food
guide e.g. grains
and fibers
5. If constipation
persist, refer to an
entrostomal
nurse/specialist

Noncompliance
Behavior for
Prescribed Diet

1. I will develop a

2.

3.
4.

5.

therapeutic
relationship with
patient and family to
foster trust and open
communication
I will work with
patient to identify
factors associated
with noncompliant
I will emphasize the
positive aspect of
compliance
Using the Canada
Food Guide
Resource, I will
include patient in
planning meals in
collaboration with a
dietician.
I will encourage
parents to allow fast
food treats but
encourage patient to
choose nutritive
meals

Risk for infection

related to reddened
stoma

1. I will first inspect the

stoma site for any
further tissue
breakdown/swelling
2. Then will educate
on care and
treatment on the
involved ordered by
the physician;
3. Explain the
importance of
compliance of diet
and care;
4. Educate patient and
family on
preventing swelling
5. And inform parents
to report to
physician if no
improvement on
the swelling/
redness

Risk of Disturbed Body Image related to

Colostomy

Risk for low selfesteem based on

patients question
1. I will encourage
patient to verbalize
feelings regarding the
ostomy.
2. I will acknowledge
normality of feelings
of anger, depression,
and frustration over
the stoma site
3. I will help client to
identify what he can
do to make it work
such as body art work
around stoma
4. I will determine
patients desire to visit
with a person with an
ostomy. Make
arrangements for visit
if so desired
5. I may also have to
refer patient and
family organizations
such as Ostomy
Canada to help with
positive self-image

Knowledge Deficit
on Ulcerative Colitis

1. I will assess the

2.

3.

4.

5.

motivation/willingness
of patient & parents to
learn & learning style
I will evaluate
patients emotional,
cognitive, and
physical capabilities.
Based on patients
age/learning style, I
will include written,
visual (photo, and
video) learning
resources as well as
hands-on techniques
I will discuss
resumption of presurgery level of
activity. Thus suggest
emptying the ostomy
appliance before
leaving home.
I will provide more
take home resources
such as pamphlet
guide for ostomy care

Family Participation

1. From onset, I will

create an accepting
nonjudgmental
atmosphere for the
patient and his family
by listening to them
attentively
2. I will then determine
how family behavior
affects patient;
3. Also provide an outlet
for family members
(without childs
presence) express
their present care
giving responsibility
4. I will assess their SES
in their ability to
follow proper diet and
care for patient;
5. Finally, provide social/
community referrals
for further support