Situation: Mr. Hayes is a 43-year-old white male who underwent a laparoscopic abdominal perineal resection with a permanent sigmoid colostomy 3 days ago for rectal cancer.

Patient Introduction

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Location: Surgical Unit 0800

Report from night nurse:

Situation: Mr. Hayes is a 43-year-old white male who underwent a laparoscopic abdominal perineal resection with a permanent sigmoid colostomy 3 days ago for rectal cancer.

Background: Mr. Hayes experienced weight loss, increasing fatigue, and narrowing stools with blood, which led to the diagnosis of rectal adenocarcinoma and the recent surgery.

Assessment: Vital signs have been stable with a saturation of 94%–97%. Pain level is currently 1 after pain medication was administered an hour ago. The colostomy appliance is an open-ended pouch attached to a skin barrier. The stoma is red and moist with liquid, brown stool output. The three small abdominal incisions are open to air. There is a clean pad covering the perineal incision. Mr. Hayes has been up and ambulating and is taking full liquids.

Recommendation: It is time for Mr. Hayes’s morning assessment. Assess his colostomy, and empty the pouch, if necessary. He can advance to a regular diet as tolerated. Start providing patient education to prepare him for discharge in 2–3 days.

Opening Questions

How did the simulated experience of Marvin Hayes’s case make you feel?

Talk about what went well in the scenario.

Reflecting on Marvin Hayes’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change?

Scenario Analysis Questions*

PCC         What priority problem(s) did you identify for Marvin Hayes?

PCC         What potential problems could arise due to the newly placed colostomy?

PCC         Discuss what type of diet would be appropriate for Marvin Hayes.

PCC/T&C   Discuss the importance of peer support groups with other adults with colostomies.

EBP          Explain why it is important to measure the stoma at least once a week for the first 6-8 weeks after surgery.

T&C      What other interprofessional team members should be involved in Marvin Hayes’s care?

I                 Cite one source that you could give to Marvin Hayes that would provide more information on colostomy care and resources.

Concluding Questions

Describe how you would apply the knowledge and skills that you obtained in Marvin Hayes’s case to an actual patient care situation.