Nursing A Patient Receiving Ostomy Surgery Nursing Essay

Nursing A Patient Receiving Ostomy Surgery Nursing Essay Various gastrointestinal and genitourinary etiologies may need the creation of urinary or fecal diversion. These may include inflammatory bowel disease, diverticular disease, intestinal obstruction, colon-rectal cancer, gynecological cancers and gastrointestinal trauma (Beitz, 2004). Indications for coming up with the urinary stoma include; neurogenic bladder, bladder cancer, refractory radiation cystitis and interstitial cystitis. The cause of the disease will determine if the condition will be a temporary or permanent one (Thomas and McGinnis 2004). Among various types of surgically created ostomies, colostomy involves the opening made on the large intestine to allow for the passage of stool. The location of colostomy can be in sigmoid, transverse or ascending position. In this case, surgical resection will ultimately determine the stool output consistency. Ileostomy is a surgical construction from the small intestine and it is located high in the gastrointestinal route hence the stool output is comparatively of high quantity and liquid consistency (Gordon and Vasilevsky, 2004). Ileal conduit or urostomy is made using a short portion of the ileum to assist in urine elimination. Ureters are connected to conduit to allow urine to flow out of the body into ostomy pouch through the stoma (McGinnis and Tomaselli, 2004). Whether the ostomy is temporary or permanent, nurses must posses the knowledge to give the patient and the family the necessary information to improve recovery and enable a positive experience when obtaining informati on about ostomy care. Patient education. Any patient who is scheduled for an ostomy surgery can experience a number of feelings like fear, anxiety, depression and loss of body image especially if the cause of the surgery is a diagnosis related to cancer. Pre operative teachings assist the patient by receiving these feelings and contribute to quick recovery of the patient (Oshea, 2001). A very important ingredient in the teaching procedure before the operation is the Wound Ostomy and Continence Nurse (WOCN). Counseling before the operation allows for the assessment of the patients knowledge about the disease, support systems, level of education, employment, physical activity involvement, financial concerns and hobbies. Assessment of any physical shortcomings is also necessary because poor manual dexterity, poor vision and loss of hearing may affect the patients ability to undertake ostomy self care. Patients spiritual and cultural beliefs should be also assessed because certain particular rituals concerning ostomy care may n eed to be taken in. Employing all these factors can assist the patient to recover successfully and feel confident in managing the condition (Oshea, 2001). WOCN reviews the cause of the disease, stoma characteristics, surgical procedure, peristomal skin care, dietary considerations and a variety of ostomy appliances. If appropriate teaching proceedings may enable the patient to have an insight of the ostomy pouching system. Use of teaching booklets and illustrations helps to improve the education. Another component of preoperative teaching is the stoma site marking. This is recommended for all who are set to undergo a permanent or temporary stoma (Goldberg and Carmel, 2004). A poorly located stoma on the patients abdomen can lead to peristomal skin complications, stool and urine leakage, stoma, emotional and physical stress for the patient. During stoma site marking, there is abdomen assessment with the patient in sitting standing and lying positions. Also the abdomen can be assessed for the skin folds, bony, creases, scars and prominences. Patients belt and line should be avoided from the stoma site and not affect any prosthetic devices. The stoma site should also be put in an area that the patient can visualize and access. Ideal stoma site is situated in the anal muscle that extends to symphysis from the xyphoid process (Goldberg and Carmel, 2004). Nursing education. In stoma assessment the patient must enter the operating room with the pouching system on stoma. Immediately after the operation the, a transparent pouch is recommended to enable the nurse to have a view of stoma characteristics and stool and urine presence (Goldberg and Carmel, 2004). Initially after the operation period, the stoma can appear edematous, red, shiny and moist. In general terms, the stoma is red to pink in color according to tissue that was used in construction. Brown to dark color may show stoma ischemia and the consultations must be made with the physician. The shape of the stoma ranges from round to oval. It changes its shape and size in a period of six to eight weeks after the surgery. Since the stoma decreases in size with time, the nurse must use a skin barrier that has been cut to fit to the stoma (Goldberg and Carmel, 2004). For the first six to eight weeks after the surgery, measurements of the stoma should be taken each time the barrier of the skin is changed. Measuring guides are provided to measure round stomas, oval stomas will need the length and width measurements of the stoma (Colwell, 2004). Lack of sphincter by the stoma to regulate the passage of urine or stool, then the opening should be placed near the center of the stoma to aid the flow of urine and stool (McCann, 2002). The stoma may not or may protrude out of the skin surface. Stomal protrusion vary from a flush stoma at the skin level to a moderate one which is about 1-3 cm in length (Erwin-Toth and Doughty, 2002). Actually, stoma protrusion should be at least 0.8 inches above the skin level (Colwell, 2004). Protruding stoma helps urine and stool to flow into the pouch directly. A flush stoma is not suitable because it can cause difficulties when skin barrier attaches to it and leakage of stool below the skin barrier leading to peristomal skin irritations. The stoma output is determined by the location of ostomy. The output resulting form the ascending colon produces a semi liquid consistency whereas the one from the transverse colon produces a semi-liquid to pasty consistency and the one located in a sigmoid or descending colon will be more of a solid stool (McCann, 2002). An Ileostomy stool output is constant and watery with a lot of digestive salt and digestive enzymes. At the initial postoperative stages, the stool may be greenish and thick. The stool output from Ileostomy range from 800-1,700 cc in one day (Colwell 2004). When the patient comes back to the regular diet, there is development of the stool consistency from the ileum and a reduced out put in a daily basis ranging from 500-800cc/day. With time the small intestines recovers and with a decrease in stool output (McCann, 2002). Urine is immediately produced after the surgery by the Ileal conduit stomas. It is usually normal for the urine to be blood-tinged after the operation. Also the small intestines produce mucous which may be seen in urine (Colwell, 2003). Peristomal skin care involves the protection of the peristomal from coming into contact with the urine and stool to stop the occurrence of peristomal skin complications. Skin barrier needs to be properly measured to suit the stoma. If the skin barrier opening is too large, urine or stool will cause irritation on the peristomal skin area. The opening should not be more than 2cm larger than the size of the stoma. Cleanliness of the peristomal skin can be done by gently using warm water then dry it. Moisturizing soaps must be avoided because they affect negatively the skin barrier attachment. Male patients need to be taught trimmed peristomal using electric razor, scissors and other safety devices in an outward manner from the stoma (McCann, 2002). When choosing the pouching system of the patient, the information that was gathered before the operation is heavily relied upon. Other factors to be considered include location of the stoma, its size and shape plus the anatomical location. Pouching system should give anticipated wear time and protect the underlying skin from stool and urine (Colwell, 2003). Most of the pouching systems are designed in a way that the weight is light, easy to maintain and odor-proof (Colwell, Carmel and Goldberg, 2001). One of the most important components of the pouching systems is the skin barrier because it protects the peristomal skin from stool and urine (Colwell, 2004). Skin barriers can be found in either cut-to fit or pre-cut product. The pre-cut models are meant for the round stomas. Barrier opening should fit stoma size to limit the probability of the urine and stool coming into contact with the peristomal skin. The cut-to fit models can be used in oval stomas or the ones which are irregular in shape. The cut-to fit barriers are the commonly recommended in initial postoperative stage because the size of the stoma will reduce for not less than six to eight weeks from the day the surgery was performed. A large skin barrier may cause peristomal skin problems resulting from the exposure to stool or urine (Colwell, 2004). Skin barrier wear time is necessary; the barriers are either classified as extended or standard. The difference between the two lies in their interaction with the moisture and the degree of affinity to the skin. The two barriers absorb the moisture. However, the extended model absorbs moisture slowly as compared to the standard model. This delays the erosion of the skin barrier (Colwell, 2003). Skin barriers have flat or convex shapes. At the back of a f lat barrier is one level surface while the convex one has an outward protrusion. Skin barriers are made with in-built convexity which is created by putting the ring into the barrier. The intention of the curve is to place pressure in a downward position to the peristomal skin to enable the stoma to protrude in an outward position (Colwell, 2003). Different convexity depths are referred to as deep, moderate and shallow. Generally convexity is used in stomas which are flat and retracted to minimize urine and stool leakage below the pouch. Also the convexity can be used in abdomens with skin folds or soft abdomens in peristomal skin (Colwell, 2004). Various ostomy pouching systems are available. It is therefore necessary to elaborate to the patient that the systems used in hospital after surgery may not be necessarily the system he or she will continue using after recovering from the operation. The following must be considered while selecting the ostomy pouching system; the ostoma size and shape, effluent type, presence or absence of abdominal folds and contours and the type of the ostomy. The patients manual and visual dexterity must be considered as well including day to day activities (Colwell, 2004). Pouches sealed to the barrier are categorized as a single piece, and systems that are connected to the skin barrier are seen as a double piece. A two piece pouch gives the patient the capacity to change or remove it without altering the skin barriers. Again it is easier to position the skin barrier at the middle of the stoma. One mechanism for making sure that a two piece pouch is closed is will ultimately depend on the ability of the patient to snap the pouch and the wafer together. Application of the pouch to the wafer will require the patient to be instructed so that he or she can listen to an audible click to make sure that the pouch is safe to the skin barrier.

Stability of a Sailing Kayak :: physics kayak sport sports

"Strippers" they are often called, relate to the method of boat building is old and well perfected. It basically involves setting up a series of molds and then wrapping strips of wood around them. More specifically, I'm mostly using the method outlined in the book Kayakcraft which is a great set of instructions for anyone wanting to take on this type of project. The wood for this boat is clear cedar that has been ripped into 3/4" x 1/4" strips. Each of those then get a concave and convex edge. This a great method because then each strip fits together perfectly at any angle seen on the plans. The molds and raised construction surface are all made of particle board. It's cheap and easy to work with but you have to make sure it doesn't get wet. You can see in the photo how the strips fit over the molds. Eventually, all the wood inside and out will be coated with a clear epoxy over fiberglass which ultimately will provide most of the strength and all of the water resistance. The sail plan is going to be quite simple but could consist of either 1 or 2 sails. Each option has its benefits. Dividing the load of the wind between two sails would lower their center of effort and therefore lower their leverage on the boat. But, these are fairly small sails to begin with and, aerodynamically, larger sails are generally more efficient. So while having two sails would increase my stability, having one would likely increase the performance. The option I will likely choose will be two large sails that can be easily reefed (or taken down). Then you could travel with one, or both if the wind was light. This problem can be thought of as one of rotational motion due to force. As the wind pushes on the sail, the buoyant force and keel mass push in the opposite direction. So, if we can define all of the forces acting on the system, we should be able to say something about how the boat will react at certain wind speeds. One problem in determining the wind speed necessary for capsize is the changing function of this system's center of mass, particularly the people inside. Most boat models involve boats that are much more massive than their passengers but mine will weigh around 75 lbs and carry 2 passengers. Stability of a Sailing Kayak :: physics kayak sport sports "Strippers" they are often called, relate to the method of boat building is old and well perfected. It basically involves setting up a series of molds and then wrapping strips of wood around them. More specifically, I'm mostly using the method outlined in the book Kayakcraft which is a great set of instructions for anyone wanting to take on this type of project. The wood for this boat is clear cedar that has been ripped into 3/4" x 1/4" strips. Each of those then get a concave and convex edge. This a great method because then each strip fits together perfectly at any angle seen on the plans. The molds and raised construction surface are all made of particle board. It's cheap and easy to work with but you have to make sure it doesn't get wet. You can see in the photo how the strips fit over the molds. Eventually, all the wood inside and out will be coated with a clear epoxy over fiberglass which ultimately will provide most of the strength and all of the water resistance. The sail plan is going to be quite simple but could consist of either 1 or 2 sails. Each option has its benefits. Dividing the load of the wind between two sails would lower their center of effort and therefore lower their leverage on the boat. But, these are fairly small sails to begin with and, aerodynamically, larger sails are generally more efficient. So while having two sails would increase my stability, having one would likely increase the performance. The option I will likely choose will be two large sails that can be easily reefed (or taken down). Then you could travel with one, or both if the wind was light. This problem can be thought of as one of rotational motion due to force. As the wind pushes on the sail, the buoyant force and keel mass push in the opposite direction. So, if we can define all of the forces acting on the system, we should be able to say something about how the boat will react at certain wind speeds. One problem in determining the wind speed necessary for capsize is the changing function of this system's center of mass, particularly the people inside. Most boat models involve boats that are much more massive than their passengers but mine will weigh around 75 lbs and carry 2 passengers.

Being a Part of a Team More Important Than Leading It

â€Å"Being part of a team is more important than leading it. † It is too difficult these days during the complexity of business and corporate pressure to build out teams, in order to resolve business challenges situations like service, product renovation, turnaround recovery plans, launch new products, meet the market changes and challenges it’s important to pay attention to building a team.Team, by concept, is a group of members whom could be selected or nominated usually by management; the role is to execute a certain business â€Å"mission† within the organization under a very clear goals and objectives with a defined timeline as well as deliverables. Now a day’s both economy and the business growing very fast and the challenges is continuously increasing.New concepts came up, new technology and new strategies invented ,the world moving very fast ,everything now in a mass, production in a mass ,corporate in a mass ,so all the people they don’t h ave time to work individually to achieve the mission assigned to them ,so now the techniques to work in a group came up with all the challenges we have it, one person can’t solve the problem right from the first time and with required time.Single person doesn’t have the time, the required skills and /or the expertise to accomplish various tasks, task that must be carried out successfully in order to successfully tackle the problem of interest. By wording we are calling it a team not a group, hence there is a big difference between the both, we can’t call the football or basketball team a football group, group not like the team, team usually have one goal, one mission, one task and one problem to solve, but the group is a group of people from different place and different objective but they met together, Like a random sample taken. There is no I in team but there is in win† , team must have a harmony between each other’s and with the team leader they must have the same spirit and the same challenges with different skills /experiences to complete each other’s and reach to the ideal team, â€Å"I am a member of a team, and I rely on the team, I defer to it and sacrifice for it, because the team not the individual is the ultimate champion†, It is not only the matter to form a team and nominate a team leader to let the team working under his/her coaching, but all the team member including the team leader must be an effective member, and to be an effective team member it is must have good people skills and communication skills in addition to a high strong technical skill set, the guidelines for being an effective team member include: ResponsibleA team member must be a proactive ,if they came to know there is a task needs to be solve or done, the team member have the skills to do it ,a team member has to take the initiative to do it and to be dependable to do fair share of the work and strive to accomplish any tasks in a timely manner, doing so will allow the team to meet the dead line, and to be accountable if the team member agreed to take on a specific task. It is also important to deliver his promises and if he faces difficulties in solving the problem he has to communicate to the team at the right time so they can come up with alternatives to solve a problem and meet the dead lines as well as obligations, as a result the team can meet the goal desired. Effectively communicationGood communication skills s important for an effective team member, that’s mean all the team members must be open to each other, talk to each other, listen good and show the respect to the new ideas and take the intuitive to share to add value to the ideas generated by any team member, this is important to reach to the a good guidelines to achieve the team mission at the end, a good communication style involves honesty, friendliness, thoroughness, and high quality in achieving the goals. Respect As a team member, one has to respect other members and understand each member is an expertise in his field and has the enough knowledge to meet the task required from him, the respect attitude has to be shown between all the members and therefore there is no one better than the other, all are equal and complete each other’s. ContributionAll the team members must contribute with each other each member must do the his/her full efforts and contribution to meet the team objectives and goals, this one of the important role for an effective team leader to get all the member share equally the contribution and spread the spirit of working in an effective teal to let the team succeed. Team could suffer heavily from a team member who is not cooperating, or blending, or benefiting the team with his expertise and input. A survey conducted by The American Institutes for Research, showed that one-third of 1,000-plus respondent organizations reported that strong internal resistance and/or sabotage is a sign ificant barrier to be overcome on the road to successful team implementations. Conflict of interestConflict is unavoidable whenever we work in a team, each member has a different views/opinions and sometime stuck on it, as an effective team member one must work on it and show the other member respecting of his/her views and try work with and adapted it slowly to show the positive if we do some alteration or changes for the member views and this one of the most common difficulties meet an effective t eam. Appreciations Not all of the team members do the same efforts, it different from one member to the other, and here the role of the team leader appear to give the credit to the member who do the best efforts and encourage other members to do the same and get the credit and keep up the work, but this tactics must be done by the right way to avoid any bad feelings against the other member. All the above mentioned points rose to reach for an effective team member to achieve the team mis sion, and goals. The way a team plays as a whole determines its success, you may have the greatest bunch ofcindividual stars in the world, but if they don’t play together, the club won’t be worth a dime† , as we covered the guide lines to have an effective team member, now it comes the role of the team leader, the objectives, the goals and the leadership style. The leadership style is simply the patterns of behavior a leader adopts to plan motivate and control, it is the extent to listens, set the goals and standards, develop action plan (long/short term), guide others, gives his/her feedback and reward and punish. Although the leaders face an unlimited range of situations, research has shown that there are six styles or behavior patterns that they apply to the situations they encounter: 1-The coercive styleThis style primary objective is immediate compliance from employees but the downside of it is lack of flexibility, empowerment and responsibility. This style can be used in straight forward tasks and in crisis situation (team needs clear directions and you have relevant information), but it is a least effective in a complex tasks and over the long term. 2-The authoritative style This style primary objective is providing long term direction and vision for the team, the downside is that it’s not good with expert groups, this is can be more effective when a new vision is needed and new team member needs guidance, this style should be avoided when employees are experienced and know as much if no more than the leader. 3- The affiliative styleThis style has the primary objective of creating the harmony among employees and between the leader and the team, the downsides of this style is lack of constructive feedback and direction, this style to be used more effective in a straightforward task and with an adequate performance, this is style should be avoided when employees’ performance is inadequate and corrective performance feedba ck is required. 4-The democratic style This style has the primary objective of building commitment and consensus among employees, the downside of this style is the time consuming, leave team member confused, this style is more effective when the team member are competent and have a knowledge more than the team leader and least effective in crisis situation and there is no time for a meetings or discussions. 5-The pacesetting styleThis style has the primary objective of accomplishing tasks to a high standard of excellence, the downside of this style can lower moral and lead to feelings of being overwhelmed and pressured, this style more effective when team members are also pacesetters and resource or time constraints necessitate the leader involvement. This style is least effective when direction of the team is unclear and team members are unconvinced 6-The coaching style This style has the primary objective of employees long term professional development, this is style is not effect ive when employee lacks motivation, resistant to changing, or leader lacks expertise, this style most effective hen the team member have a clear sense of aspirations and are motivated, this style is least effective if the team members are new and have a lack of experience, it’s important to avoid this style during crisis situation. Before applying any style from the above mentioned leadership styles, the leader has to stimulate his/her thinking about which style to use, and how the style will affects others motivation, the effective manager has to diagnose the demand of the situation, the experience of the team, the strengths and weakness of the team member, another dimension to watch is the complexity of the task, time pressure, resources available, and keep an open mind and watch out for changes in the situation.Leader should avoid using one style as a habit, the style should match the situation as one style does not apply for all ,the team leader has to select a style that best fit the situation and even the leader can as the team member too to assist him/her to select the style matching with the situation and the team goals and objectives ,the team leader must be flexible to switch from one style to another, even the leader can mix two or more styles to meet all required tasks and to assist for achieving the team goals, â€Å" A working relationship that provides influence or support on a regular basis for the most important decisions a has to make† , Form my opinion I think the team must slow down first before speeding up to tasks, most of the teams like to jump right into the task, but relationship building, active development of norms, and goal setting is needed first. The team leader must be more strategic about the first team meeting, he/she must structure team culture first and not to leave it to chance, building a relationship and trust first is a key to avoid long term problems like task conflict and discovering expertise. One of the most crucial components of success is to know how to work productively in a team environment, working well with others and having strong interpersonal skills can take a person far in life, in career settings and beyond.It is a combinations between the team leader and the team member starting from constructed the team till set the team goals and objectives, all parties including team member and team leader have to work together effectively to put the style of work and agreed to spread a good spirit between all the members, the whole team has to work as one person everyone knows his/her responsibilities very well and ready to assist the other to achieve their goals, it’s not about raising the hands and step away from the other member hence the successful of the team depend on all parties not one party , It is the responsibility of the team leader to set everything before starting the task and the responsibilities of the others to believe they are like a stone corner for the tea m no way the team finish the task without the other ,,, Amgad Ali ——————————————– [ 1 ]. Michael Jordan. [ 2 ]. Mia Hamm. [ 3 ]. Case commentary by Ed Mussel white. Ditto. [ 4 ]. Babe Welch. [ 5 ]. Nigel Nicholson.

Argumentative Essay - Thick Skin - 838 Words

THICK SKIN--------------------------------------------------------- â€Å"Do what you have to do, and send me to the main office.† â€Å"I don’t care,† said Alexander, a teenage student who I disciplined in the hallway. â€Å"No,† I said. â€Å"I’m not sending you out because, I believe you do care.† With God’s help, I flipped the script as I talked to Alexander. He seemed shocked by the positive reaction I spattered toward him. In fact, he expected me to write a note, and send him on his way. I realized how thick my skin was after I brushed-off Alexander’s disrespect. No, I don’t do that often, but I could sense his anger and his agonizing pain. I discovered many of my students came to school angry. In fact, they were†¦show more content†¦The class had just started. I reminded the students of the cell phone policy. This policy was not developed by me. The strict policy was created and enforced by the school’s district. While I taught, I noticed a student consistently using his cell phone, and I tried to discretely collect his property. My initial plan was to return the phone before class ended. The student kept holding on to his cell phone, and he would not let go. Most of the students let out an irrepressible laughter while I frantically paced around the classroom trying to locate the security button. I felt as if I were in a foreign land. Since then, I learned to know exactly where all security buttons are located prior to class. On that awkward and confusing day, I shifted from corner-to-corner. Finally, one of the students said, â€Å"Miss.† â€Å"Miss.† â€Å"The security button is over there.† When the security officer arrived, I gave him a vivid report of what happened. He disrespected my role in front of all the students. For instance, even though he took the phone (without any resistance from the student), the officer wore a proud smirk on his face and told the rebellious student to stop by his office. He said that he would return the student’s phone to him -- right after my class ended. Once the security officer left my classroom, the 10th grader looked at me and giggled. He added a disdainful remark: â€Å"Good enough for you.† InShow MoreRelated A Comparison of Charles Dickens and Jane Austen Essay2446 Words   |  10 PagesCharles Dickens and Jane Austen ADVANCED ENGLISH LANGUAGE ESSAY Of the many authors to emerge during the nineteenth-century, Charles Dickens and Jane Austen were among the few who would make a lasting impression on the literary world for generations. Hard Times, often referred to as Dickens’ ‘Industrial novel’ and Austen’s Pride and Prejudice have been much read and well-loved classics for many years. It is the purpose of this essay to compare and contrast the different worlds depicted inRead MoreLogical Reasoning189930 Words   |  760 Pagesown conclusion, then its your responsibility to give them reasons they can appreciate. Lets examine that last remark. A conclusion backed up by one or more reasons in any order is called an argument, even when the reasoner is not being argumentative or disagreeable. The word â€Å"argument† is a technical term we will be using frequently in this course. Being logical means, among other things, that you should give an argument to support your conclusion if you expect other people to accept itRead MoreIgbo Dictionary129408 Words   |  518 Pagesillustrated the meaning and use of words; the great majority of the examples are due to him. Their merit is that they are not translations from English, but natural Igbo sentences elicited only by the stimulus of the word they illustrate. The short essays which appear from time to time (e.g. under otà ¹tà ¹, à ²Ã¯â‚¬ ¤gbanÌ„je) on aspects of culture are also his work, as are the sketches which served as basis for the illustrations, a large number of new words, and various features of the arrangement. When he hadRead MoreDeveloping Management Skills404131 Words   |  1617 Pagessolvers and decision makers who prefer to deal with technical tasks and straightforward, prescribed problems rather than social or interpersonal issues. They excel at problems that have one correct answer. Multiple-choice exams are preferred over essay exams. Research has suggested that these individuals are incli ned toward careers in technology, engineering, and law. In college, students with a knowing style tend to major in the physical sciences, engineering, law, and computers. In business, they