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INTRODUCTION
Despite of providing critical care to maintain life, maintaining urinary and bowel elimination for patients are also the key elements.
BACKGROUND
Ms B, age 27, known chromosomal abnormality with severe mental retardation. She suffered end stage renal failure with renal transplant done. Owning to recurrent urinary tract infection, urinary bladder reconstruction with ‘laparotomy, augmentation sigmoid colocystoplasty, Mistrofanoff appendicovesicustomy, Malone antegrade colonic enema conduit’ (MACE) was done. She was on long term suprapubic foley catheter. She also had bowel leakage with fecal peritonitis, Hartmann’s operation was performed. She requires regular urinary and bowel irrigation.
Recently, she was admitted to critical care unit for septic shock, turbid urine, watery diarrhea from stoma.
PATIENT ASSESSMENT.
A suprapubic catheter was insitu. A MACE and colostomy was found at right and left abdomen respectively. A hole was found at the umbilicus which communicate with the ‘urinary bladder”
URINARY CARE
By using aseptic technique, perform bladder irrigation daily with warm normal saline by either one of the following method;
1, Irrigate the supra-pubic catheter
2, Cannulate the umbilical hole, allow fluid go in and fluid drain out via the supra-pubic catheter.
In order to prevent the blockage of the supra-pubic catheter, perform bladder irrigation until return fluid clear . Observe, record the nature and volume of the irrigation fluid in and out.
BOWEL AND STOMA CARE
MACE: Because of diarrhea, we cannulate the MACE with an infant feeding tube to keep it open.
COLOSTOMY:
Protect the peristomal skin with “no sting spay”
Apply a one-piece colostomy pouch to collect effluent
Observe, record the nature and volume of fecal output.
Start bowel irrigation daily when diarrhea stop, by cannulating the MACE with suction catheter, allow warm fluid go in and fecal matter drain out to colostomy bag.
OUTCOME
Bowel motion and urinary drainage are maintained, patient free from urinary tract infection.
Despite of providing critical care to maintain life, maintaining urinary and bowel elimination for patients are also the key elements.
BACKGROUND
Ms B, age 27, known chromosomal abnormality with severe mental retardation. She suffered end stage renal failure with renal transplant done. Owning to recurrent urinary tract infection, urinary bladder reconstruction with ‘laparotomy, augmentation sigmoid colocystoplasty, Mistrofanoff appendicovesicustomy, Malone antegrade colonic enema conduit’ (MACE) was done. She was on long term suprapubic foley catheter. She also had bowel leakage with fecal peritonitis, Hartmann’s operation was performed. She requires regular urinary and bowel irrigation.
Recently, she was admitted to critical care unit for septic shock, turbid urine, watery diarrhea from stoma.
PATIENT ASSESSMENT.
A suprapubic catheter was insitu. A MACE and colostomy was found at right and left abdomen respectively. A hole was found at the umbilicus which communicate with the ‘urinary bladder”
URINARY CARE
By using aseptic technique, perform bladder irrigation daily with warm normal saline by either one of the following method;
1, Irrigate the supra-pubic catheter
2, Cannulate the umbilical hole, allow fluid go in and fluid drain out via the supra-pubic catheter.
In order to prevent the blockage of the supra-pubic catheter, perform bladder irrigation until return fluid clear . Observe, record the nature and volume of the irrigation fluid in and out.
BOWEL AND STOMA CARE
MACE: Because of diarrhea, we cannulate the MACE with an infant feeding tube to keep it open.
COLOSTOMY:
Protect the peristomal skin with “no sting spay”
Apply a one-piece colostomy pouch to collect effluent
Observe, record the nature and volume of fecal output.
Start bowel irrigation daily when diarrhea stop, by cannulating the MACE with suction catheter, allow warm fluid go in and fecal matter drain out to colostomy bag.
OUTCOME
Bowel motion and urinary drainage are maintained, patient free from urinary tract infection.