Mrs. Garden is a 51- year- old female who is admitted to the medical surgical unit following a resection of the sigmoid colon and rectum due to a cancerous growth. She has a colostomy. Mrs. Garden is married, has three children - two daughters, age 29 and 26, who are living on their own approx. 2 hours away and a son, age 20, who is in university and living at home. Mrs. Garden had been in good health until January of this year when she noticed a decrease in appetite, abnormal bowel movements, varying from small hard stools to loose watery stools, and a sudden drop in weight of 9 lbs over 4 weeks. Mrs. Garden stated she had not been on a diet, had always struggled with her weight and was secretly elated when she began to lose weight with no effort. Mrs. Garden is on a blood pressure medication and takes vitamin D and Calcium po daily. She has no known allergies. Doctor’s Orders post operatively include: Vital signs q4h AAT – ambulate daily Diet – clear fluids for 12 hours then soft foods with low sodium IV Normal Saline at 100 cc/hr Medications: Norvasc 5mg po OD Calcium / Vitamin D supplements as per routine Clean area around stoma 2x daily Consult to Enterostomal therapy Morphine 2.5 mg IV every 2 hours prn Gravol 50 mg po q 4 hr prn You are assigned total patient care for Mrs. Garden. She is now 19 hours post- operative. When you approach Mrs. Garden and introduce yourself, she nods but does not respond. The patient has an IV #20 intercath infusing in the left forearm of Normal Saline at100 cc/hr. She has a stoma protruding from the left side of the abdomen. A stoma bag is covering the stoma and attached to the skin surrounding it. During your initial assessment, Mrs. Garden begins to cry and says: “I can’t believe this is happening to me.” While you are providing personal care Mrs. Garden covers her head with the sheet. You examine the stoma, note that it is pink and oozing liquid stool into the stoma bag. You inform Mrs. Garden that the incision site is very clean and looks healthy. Mrs. Garden refuses to look at the stoma and tells you “I do not want to hear anything about this.” A liquid diet was initially ordered but now soft foods have been ordered for Mrs. Garden. Mrs. Garden refuses the tray stating “I’m not hungry.” Mrs. Garden’s husband and son arrive after breakfast and are very concerned and attentive over her. She smiles, and asks them several questions about their work and university. Her daughters will be arriving later in the day. You explain to Mr. Garden that it is important to ambulate daily (as per Dr Orders) and that he and their son can certainly be there and assist. Mrs. Garden tells you she is in too much pain to get out of bed and perhaps it is better that her husband and son go home and come back later. You ask Mrs. Garden about the intensity of the pain. She says it is 7/10. Later that day, Mrs. Garden appears flushed and you note the following assessment findings: Temp 37.9, HR 87, BP 153/87, R 20, O2 saturation per pulse oximetry-100% on room air. The skin around the stoma is red and appears irritated, the stoma is still pink, and draining a very soft slightly formed stool.

Part A- Worth 15% Check the class schedule for the due date. 

Develop a Nursing Care Plan based on the case scenario provided. Complete the first 3 steps of the Nursing Process-Assessment, Nursing Diagnosis and Planning. Four Nursing Diagnoses with corresponding Assessment data and one Short term and one Long term Goal per Diagnosis is required.