P010 Case Study of a Patient With Crohn's Disease and Surgical Wound Dehiscence

Abstract

CASE: Background: Specialized nursing care makes all the difference in the management of patients with inflammatory bowel disease (IBD). The aim of the study is to report the experience of an IBD nurse in Brazil, caring for a patient with Crohn's Disease (CD), with emphasis on nurse empowerment as a member of the multidisciplinary team. Methods: Case study with a description of the nurses' behavior regarding an outpatient CD patient from São Paulo State/Brazil. Data were collected through outpatient follow-up and home visits from December 2017 to April 2018. Consultations were performed by an IBD nurse, a general nurse and a stomatherapist. To obtain the data, we used the clinical anamnesis, physical examination and visualization of the records in the patient's medical record. Results: Male patient, 20 years-old, presenting stenosing and fistulizing ileocolonic CD since 2009. Refractory to Adalimumab, using Infliximab 10mg/kg every 8 weeks and Azathioprine 50 mg/day. In December 2017, he underwent Hartmann rectosigmoidectomy for intestinal sub-occlusion, requiring provisional ileostomy. The surgery was succesful and the patient remained at postoperative rest in the hospital for five days. Two days after hospital discharge, the patient sought emergency room due to several abdominal pain, especially in the surgical incision; edema and seropurulent exudate, which required removal of the stitches, resulting in surgical wound dehiscence. The patient's first evaluation after surgery at the IBD nursing outpatient clinic occurred four days after hospital discharge. The patient reported having a good recovery, did not perform any kind of physical activity, kept the diet as directed by the nutritionist, maintained good hygiene of the incision and that his mother was changing the stoma bag as directed by the nurse. The open surgical wound had full-length fibrin tissue, exudate, greenish discharge, characteristic odor, presence of biofilm, measuring 15 cm in height and 5 cm in width. After discussion with the multidisciplinary team, we opted for second intention healing. For cleaning the wound bed we used the 10-minute gauze-soaked Polyhexanide Solution, the primary dressing was performed with the adaptive polyester mesh impregnated with fatty substances, hydrocolloids and silver particles and then the secondary dressing with gauze and microporous tape. Primary dressing was done once a week by nurses and secondary dressing daily by the patient's mother after training. Complete wound healing took 4 months and after that, the patient resumed daily activities more safely. Conclusion: In this context, it was clear that the nurses' knowledge about the disease, the correct management of postoperative complications enabled the more agile and effective progress of wound treatment, favoring better quality of life for the patient and allowing reflection on the subject exposed.