Chapter 48: Caring for Clients with Ostomies

In a client with an ileoanal reservoir, perineal exercises involve tightening the anus and holding the contraction for a count of how many seconds before relaxing?

10

A nurse is caring for a client with chronic ulcerative colitis who is scheduled to have surgery to create an ileoanal reservoir. How would the nurse describe this procedure?

An ileoanal anastomosis is performed in two stages. A temporary ileostomy is performed in the first stage, and 2 to 3 months later, the surgeon closes the temporary ileostomy and reunites the two sections of ileum.

A client with Crohn's disease is recovering from a recent total colectomy and ileostomy. The nurse is providing postoperative teaching with the primary focus on how to avoid complications. What would be included in the postoperative teaching?

Chew food into easily digested pieces.

Which of the following measures would the nurse recommend to an ostomate to help facilitate a regular bowel pattern without relying on irrigation? Select all that apply.

Drinking prune juice • Performing mild exercise • Using a stool softener

The nurse is caring for a client with severe ulcerative colitis who will be having the diseased portion of the colon removed and an ileostomy placed. The nurse knows that the client will be seen by the surgeon and which professional prior to surgery to decide the best position for the stoma?

Enterostomal therapy nurse

Which of the following statements about ostomy irrigation is true?

For some clients, regularly scheduled colostomy irrigation can be used to establish a predictable pattern of

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:

Liquid consistency

For 3 weeks, a client's stoma was draining adequate amounts of stool. Several days ago, the nurse began to notice that the client's intestine has begun to telescope through the stoma. The nurse suspects which of the following?

Stomal prolapse

The nurse is preparing a client for surgery where a Brooke ileostomy will be placed. The nurse assists the client to understand that this type of ostomy handles the passage of stool in what way?

The client must wear an external pouch and fecal contents drain directly into the pouch.

A nurse is assessing the stoma of a client with an ostomy. Which of the following interventions should the nurse perform when providing peristomal care to the client to preserve skin integrity?

Wash it with soap and water.

A nurse is caring for a client with an ostomy pouch. When should the nurse ask the client to empty the pouch?

When the pouch is one-third to one-half full

When an appliance is necessary to collect stool from an ostomy, what primarily determines the consistency of the stool that is collected?

intestinal placement of the stoma

A nurse is teaching a client how to irrigate his colostomy. The nurse informs the client that the colostomy should be irrigated for which of the following reasons?

regulate the timing of bowel movements

In which part of the colon would the nurse expect to see a double-barrel colostomy?

transverse

The nurse is talking to a client who had a colostomy 4 months ago. The client is complaining that her stools are not passing very easily and is afraid that the cancer that caused the need for the colostomy has returned. Which statement by the client would help the nurse to know why the client is experiencing this problem?

"I am currently on a diet to try and lose weight but the foods I eat are high-fiber."

The nurse is caring for a client who has had a sigmoid colostomy. The client has expressed opposition to using irrigation as a regular way to regulate bowel elimination. What suggestion would help the client achieve this goal?

Increase the amount of fresh and dried fruits that are eaten on a daily basis.

A nurse assessing a patient with an ostomy appliance documents the condition "prolapse" in the patient chart and notifies the physician. Which of the following statements describes this condition?

The stoma is protruding into the bag and may become twisted.

A client received a continent ileostomy 10 days ago, and the surgeon is removing the ileal catheter today. How often should the client empty the reservoir?

every 2 to 4 hours

The nurse is caring for a client who had a Loop Transverse colostomy performed because of a rupture of the colon from a diverticulitis abscess. The client asks the nurse when all of this will be over and life will return to normal. What is the nurse's best response to this client?

"I think you may mean when the colostomy will be reversed. It all depends on how soon your colon heals but it's usually about two to three months."

A nurse is documenting the appearance of feces from a patient with a permanent ileostomy. Which of the following would she document?

"Ileostomy bag half filled with liquid feces."

A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which of the following actions should the nurse take to rectify the problem?

A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which of the following actions should the nurse take to rectify the problem? Rotate the catheter tip inside the stoma.

A nurse is reviewing postoperative interventions with a client who recently received a colostomy. The client asks what should be done if there is leakage around the ostomy pouch. What advice would the nurse provide?

Change the ostomy pouch.

The nurse is caring for a client who received a Brooke ileostomy five days ago. The nurse, when assessing the ileostomy site, notes that the stoma appears to be extending out from the client's skin by approximately 1 inch. What is the nurse's best action at this time?

Contact the health care practitioner immediately and report the finding.

A nurse is providing discharge instructions for a patient with a new colostomy. Which of the following is a recommended guideline for long-term ostomy care?

Increase fluid intake, preferably of water, daily.

The nurse is caring for a client with a Brooke ileostomy and should know that what laboratory tests will be ordered on a regular basis for this client?

Potassium and sodium levels

The nurse is caring for a client who recently had a Brooke ileostomy and will place priority on what aspect of physical assessment?

Skin integrity

A client underwent a continent ileostomy 2 months ago. How often should the client's reservoir be emptied?

every 2 to 4 hours

If the client is otherwise healthy, which stoma placement would result in a firm stool?

sigmoid colostomy

A client is recovering from the creation of an ileostomy due to complications of a bowel disorder. The client has a history of arthritis and takes daily medication to reduce inflammation. Which medication will the health care provider avoid prescribing?

sustained-release tablets

A client had a colostomy placed 30 years ago and is experiencing difficulties with constipation. As recommended, the client has increased fluid intake, which has slightly lessened the symptoms, but the client remains constipated. What is another intervention that might make elimination easier?

eat regular meals

A common nursing diagnosis for a patient who had a colostomy surgically created 6 months ago would be:

Ineffective Coping impaired due to colostomy

The type of stool that will be expelled into the ostomy bag by a client who has undergone an surgery for an ileostomy will be:

Liquid

A nurse is providing education to a client with a continent ileostomy. The client asks what should be done if the catheter is obstructed. What would not be included?

Notify health care provider if unable to obtain drainage after 12 hours.

A client is undergoing a colostomy as depicted in the accompanying image. When teaching the client, what kind of feces will the nurse instruct will result with the ostomy type?

Solid

A nurse is performing an assessment on a client who has returned from colostomy surgery. What action would not be included?

Take the client's temperature via the rectal route and report a sudden elevation in temperature over 101°F.

The nurse is assessing an older client with an ileostomy who states that the fecal matter coming from the stoma has been at a much greater quantity than usual for the last three days. The nurse is concerned that the client is dehydrated but because of lack of subcutaneous fat, the client's skin is already tented. The nurse will assess the client's fluid status by observing what other part of the client's body?

Tongue

A client is scheduled to have a conventional ileostomy. A conventional ileostomy involves the removal of:

the entire colon and rectum.

A client is in the postoperative phase of an abdominal resection and colostomy. When educating the client on his ostomy care by providing him with educational materials to read, it is important to assess the client's:

vision