Chapter 42: Colon Diversion Devices
What does a single-barreled sigmoid colostomy look like?
In a single-barreled sigmoid colostomy, an end stoma is constructed surgically by dividing the bowel to bring out the proximal end as a single stoma.
The nurse provides discharge teaching for a patient with a new ostomy. Which statements made by the patient indicate effective learning? Select all that apply. "I can select clothes that will hide the stoma." "I can't swim with my pouching system in place." "In six to eight weeks, I can resume activities other than heavy lifting." "I should maintain contact with the local support services." "My sexual dysfunction may be temporary and resolve in three to twelve months."
"I can select clothes that will hide the stoma." "In six to eight weeks, I can resume activities other than heavy lifting." "I should maintain contact with the local support services." "My sexual dysfunction may be temporary and resolve in three to twelve months."
The nurse is preparing education regarding ostomy self-care for a patient with a new colostomy. Which statement made by the patient is most indicative that the patient is ready to learn? "I'm ready for discharge and have no questions." "I'd like for my spouse to be taught about ostomy care first." "I'd like to arrange for a visiting nurse at home for a short period of time." "I need more information about the procedure for changing the bag."
"I need more information about the procedure for changing the bag." The patient is expressing indirect but definite interest when the nurse is providing colostomy care. The patient indicates a willingness to watch, which is a first step in self-care. Indicating that he or she has no questions, asking for the spouse to be taught first, and asking for a visiting nurse reflect difficulty accepting and providing self-care for the new colostomy.
A patient with a newly formed ileostomy asks the nurse, "When can I start training my ostomy to produce stool only at certain times?" Which is an appropriate nursing response? "We will start the training when the stoma heals." "We will start the training when your stools transition from liquid to semisolid." "Because you have an ileostomy instead of a colostomy, we can start any time." "We will not be able to train your ostomy because of the frequent drainage from the site."
"We will not be able to train your ostomy because of the frequent drainage from the site." Drainage from the ileostomy is frequent, of liquid consistency, and irritating to the skin, preventing regularity from being established. Not all colostomies can be trained. A colostomy formed in the sigmoid or descending colon produces semiformed or formed stools and can be regulated by the irrigation method.
A patient's colostomy stoma is scheduled to be irrigated on the fifth postoperative day. Which does the nurse understand to be the main purpose of the irrigation? Act as an enema Help to stimulate emptying of the colon Remove any blood clots Assess the patency of the colostomy
A new colostomy may require irrigation to train, or regulate, the colon for its modified function. The patient should also be instructed to contract abdominal muscles and to massage the abdomen from right to left to stimulate peristalsis. Although colostomy irrigation may act as an enema to facilitate a bowel movement, its greater purpose is the regulation of the colon. Blood clots should not be present, and an irrigation is never used to assess the patency of the colostomy.
The nurse reviews the postoperative notes of a patient who is hospitalized after an ostomy surgery to treat cancer of the rectum. The nurse notes that the patient's stool consistency is formed. The nurse identifies that the patient has undergone which type of surgery? Ileostomy Sigmoid colostomy Ascending colostomy Transverse colostomy
A sigmoid colostomy is performed to treat cancer of the rectum or rectosigmoid area, a perforating diverticulum, or trauma. The stool consistency associated with a sigmoid colostomy is formed. The stool consistency associated with an ileostomy, an ascending colostomy, and a transverse colostomy is not formed. With an ileostomy, it is semiliquid or liquid. With an ascending colostomy, it is semiliquid. With a transverse colostomy, it is semiliquid to semiformed.
The nurse reviews the medical records of patients who are undergoing treatments for intestinal problems. Which patient is susceptible to obstruction of the colon?
After an ileostomy, the lumen of the ileum becomes less than one inch in diameter, and it may narrow further at the point where the bowel passes through the fascia/muscle layer of the abdomen. Thus, a patient who has undergone ileostomy surgery is more susceptible to a colon obstruction. Budesonide is a corticosteroid; prolonged corticosteroid treatment can lead to hypokalemia and osteoporosis. Antitumor necrosis factor agents can cause upper respiratory and urinary tract infection. A patient who has undergone total proctocolectomy with ileal pouch/anal anastomosis surgery has a risk for pouchitis.
The nurse provides care to a patient who has undergone a low anterior resection (LAR) in which the sphincters were preserved. When the patient experiences diarrhea, the nurse anticipates a prescription for which medication? Aspirin Loperamide Sulfasalazine Panitumumab
After sphincter-sparing surgery, a patient frequently experiences diarrhea. Thus an antidiarrheal drug such as loperamide would be prescribed to decrease gastrointestinal motility and control bowel movements. Aspirin can reduce pain, but it does not reduce diarrhea. Sulfasalazine is used to treat rheumatoid arthritis and arthritis associated with bowel inflammation. Panitumumab is used to block the epidermal growth factor receptor; it does not treat diarrhea.
The nurse provides care for a patient whose terminal ileum has been removed and anticipates a prescription for which type of supplement? Iron supplement Zinc supplement Folic acid supplement Cobalamin supplement
Cobalamin is absorbed in the terminal ileum; thus, the patient may have a cobalamin deficiency after the ileum's removal. Cobalamin supplements should be prescribed for the patient. Iron supplements are recommended for a patient with iron-deficiency anemia. Zinc and folic acid supplements do not need to be prescribed for a patient whose terminal ileum is removed.
The nurse is educating a patient about performing colostomy irrigation and includes which rationale for the procedure? To reduce odor To prevent skin irritation To reduce the risk of diarrhea To stimulate emptying of the colon
Colostomy irrigation helps stimulate emptying of the colon. The use of gas filters and diet modifications helps to reduce odor. Using skin barriers and avoiding placing the pouch on irritated skin prevents skin irritation. Modifying the diet plan reduces the risk of diarrhea.
The nurse provides postoperative care for a patient following a surgery in which the patient's short bowel was shortened. To monitor for fluid and electrolyte imbalance, the nurse assesses which parameters? Select all that apply. Fluid intake and output Sodium level Potassium level Red blood cell count White blood cell count
Fluid intake and output Sodium level Potassium level
The nurse provides care for a patient with colorectal cancer with a stage II tumor in the mid rectum. The nurse anticipates that the patient will be scheduled for which surgery? Abdominal-perineal resection (APR) Laparoscopic surgery Polypectomy during colonoscopy Low anterior resection (LAR)
If the tumor is in the mid or proximal rectum, it may be possible to preserve the sphincters with an LAR. An LAR involves removing the rectum and anastomosing the colon to the anal canal. If the tumor is in the distal rectum (1 to 2 cm from the anorectal junction) and the sphincters cannot be preserved, the patient will undergo an APR. An APR involves removing the entire rectum with the tumor, and the patient will have a permanent colostomy. Laparoscopic surgery is sometimes used for stage I tumors, especially those in the left colon. Polypectomy during colonoscopy can be used to resect colorectal cancer in situ.
When selecting the site for a patient's ostomy, which consideration does the health care team make? The patient should be able to see the site. Outside the rectus muscle area is the best site. It is ideal if an abdominal stoma site can easily bend. The ostomy should be conveniently located to allow for routine irrigations.
In selection of the ostomy site, the site should be visible to the patient so the patient can take care of it. The site should be within the rectus muscle, on a flat surface; stomas placed outside the rectus muscle increase the chance of developing a hernia. If the abdominal stoma site has bends or creases, it is hard to get a good seal and the skin barrier will pull away faster. The ostomy should not need routine irrigations.
The nurse creates a teaching plan for a patient with Crohn's disease who has a new ileostomy. Which is appropriate for inclusion in the plan? Increased intterm-1ake of high fiber foods Increased fluid intake to 2 to 3 L/day when hot or sweating Decreased intake of sodium and sports drinks Increased daily exercise during acute exacerbation episodes
Increased fluid intake to 2 to 3 L/day when hot or sweating Nursing care for a patient with an ileostomy include increasing fluid intake to at least 2 to 3 L/day or more when there are excess fluid losses from heat and sweating. Patients with Crohn's disease should decrease intake of high fiber foods. They may need to ingest added sodium (for example, sports drinks) to account for losses. The patients should limit daily exercise during acute exacerbations.
The nurse reviews the medical records of patients being treated for colorectal cancer (CRC). The nurse anticipates that a wide resection and reanastomosis will be performed on which patient? A: stage I tumor in left colon B: stage II colonic tumor C: stage II colonic tumor D: spread of colonic cancer to distant sites
Patient B, with a stage II colonic tumor, needs a wide resection and reanastomosis. Patient A has a stage I tumor in the left colon that requires laparoscopic surgery. Patient C, with stage III colonic tumor, would need surgery and chemotherapy. Patient D has had metastasis of colon cancer to distant sites, which is a sign of stage IV cancer. This patient would require surgery, chemotherapy, and radiation therapy.
The nurse provides postoperative care for a patient who underwent an ostomy surgery, in which the stoma is located outside the rectus muscle site. The nurse monitors the patient for which postoperative complication? Hernia Necrosis Severe edema Moderate bleeding
Placing a stoma outside the rectus muscle increases the chance of developing a hernia. Stomas should be placed on the flat site of the abdomen to avoid leakage. The nurse monitors blood flow to the stoma to prevent necrosis. Placement of the ostomy does not contribute to edema. The nurse should monitor coagulation factors to avoid moderate bleeding.
The nurse provides care for a patient with ulcerative colitis and expects that which surgery will be beneficial for the patient? Sigmoid colostomy Ascending colostomy Total proctocolectomy with permanent ileostomy Total proctocolectomy with ileal pouch/anal anastomosis (IPAA)
The most commonly used surgical procedure for ulcerative colitis is a total proctocolectomy with ileal pouch/anal anastomosis (IPAA). During this procedure, a diverting ileostomy is performed and an ileal pouch is created and anastomosed directly to the anus. After this surgery, the patient is able to control defecation at the anal sphincter. Sigmoid colostomy is recommended for a patient who has cancer in the rectosigmoidal area. Ascending colostomy is recommended for a patient who has a perforating diverticulum in the lower colon. Total proctocolectomy with permanent ileostomy involves the removal of the colon, rectum, and anus.
A patient has undergone surgery for treatment of colorectal cancer (CRC). The surgical note indicates that the procedure performed was sphincter-sparing. The nurse closely monitors the patient for which common complication? Diarrhea Hemorrhoids Diverticulitis Malabsorption syndrome
The patient may lose control over the sphincter after sphincter-sparing surgery; therefore the patient frequently experiences diarrhea. Hemorrhoids occur as a result of increased anal pressure and weakened connective tissue. Diverticulitis occurs due to inflammation of the diverticula. Malabsorption syndrome occurs due to impaired absorption of fats.
The nurse reviews the medical records of four patients and identifies which patient will most likely need a permanent ostomy? Patient A: presence of stabbing injury at thigh Patient B: Presence of draining fistula Patient C: presence of rectal cancer Patient D: presence of gunshot wound
The treatment of rectal cancer tumors involves the removal of the bowel distal to the ostomy. Therefore, the patient with rectal cancer needs a permanent ostomy. A patient with a draining fistula requires a temporary ostomy to prevent the contact of stool with the diseased area. A patient with a stabbing injury in the thigh would not need an ostomy. A patient with gunshot wound may require a temporary ostomy.
A patient develops diarrhea after colostomy surgery. After reviewing the patient's list of foods consumed regularly, the nurse suspects that which item is the cause of the condition? Fish Eggs Strong cheeses Raw fruits in the diet.
The type of foods consumed by a patient affects the stoma output. Raw fruits can cause diarrhea. The consumption of fish and eggs can produce an odor. The consumption of strong cheeses can cause gas to form.
A nursing student provides postoperative care for a patient who underwent ostomy surgery. The nurse intervenes when the student performs which action? Uses an open-ended, transparent pouch Plans to empty the collecting bag when it is two-thirds full Places a pouch on irritated skin using a skin barrier Releases flatus from the bag using a charcoal filter
The weight of drainage from the stoma pulls the skin barrier away from the skin and loosens the seal. Therefore, the nurse should empty the ostomy bag when it is one-third full. Using open-ended and transparent pouches helps the nurse to observe the stoma and collect the drainage. Placing a pouch on irritated skin using a skin barrier is done to prevent harm to the area. Optional charcoal filters can deodorize and automatically release flatus. They are available for both drainable and nondrainable pouches.
The nurse provides postoperative care of a patient following an ileostomy. The patient experiences incontinence of mucus. The nurse recalls that which event may be the cause of this condition? Kegel exercises Iron dextran treatment Corticosteroid treatment Intraoperative manipulation of the anal canal
Transient rectal incontinence of mucus is a result of intraoperative manipulation of the anal canal. Kegel exercises performed immediately after surgery may increase the risk of bleeding. Iron dextran treatment is used to treat anemia; this treatment does not affect the bowel function. Corticosteroid treatments may cause hypokalemia and osteoporosis as side effects.