Ostomies
The nurse is assessing the stool consistency of a client with an ascending colostomy. Which of the following would the nurse expect to find? A) Liquid B) Semiliquid C) Soft D) Formed
B The consistency of fecal material ranges from semiliquid to formed depending on the area from which the colostomy is formed. With an ascending colostomy, stool would be semiliquid. An ileostomy would produce liquid stool; a transverse colostomy would produce soft stool; a sigmoid colostomy would produce formed stool.
A client is to have a total colectomy and has been on prednisone 3 months ago for the treatment of Crohn's disease. What medication does the nurse anticipate administering in the preoperative phase to prevent adrenal crisis? A) Intravenous hydrocortisone B) Intravenous antibiotics C) Blood transfusion D) A low-molecular-weight heparin
A A preoperative "stress dose" of IV steroid (i.e., hydrocortisone) is given to clients who have been on prednisone within the previous 6 months to prevent adrenal crisis. Antibiotics, blood transfusions, and low-molecular-weight heparin will not supply cortisone, which is needed to prevent adrenal crisis.
A client will be having a total colectomy in 4 days. The client does not have an obstruction. What does the nurse anticipate instructing the client about doing prior to the surgery to prepare the bowel? A) Instructing the client about dietary restrictions and lavage agents B) Making sure the client drinks 2 L of fluid prior to the procedure C) Instructing the client to have no food except clear liquids for 4 days D) There will be no special preparation, and the client may eat until midnight the night prior to surgery.
A Cleansing of the bowel before surgery is carried out using dietary restriction in combination with laxative or lavage agents, depending on the client's condition (i.e., presence or absence of obstruction) and according to the surgeon's preference. There are no benefits to the client drinking 2 L of fluids for 4 days prior to the procedure or only taking in only liquids for 4 days.
The nurse is preparing to irrigate a client's single-barrel colostomy after surgery. What postoperative day should the nurse irrigate the colostomy? A) Fourth or fifth postoperative day B) The day after surgery C) The seventh postoperative day D) The colostomy should be irrigated immediately postop
A Colostomy irrigation begins on the fourth or fifth postoperative day. Standard irrigation is a scheduled irrigation, using 500 to 1500 mL of tepid water
The client expresses fears about looking at the stoma for the first time. What can the nurse inform the client will occur when he first views and touches the stoma? A) An assigned staff nurse will be there when the stoma is exposed for view. B) The client will be expected to perform self-care of the stoma after surgery. C) The client will not have to look at the stoma; a family member can do the care. D) The stoma will be covered so the client will not have to view it.
A Inform the client that an assigned staff nurse will be there when the client first views and touches the stoma. Such information gives reassurance that a familiar nurse will be available to answer questions and give support. The client will not be expected to perform stoma care directly after the surgical procedure because he will require medication for pain and discomfort. An expected outcome is that the client will be able to perform self-care of the stoma. The stoma will not be covered; it will have an appliance that is clear.
A client with an ileostomy tells the nurse that he is having a lot of problems with the formation of gas. What can the nurse tell the client to help her with this common issue? A) Eat slowly and chew food well with mouth closed. B) Restrict fluids. C) Administer an enema to clear out the stool. D) Dilate the stoma.
A The client should eat slowly and chew food well with the mouth closed to help lessen the development of gas. Restricting oral intake should only be done with medical supervision and will not help with gas reduction. Enemas should not be administered. The stoma is only dilated when the stool volume decreases.
The client is having a total colectomy with an ileostomy created. What does the nurse explain to the client that the stool consistency will be? A) Liquid or mushy B) Bloody, soft C) Small balls of feces D) Thin and firm
A The fecal material discharged from an ileostomy is liquid or mushy and contains digestive enzymes. The stool does not have time to harden since there is not the large intestine available to process.
The nurse is instructing a client with an ileostomy on appliance use and changing it. What statement made by the client demonstrates the client understands of using a new appliance for the first time? A) "I will patch test it first on nonirritated skin at the inner aspect of my forearm." B) " I can expect the new appliance to sting or itch for the first 24 hours." C) "When changing the appliance and faceplate, I should scrub vigorously to remove all debris." D) "I should change the faceplate every 8 hours."
A When using a new adhesive product, remember to patch test it first on nonirritated skin at the inner aspect of the client's forearm. Inform the client that the most common causes of discomfort are reactions to the adhesive or solvent used to remove it or irritation from leaking fecal drainage. In such cases, the client may experience stinging, tingling, or itching immediately after an appliance change. If a sensation is prolonged or intensified, remove the appliance regardless of whether it has been on for 1 hour or several days. Avoid rubbing, which may further irritate skin. If the faceplate is changed too frequently, skin around stoma may become raw and excoriated secondary to removal of protective layers of epithelium with the faceplate.
A male client will be having an ileoanal anastomosis for the treatment of chronic ulcerative colitis. What is the benefit to this client of having this procedure rather than a total colectomy? Select all that apply. A) Maintains bowel continence B) Unlikely to experience bladder dysfunction C) Unlikely to experience erectile dysfunction D) Unlikely to experience infertility E) Able to have the procedure as an outpatient
A, B, C, D The ileoanal reservoir, also called an ileoanal anastomosis, is a procedure that maintains bowel continence. It is performed on selected clients who have chronic ulcerative colitis or whose disease does not affect the anorectal sphincter. Besides allowing the client to control bowel elimination, this procedure, as opposed to a conventional ileostomy with total colectomy, preserves innervation to the male genitalia. Subsequently, the male client is unlikely to experience bladder dysfunction, erectile dysfunction, or infertility. The client will not be able to have this surgery done on an outpatient basis; they require postoperative care for a longer duration.
The nurse is discussing care of the client's ileostomy and is instructing the client to avoid certain medications that may pass through without being absorbed. What medications should the nurse instruct the client to avoid? Select all that apply. A) Enteric-coated products B) Liquid medication C) Slow-release beads D) Layered tablets E) Chewable tablets
A, C, D Clients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. These products may pass through without being absorbed. The client may take liquid and chewable tablets because they will go through the breakdown process in the stomach.
A client is to undergo surgery for the creation of a continent ileostomy. Which statement by the client indicates successful teaching? A) "I'll need to empty the appliance more frequently." B) "I'll need to learn how to empty the reservoir several times a day." C) "My stool will be loose initially but then become formed in a week or so." D) "I'll just push on the valve and the drainage will flow out easily."
B A continent ileostomy involves the creation of an internal reservoir for the storage of GI effluent. It stores the effluent for several hours until the client removes it with a catheter. Initially, the reservoir is emptied every 2 to 4 hours, and then three to four times per day as the capacity of the reservoir increases (usually about in 6 months). This reservoir eliminates the need to wear an external appliance. Stool will continue to be liquid at all times. A continent ileostomy does have a nipple valve through which a catheter is inserted to drain the reservoir.
The nurse is caring for a patient in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time? A) A reusable pouch appliance should be used. B) A disposable or temporary appliance should be used. C) A dry sterile dressing should be used over the stoma. D) A wet to dry dressing should be used over the stoma to keep it moist.
B A disposable, or temporary, appliance is preferred in the immediate postoperative phase because the size of the stoma changes over time as a result of swelling from the procedure itself. The size of the stoma may change rapidly and differ from one appliance change to the next. After the stoma heals and reaches its final size and shape, a permanent appliance (reusable) may be used. A dry sterile dressing or wet to dry dressing should not be placed over the stoma due to the saturation of stool, which may cause maceration of the skin around the stoma.
A client is preparing to have colorectal surgery and will have a colostomy created temporarily in hopes that he may be able to have it reversed in 6 months. The client is very concerned about the care of the colostomy. What preoperative interaction would the client benefit from? A) Discussing other options with the surgeon B) Meeting with an enterostomal therapist C) Going to a support group with other clients that have colostomies D) Watching a video about colostomies
B Clients benefit from preoperative interactions with a specially certified nurse, referred to as an enterostomal therapy nurse; enterostomal therapist; or wound, ostomy, and continent nurse. This nurse assists with marking placement of the stoma and collaborates with the surgeon regarding placement and the client's educational needs. Other options may not be available for this client, especially if there is a tumor present. Going to a support group would be a good option in the postoperative management because the client should be given information from the professional prior to going to surgery. Watching the video with the therapist and having the option to answer questions would be a better choice than watching it alone.
A client is having a procedure that will remove the entire colon and rectum and will bring the end of the ileum through a separate area on the right lower quadrant of the abdomen. What type of procedure does the nurse understand this client will be having? A) Appendectomy B) Total colectomy C) Double-barrel colostomy D) Abdominoperineal resection
B In the usual surgical procedure for a conventional ileostomy, the entire colon and rectum are removed (total colectomy). The terminal end of the ileum is brought out through a separate area on the right lower quadrant of the abdomen slightly below the umbilicus, near the outer border of the rectus muscle. The end is averted and sutured to the skin, a process referred to as a matured stoma. An appendectomy is removal of the appendix. A double-barrel colostomy may be a temporary colostomy for rest of the bowel. Abdominoperineal resection removes the anus, rectum, and part of the sigmoid colon.
A nurse is preparing to administer the prescribed vitamin B12 to a client who has had most of his ileum removed. The nurse understands that this is necessary for which reason? A) Prevents thrombosis B) Prevents deficiencies C) Aids proper digestion D) Prevents constipation
B Parenteral injections or intranasal administrations (Nascobal) of vitamin B12 are used to prevent deficiencies in clients who have had most or all of the ileum removed because this area is responsible for B12 absorption. Vitamin B12 does not prevent thrombosis or constipation or aid digestion.
When the nurse is teaching the client about attachment of the faceplate around the stoma, what measure will ensure secure attachment of the pouch to the peristomal skin? A) Apply a large quantity of adhesive around the stoma prior to attaching the faceplate. B) Press the adhesive faceplate around the stoma for about 30 seconds. C) Press the adhesive faceplate from the outward edge of the stoma inward. D) Wipe the faceplate with alcohol to remove debris.
B Press the adhesive faceplate around the stoma for about 30 seconds. This measure ensures secure attachment of the pouch to the peristomal skin. A large amount of adhesive is not necessary to adhere the faceplate around the stoma. The adhesive faceplate should be pressed from the stomal edge outward. The faceplate should not be wiped with alcohol first.
A client who is scheduled for an ileostomy surgery says to the nurse, "I'm afraid I won't be able to look at that stoma." Which response by the nurse would be most therapeutic? A) "That's something you don't have to think about now." B) "I'll make sure there is a familiar nurse here with you the first time." C) "It's okay, everybody feels this anxious about this." D) "Don't worry, I'm sure that you will be able to do this just fine."
B Telling the client that a familiar nurse will be with him the first time provides the client with reassurance that he will not be alone and will have the support of a familiar person to answer questions and provide comfort and support. Telling the client not to worry about it now, that everybody feels anxious, and that he'll do just fine discounts the client's feelings and is not therapeutic.
Which of the following interventions would the nurse need to keep in mind when a loop colostomy of a client is to be opened? A) Provide the client with plenty of fluids before the procedure. B) Prepare the client for the pungent odor before the procedure. C) Elevate the client's legs before and during the procedure. D) Note the color and amount of fecal material during the procedure.
B When the loop colostomy of a client is to be opened, the nurse should prepare the client for the pungent odor of cauterized tissue before the procedure. Intake of fluid and elevation of the legs have no implications in such a procedure. There is an initial gush of fecal material during the procedure. However, the nurse need not note the color and amount of fecal material passed.
A client is scheduled to have a total colectomy due to a colon mass and is also taking prednisone for asthma. The physician has instructed the client to taper down on the prednisone and discontinue. What negative outcome does the nurse know may occur if the client does not adhere to the instructions? A) Liquid stools after surgery B) Delayed or altered tissue healing C) Hypertension D) Increase in blood loss
B Whenever possible, prednisone should be tapered and discontinued before surgery to avoid negative effects of the drug on tissue healing. The client will have liquid stools after the ileostomy through the pouch because the stool is not formed. Hypertension and increase in blood loss do not necessarily correlate with the corticosteroid use.
The nurse is preparing a client for surgery and observes on the operative permit that the client will be having a double-barrel colostomy. What portion of the large intestine is the nurse aware that this is performed? A) Descending B) Ascending C) Transverse D) Sigmoid
C A double-barrel colostomy, which is performed most often in the transverse section of the large intestine, contains both a proximal and distal stoma.
A client scheduled for a total colectomy has been taking the immunosuppressive agent, azathioprine (Imuran). When should the client be told to discontinue the medication to prevent negative effects on tissue healing? A) 3 days before surgery B) 1 week before surgery C) 1 month before surgery D) 3 months before surgery
C Immunosuppressive agents such as azathioprine, 6-mercaptopurine, and cyclosporine should be discontinued 3 to 4 weeks before surgery to prevent negative effects on tissue healing. Aspirin-containing compounds are discontinued at least 1 week before surgery to decrease the risk of bleeding.
A client has been discharged from the acute care facility with an ileostomy. The client comes to the clinic for a follow-up visit and informs the nurse that the wound has been draining and they are having abdominal pain and running a fever. What does the nurse suspect is occurring with the client? A) The client is having an allergic reaction to the appliance. B) The client has developed anemia from blood loss. C) The client has developed a wound infection. D) The client is not emptying the pouch correctly.
C Signs of wound infection are wound drainage, abdominal pain, and elevated temperature. These symptoms do not indicate an allergic reaction, anemia, or not emptying the pouch correctly
A client with a colostomy is concerned with the odor that is left on the ostomy appliance and believes it may be caused by some of the medication that they take. What suggestion should the nurse provide to the client to determine if her medication is causing this problem? A) The client should abstain from her medications, reintroducing them one at a time to see which one is causing the odor. B) The client should abstain from taking any over-the-counter vitamin preparations because they are most likely the offending medication. C) The client can obtain a list of drugs from an ostomy association or appliance manufacturers. D) All colostomies have an offensive odor, and it is probably not the medication that is causing it.
C Some medications, especially vitamins, antibiotics, and antituberculosis drugs, cause particularly strong odors that cling to the appliance. The client can obtain a list of drugs that may leave an odor on an ostomy appliance from an ostomy association or ostomy appliance manufacturers. The client should not abstain from taking prescribed medications because this could cause severe complications. The client should check with the physician prior to taking any over-the-counter medications but not abstain from taking them if they are prescribed. All colostomy odors can be controlled with interventions and may be caused by medications.
A client with an ileostomy who has been discharged from the hospital calls the clinic and asks the nurse if he should take another one of his "potassium pills" because there is a waxy coating on the ileostomy from the pill. What is the best response by the nurse? A) "You should take another pill because the residue means the potassium was not absorbed." B) "You will just have to omit the dose for today because we don't know how much of the medication was absorbed." C) "Some medications like this leave a "ghost" of the wax matrix coating, but it doesn't mean the drug wasn't absorbed." D) "There must have been a defect in the medication for it to leave the waxy coating."
C Some preparations such as potassium chloride (Slow-K) leave a "ghost" of the wax matrix coating, but that does not indicate the drug has been unabsorbed. The client should not take another potassium supplement that could increase the risk of elevated potassium levels. The dose was not omitted, and there is not a defect in the medication; it is an expected effect.
Which intervention would be most appropriate for a client who has undergone colostomy surgery? A) Monitoring vital signs once a day. B) Taking temperature by rectal route. C) Monitoring the volume of gastric secretions. D) Minimizing the client's fluid intake.
C The nurse should monitor the volume of suctioned gastric secretions in a client who has undergone colostomy surgery. The nurse should monitor vital signs once every 4 hours and take temperature by any route other than rectal. The nurse should also ensure that the client's fluid intake is adequate and not minimized.
A client who had a total colectomy with an ileostomy has rectal packing in place to absorb drainage and promote healing. When does the nurse know that the rectal packing will be removed? A) Within 24 hours B) 2 days C) Within 1 week D) In 2 weeks
C The rectum is packed with gauze during surgery to absorb drainage and promote gradual healing. The rectal pack usually is removed in 5 to 7 days.
A client has had surgery to create an ileoanal reservoir surgery. Which instruction would the nurse give to reduce the risk for bowel incontinence? A) Avoid high-protein food. B) Take frequent brisk walks. C) Perform perineal exercises. D) Perform warm water soaks.
C To reduce the risk for bowel incontinence, the nurse should instruct a client who has undergone ileoanal reservoir surgery to perform perineal exercises. The client need not avoid high-protein food, take walks, or perform warm water soaks because these do not minimize the risk of bowel incontinence
A male client, age 32 years, was recently married, and he and his wife would like to have children. The client is scheduled to have a total colectomy and is concerned with being able to have children. What is the best answer given by the nurse related to the client's concern? A) "There is no risk of you not being able to father children after this surgery." B) "I certainly understand your concern, but there are other options such as artificial insemination and adoption." C) "You may want to consider collection and storing of sperm for later use if you are planning to have children." D) "Infertility is a side effect of this surgery and should be considered carefully."
C Young male clients may wish to collect and store sperm for later use if they plan to have children. Sexual dysfunction in men after a total colectomy is unusual but sometimes occurs. If such dysfunction persists after a colectomy, operative and nonoperative options are available to facilitation erection.
What potentially life-threatening complication can the client have if corticosteroids are abruptly withdrawn or the client has significant stress due to the impending surgical procedure? A) Cushing's disease B) Myxedema coma C) Thyroid storm D) Adrenal crisis
D Adrenal crisis is potentially life threatening and can result from the abrupt withdrawal of corticosteroids or significant stress after the client has been treated with corticosteroids. Cushing's disease is a disease when there are increased levels of cortisol released. Myxedema coma is a result of dangerously decreased levels of thyroid hormone, and thyroid storm is a dangerously increased level of thyroid hormone
A client who is scheduled for an ileostomy surgery and been taking corticosteroids is instructed to taper the drug, eventually discontinuing it. The nurse would monitor this client for which of the following? A) Cerebral anoxia B) Cardiac dysrhythmias C) Hypothyroidism D) Adrenal insufficiency
D Adrenal crisis is potentially life threatening and may result from the abrupt withdrawal of corticosteroids. Therefore, the nurse should closely monitor a client who is scheduled for an ileostomy surgery for adrenal insufficiency, resulting from corticosteroid withdrawal. Withdrawal of corticosteroids does not cause cerebral anoxia, cardiac dysrhythmias, or hypothyroidism.
A client is having the first stage of an ileoanal anastomosis. What should the nurse inform the client they will experience? A) Solid stool from the anus B) Very little discharge from the anus C) Control of the fecal material from the anus D) Continuous discharge of mucus from the anus
D After the first stage of surgery, clients experience an almost continuous discharge of mucus from the anus and a frequent discharge of fecal material from the ileostomy. Initially, clients cannot control the frequent watery discharge.
A client who will be having a portion of colon removed and colostomy created informs the nurse that he "will not be attractive any longer." The nurse determines the nursing diagnosis is Disturbed Body Image related to the stoma and altered bowel elimination. What expected outcome related to this diagnosis will the client have? A) The client will be given instructions on how to care for the ostomy. B) The client will demonstrate adequate coping skills. C) The client will be allowed time and support to promote communication. D) Client verbalizes what the changes will be and the benefits to future health.
D For a nursing diagnosis of Disturbed Body Image, the expected outcome is that the client verbalizes what the changes will be and the benefits to future health. This demonstrates that the client understands and is accepting of the changes that are to occur. Giving instructions is a nursing intervention and not an outcome. Demonstrating adequate coping skills is not a measurable goal and supporting and promoting communication does not correlate with the nursing diagnosis of body image.
The nurse is providing ostomy care to the client with an ileostomy. What can the nurse use to protect the skin and promote adhesion of the ostomy appliance? A) Adhesive glue B) Tincture of Benzoin C) Vaseline D) Karaya gum
D Karaya gum, which becomes gelatinous when in contact with moisture, is commonly used in place of an adhesive. Karaya gum protects the skin and promotes adhesion of the ostomy appliance.
A client undergoes surgery for a Kock pouch and returns to the nursing unit. The nurse anticipates that the ileal catheter will be removed in about? A) 3 to 4 days B) 5 to 7 days C) 7 to 9 days D) 10 to 14 days
D The ileal catheter of a Kock pouch or continent ileostomy typically is removed in approximately 10 to 14 days, when ileal drainage stabilizes.
Which of the following instructions should the nurse include in the teaching plan of a client who has undergone colostomy? A) Restrict traveling by air. B) Limit outdoor activities. C) Avoid tight clothing. D) Chew food well.
D The nurse should instruct a client who has undergone colostomy to chew food properly. This helps decrease gas that results chiefly from swallowing air rather than from digestion. The client need not limit or avoid traveling or outdoor activities. If traveling by air, the nurse should instruct the client to take ostomy supplies in carry-on luggage to prevent their loss if luggage is misdirected or lost. If the client requires firm tight support, he or she should find a stoma shield to help prevent irritation or undue pressure on the stoma.
