Ostomy Care

Ostomy pouches will expand as gas collects in bag.

"Burp" Note: Some bags have filters that allow gas to escape while filtering the smell or drops for the bag

When applying the pouch system, the skin barrier should measure?

1/8" LARGER than the stoma

Which type of colostomy can allow a patient to have bowel continence? A. Descending or Sigmoid Colostomy B. Ascending or Transverse Colostomy C. Transverse or Descending Colostomy D. Ascending or Descending Colostomy

A. Descending or Sigmoid Colostomy The answer is A. Patients with a colostomy in locations most distal in the GI track have the highest chance of bowel continence (hence, learn to control their bowel movements).

Thinking back to the patient in Question 1, what type of stool would you expect the stoma to be excreting? B. Lose to partly formed stool C. Similar to normal stool D. Semi-solid stool

A. Liquid stool The answer is A. Stool from an ascending colostomy will be liquid. Stool from a Transverse Colostomy: lose to partly formed stool, Descending/Sigmoid: similar to normal solid consistency. An ileostomy will always excrete liquid stool.

A patient, who has a colostomy, asks what type of foods they should avoid to decrease odorous gas. You would tell the patient to avoid: A. Onions, alcoholic beverages, eggs, and cabbage B. Beef, fried foods, lettuce, and rice C. Apple, pears, nuts, and wheat D. Potatoes, peas, carrots, and chicken

A. Onions, alcoholic beverages, eggs, and cabbage The answer is A. The patient should avoid foods like: onions, alcoholic beverages, eggs, and cabbage etc. to decrease odorous gas.

A patient has a double-barrel colostomy of the transverse colon. You note on assessment two stomas, a proximal and distal stoma. What type of stool do you expect to drain from the proximal and distal stomas? B. Proximal: liquid stool; Distal: mucous C. Proximal: mucous; Distal: lose to partly formed stool D. Proximal & Distal: lose to partly formed stool

A. Proximal: lose to partly formed stool; Distal: mucous The answer is A. The proximal will drain stool while the distal will NOT. The distal will drain mucous. Since it is a double-barrel colostomy of the transverse colon, you can expect the stool to be lose to partly formed.

You're providing diet teaching to a patient with an ileostomy. Which foods should the patient consume in very small amounts or completely avoid? A. Peanut butter, bananas, rice B. Corn, popcorn, nut and seeds C. Grape juice, bread, and pasta D. Vinegar, soft drinks, and cured meats

B. Corn, popcorn, nut and seeds The answer is B. The foods in option B are difficult to digest and could block the stoma. The patient should either consume these foods in VERY small amounts or avoid them all together.

A patient is 2 days post-opt from an ileostomy placement. Which finding requires immediate nursing action? A. The stoma is excreting liquid stool. B. The patient's potassium level is 2.0 C. The stoma is bright red and moist. D. The patient reports mucoid drainage from the anus.

B. The patient's potassium level is 2.0 The answer is B. A patient with an ileostomy is at risk for electrolyte imbalances. The nurse should monitor the patient (especially after ileostomy surgery) for these imbalances. A normal potassium is 3.5 to 5.1. Therefore, a level of 2.0 requires immediate nursing action. The nurse should contact the physician for further orders. All the other options are normal findings found with an ileostomy.

A patient is 8 hours post-opt from an colostomy placement. Which finding requires immediate nursing action? A. The stoma is swollen and large. B. The stoma is black. C. The stoma is not draining any stool. D. The patient states the site is tender.

B. The stoma is black. The answer is B. An assessment finding of a stoma being black is not a normal finding but represents compromised circulation to the stoma. It requires immediate physician notification. The stoma should look red and be shiny/moist. It is normal for a stoma to be swollen and large after surgery (this will subside after a few months), and it is normal for the site to be tender due to the surgery (this will subside as well) and for the stoma to not be draining any stool yet. It can take approximately 2 day before stool drains from a colostomy.

You receive a doctor's order for a patient to take Aspirin EC by mouth daily. The patient has the following medication history: diabetes type 2, peripheral vascular disease, and a permanent ileostomy. What is your next nursing action? A. Administer the medication as ordered. B. Crush the medication and mix it in applesauce. C. Hold the medication and notify the doctor the patient has an ileostomy. D. Crush the medication and mix it in pudding.

C. Hold the medication and notify the doctor the patient has an ileostomy. The answer is C. Aspirin EC is an enteric-coated form of Aspirin. A patient with an ileostomy should not take enteric-coated or sustained-released medications. Enteric-coating medications don't dissolve until reaching a specific part of the small intestine, and sustained-released medications release slowly over a period of time. Remember a patient with an ileostomy does not have the ability to fully utilize the function of the small intestine and this medication will not be able to perform properly. The nurse should hold the medication and notify the doctor for further orders.

A patient, who had a colostomy placed yesterday, calls on the call light to say their surgical dressing "fell off". You will re-apply what type of dressing over the stoma? A. Wet to dressing B. No dressing is needed. You will keep it open to air. C. Petroleum gauze dressing D. Telfa gauze

C. Petroleum gauze dressing The answer is C. A petroleum gauze dressing will be kept in place (or a sterile dry dressing) until a pouch system is in place.

On assessment of a patient with a colostomy, you note the stoma is located on the right area of the abdomen. Due to its location, this is known as what type of colostomy? A. Descending Colostomy B. Transverse C. Ileostomy D. Ascending Colostomy

D. Ascending Colostomy The answer is D. This is known as an ascending colostomy.

Patients with these types of ostomies will have a greater chance of bowel continence

DESCENDING and SIGMOID colostomies (as they are at the end of the GI tract)

Locations of colostomy include:

Descending Colostomy Ascending Colostomy Double-barrel Ostomy Transverse Colostomy Sigmoid Colostomy

Double-barrel Ostomy

Double-barrel ostomy: type of transverse colostomy where there is the creation of TWO stomas which divide the bowel. One stoma is called the proximal(puts out stool) and the other stoma is known as the distal stoma (puts out mucus)

Pre-opt Nursing Care for Ostomy

Educate about what to expect - how the stoma will look (show them a picture), and where it will be on the abdomen. Start teaching them about the pouching system · MD may prescribe oral antibiotics to prevent post op infection by reducing bacteria in the colon 2 to 3 days before surgery soft or semi-liquid diet may be ordered A cleansing solution and laxative may be ordered to clean the colon Clear liquid diet prior to surgery (24 hours) Note: Patient may have to be hospitalized due to the profuse diarrhea they will be experiencing and may need an IV solution to maintain hydration. NPO day of surgery

Post op colostomy stool

May pass mucous stool at first Can take up to 2 days before stool is produced

Post op Nursing Care for OSTOMY

Monitor the electrolytes, sign of dehydration (urinary output) site and stoma Post op, stoma will be swollen and large, but will shrink to normal size after a couple of months Ostomies will SHOULD ALWAYS look bright pink or red and be moist/shiny. Notify MD if stoma is: pale pink patient (may have a low hgb and hct), purple or black could mean compromised circulation to the stoma.

Medications precautions for patients with an ileostomy ·

NO Enteric coating medications OR Sustained-released medication

Describe, in order, how food travels from the stomach to the rectum: A. It exits the stomach into: the cecum to the jejunum to the ileum, then into the duodenum, descending colon, transverse colon, ascending colon, sigmoid colon, and rectum. B. It exits the stomach into: the duodenum to the ileum to the jejunum, then into the cecum, ascending colon, sigmoid colon, descending colon, transverse colon, and rectum. C. It exits the stomach into: the ileum to the jejunum to the duodenum, then into the cecum, sigmoid colon, transverse colon, descending colon, ascending colon, and rectum. D. It exits the stomach into: the duodenum to the jejunum to the ileum, then into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

The answer is D.

True or False: An ileostomy is a surgical opening created to bring the large intestine to the surface of the abdomen. True False

The answer is FALSE. An ileostomy is a surgical opening created to bring the SMALL (not large) intestine to the surface of the abdomen.

True or False: Patients with an ileostomy are at greater risk for dehydration and an electrolyte imbalance. True False

The answer is True.

You're providing teaching to a patient with an ileostomy on how to change their pouch drainage system. Which statement is INCORRECT about how to change a pouching system for an ostomy? A. Empty the pouch when it is 1/3 to 1/2 full. B. Change the pouching system every 3-5 days. C. D. Keep the skin around the stoma clean and dry at all times.

When measuring the stoma for skin barrier placement, be sure the opening of the skin barrier is a 2/3 inch larger than the stoma. The answer is C. This statement is INCORRECT. When measuring the stoma for skin barrier placement, be sure the opening of the skin barrier is a 1/8 inch larger than the stoma.....not 2/3 inch.

Colostomy

a surgical operation that creates an opening from the colon(Large Intestines) to the surface of the body to function as an anus

Ileostomy Care

apply skin barriers to stoma - HUGE risk for skin breakdown d/t digestive enzymes empty bag when it is 1/3 full assess for fluid and electrolyte imbalances d/t increased risks for dehydration as content will not flow through the colon where water and electrolytes are absorbed :

The normal stoma appears _____________-

bright red and shiny

Post op ileostomy stool

dark green and then turns yellow when patient starts to eat

Colostomy care teaching

include cranberry juice and yogurt to the diet-this will help with the odor Avoid gas causing foods such as bean, onions, etc empty bag when one third full clip hair surrounding the peristomal site Keep clean and dry being sure to completely remove fecal matter healthy stomas is bright red and shiny indication good vascularization(NOT DARK RED, PURPLE or BLACK) Light pink or pale stoma may indicate decreased vascularization or anemia PURPLE or BLACK stomas indicates necrosis and is a MEDICAL EMERGENCY Report symptoms of infection including redness to skin surrounding stoma, fever, severe pain etc Monitor pouch for proper fit and signs of leakage Irrigate colostomy as ordered Change pouch when gut less active (morning before breakfast) Change pouching system every 3-5 days Avoid foods that CAN NOT be completely digested (Corn, celery, peas, coleslaw, popcorn, nuts and seeds, raisins, skin of fruits, raw mushrooms and pineapple etc) Avoid gassy foods such as (onions, eggs, broccoli, cabbage, garlic, alcoholic beverages, fish...high fibrous foods)

Ileostomy stool will be _____________

liquid

Ileostomy

new opening of the ileum (of the SMALL INTESTINE) to the outside of the body

Ostomies closer to the end of the GI tract will have similar consistency to _________________ _________________

normal stool

colostomy irrigation

obtain colostomy irrigation set (cone tip) expel air from tubing position client sitting on toilet hold irrigation bag 18 - 24 inches above the stoma (shoulder height) instil 500-1,000 mL luke warm water Lubricate cone and insert into stoma 5 - 10 min in 35 -45 min out Clamp tubing for mild cramping Stop irrigation if sever cramping

There are two types of pouch systems

one piece (skin barrier and pouch are one unit) two piece (pouch and skin barrier separate).

Post op colostomy requires that ________________ ____________________ is placed over the stoma to keep the stoma moist which is then covered by a , _________________ _______________ _______________ until pouching system in place.

petroleum gauze sterile dry dressing

A stomas that is __________________ or _______________in color indicates a medical emergency

purple black