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 patient admitted with symptoms of an anorectal infection; cultures indicate that the patient has a viral infection. The nurse should anticipate the administration of what drug?

Acyclovir Zovirax

The nurse is providing care for a patient whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the patient's medication regimen?

Anticholinergic medications 30 minutes before a meal

A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting?

Apply a skin barrier to the peristomal skin prior to applying the pouch.

The nurse applies the ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse keep in mind to avoid any leakages from the appliance?

Ask the client to remain inactive for 5 minutes.

The LPN/LVN is reinforcing preoperative teaching for a client who will be having a Brooke ileostomy and knows that the client must stop taking which home medications prior to the day of surgery? Select all that apply.

Aspirin Prednisone Cyclosporine

An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?

Assess the patient's food and fluid intake.

A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer?

Change in bowel habits

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.

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.

A nurse is working with a patient who has chronic constipation. What should be included in patient teaching to promote normal bowel function?

Consume high-residue, high-fiber foods.

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 client who has undergone colostomy surgery is experiencing constipation. Which intervention should the nurse consider for such a client?

Dilate the stoma with a lubricated, gloved finger.

A nurse is assessing a patient's stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding?

Document that the stoma appears healthy and well perfused.

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

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

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 nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis?

Engage the patient in the care of the ostomy to the extent that the patient is willing.

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

Which of the following statements about ostomy irrigation is true?

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

A nurse is caring for a patient with a colostomy. What type of stools would she expect to find in the colostomy bag?

Formed

A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?

High levels of alcohol consumption

A male client has struggled for many years with Crohn's disease and has finally decided to have an ileostomy with hopes that this will improve the quality of his life. The nurse knows that which procedure will give the client the greatest chance of maintaining normal sexual function?

Ileoanal anastomosis

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 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.

An adult patient has been diagnosed with diverticular disease after ongoing challenges with constipation. The patient will be treated on an outpatient basis. What components of treatment should the nurse anticipate?

Increased fiber intake, Reduced fat intake

During a patient's scheduled home visit, an older adult patient has stated to the community health nurse that she has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following?

Increased fluid and fiber intake

Which of the following is the most plausible nursing diagnosis for a patient whose treatment for colon cancer has necessitated a colonostomy?

Ineffective Sexuality Patterns Related to Changes in Self-Concept

A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?

Insertion of a nasogastric tube

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

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

A patient has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes?

Maintaining fluid and electrolyte balance

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.

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 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

A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the patient's most recent laboratory tests, the nurse should prioritize which of the following?

Potassium level

A patient's large bowel obstruction has failed to resolve spontaneously and the patient's worsening condition has warranted admission to the medical unit. Which of the following aspects of nursing care is most appropriate for this patient?

Preparing the patient for surgical bowel resection

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

A teenage patient with a pilonidal cyst has been brought for care by her mother. The nurse who is contributing to the patient's care knows that treatment will be chosen based on what risk?

Risk for infection

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 teaching a client who has undergone a colostomy procedure as depicted in the accompanying image. What type of feces should the client expect to manage?

Semi-mushy

A client with a new colostomy tells the nurse she thinks she is ready to learn how to care for it. Which of the following interventions would most likely be effective in preparing the client to look at the colostomy?

Show the client pictures that illustrate how a colostomy looks and functions.

What is the most common type of colostomy that needs to be irrigated to help promote regular evacuation of feces?

Sigmoid colostomy

A client is receiving postoperative instruction on how to release stool from a newly placed continent ileostomy. Which steps would be included? Select all that apply.

Sit on or beside the toilet, or on the side of the bed. Warm the catheter to body temperature and lubricate the tip.

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

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 patient with a diagnosis of colon cancer has required the creation of an ostomy following bowel surgery. What factor is most likely to influence the patient's adjustment to this change?

The coping mechanisms that the patient possesses

A nurse at an outpatient surgery center is caring for a patient who had a hemorrhoidectomy. What discharge education topics should the nurse address with this patient?

The correct procedure for taking a sitz bath

A patient has been experiencing disconcerting GI symptoms that have been worsening in severity. Following medical assessment, the patient has been diagnosed with lactose intolerance.

The nurse should recognize an increased need for what form of health promotion? Frequent screening for osteoporosis

A nurse is working with a patient who is learning to care for a continent ileostomy (Kock pouch). Following the initial period of healing, the nurse is teaching the patient how to independently empty the ileostomy.

The nurse should teach the patient to do which of the following actions? Insert the catheter approximately 5 cm into the pouch.

A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this patient?

Tofu

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 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

A patient with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the patient's care in the knowledge of potential complications.

What assessment should the nurse prioritize? Frequent abdominal auscultation

An older adult has a diagnosis of Alzheimer's disease and has recently been experiencing fecal incontinence. However, the nurse has observed no recent change in the character of the patient's stools.

What is the nurse's most appropriate intervention? Toilet the patient on a frequent, scheduled basis.

A patient's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care.

What is the nurse's most appropriate response to this observation? Acknowledge the patient's reluctance and initiate discussion of the factors underlying it.

A patient has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving his diet.

What pharmacologic intervention should the nurse recommend to the patient for ongoing use? Psyllium hydrophilic mucilloid Metamucil

The nurse is discussing with a client who has had a colostomy for approximately 6 months how he is doing with managing it. He replies that he feels very comfortable with taking care of it and completing the irrigations but he hates the terrible odor of the stool. The nurse will recommend which foods for the client to consume which may help in decreasing this odor? Select all that apply.

Yogurt Cranberry juice Buttermilk

When is the best time to irrigate a colostomy?

after meals

A nurse is assessing the stoma of a patient with an ostomy. What would the nurse assess in a normal, healthy stoma?

dark red and moist

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 planning discharge teaching for a 21-year-old patient with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors

will likely have the greatest impact on the patient's coping after discharge? The family's ability to provide emotional support

A nursing instructor is discussing hemorrhoids with the nursing class. Which patients would the nursing instructor identify as most likely to develop hemorrhoids?

A pregnant woman at 28 weeks' gestation

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.

The nurse is reviewing an upcoming colostomy procedure with a client. What type of ostomy procedure will the client be undergoing based on the accompanying diagram?

Descending colostomy

The nurse is talking to the client about the procedure for changing an ostomy appliance. Which client statement indicates that the client understands the best time for scheduling this procedure?

I will change it before eating breakfast because there is less chance of spilling feces from the stoma at this time."

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

Ineffective Coping impaired due to colostomy

A patient is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this patient's care, which of the following nursing diagnoses should the nurse prioritize?

Ineffective Tissue Perfusion Related to Bowel Ischemia

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.

A patient's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this patient's health problem?

The patient's polyps constitute a risk factor for cancer.

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 nurse is preparing a client who needs to have a colostomy procedure. What type of procedure is the client about to undergo based on the accompanying image?

Transverse colostomy

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 caring for a patient with a newly created ileostomy assesses the patient and notes that the patient has had not ostomy output for the past 12 hours. The patient also complains of worsening nausea.

What is the nurse's priority action? Report signs and symptoms of obstruction to the physician.

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

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

every 2 to 4 hours

A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the

patient's stools will have what characteristics? Watery with blood and mucus

What would be characteristic of an unhealthy stoma?

protrusion beyond 2 inches from the skin

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

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

During client education with a client who has recently had an ostomy created, the nurse discusses the importance of skin care and maintaining skin integrity around the stoma. What type of appliance is most appropriate for the immediate postoperative period

temporary

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

the entire colon and rectum.

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

transverse

A nurse is caring for a patient with constipation whose primary care provider has recommended senna Senokot for the management of this condition. The nurse should provide which of the following education points?

"Avoid taking the drug on a long-term basis."

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 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 client who underwent a colostomy is discussing lifestyle changes with the nurse. Which of the following statements from the client indicates a need for more teaching?

"I will never be able to travel outside the country again."

The nurse is teaching the client how to effectively drain the continent ileostomy. Which statement by the client indicates that the client needs further instruction?

"Once I push the catheter into the stoma I should stop once I meet resistance."

A client who underwent a colostomy reports a change in the appearance of his stoma. When the nurse asks for more information, the client says, "I was very upset about some family trouble, and my stoma became deep purple and oozed." How would the nurse respond?

"This is normal as long as the stoma has returned to its usual appearance."

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 caring for a patient who has been admitted to the hospital with diverticulitis. Which of the following would be appropriate nursing diagnoses for this patient? Select all that apply.

Acute Pain Related to Increased Peristalsis and GI Inflammation, Activity Intolerance Related to Generalized Weakness, Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea

Due to a lengthy history with Crohn's disease and the severity of symptoms, a client is being prepared for a colostomy. Which would be included in this client's individual care plan?

All options are correct.

A patient's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather that ulcerative colitis, as the cause of the patient's signs and symptoms?

An absence of blood in stool

A client with an ileostomy calls the nurse to report that she is experiencing abdominal cramps, vomiting, and watery discharge from her ileostomy. The nurse should:

Notify the physician immediately.

A nurse is providing care for a patient who has a diagnosis of irritable bowel syndrome (IBS). When planning this patient's care, the nurse should collaborate with the patient and prioritize what goal?

Patient will accurately identify foods that trigger symptoms.

A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale?

To reduce intestinal bacteria levels

nurse is talking with a patient who is scheduled to have a hemicolectomy with the creation of a colostomy. patient admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes.

Which of the following nursing actions is most appropriate? Maintain an open dialogue with the patient and facilitate a referral to the wound-ostomy-continence (WOC) nurse.

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

A nurse refers a patient with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing?

facilitating coping

A patient admitted with acute diverticulitis has experienced a sudden increase in temperature and complains of a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the

patient's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response? Contact the primary care provider promptly and report these signs of perforation.

A 16-year-old presents at the emergency department complaining of right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this patient's nursing care,

the nurse should prioritize what nursing diagnosis? Risk for Infection Related to Possible Rupture of Appendix

The nurse is caring for a patient who is undergoing diagnostic testing for suspected malabsorption. When taking this patient's health history and performing the physical assessment,

the nurse should recognize what finding as most consistent with this diagnosis? Foul-smelling diarrhea that contains fat

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