Ostomy
Role of NSWOC in preop care?
Counselling Family support and Stoma site selection/ marking
what is the frequency to empty pouch?
1-2 times per day
What are the characteristics of stoma?
RED WARM MOIST
what are two skin barriers?
flat vs convex
what is shape of the stoma?
oval or round
What are three type of ostomies?
1. Colostomy 2. Ileostomy 3. Urostomy- ileum conduit
how long until the stitches for the stoma dissolve?
2-3 weeks
Can any nurse do a wound assessment?
No, they have to be a NSWOC
Role of NSWOC postop?
Stoma viability Ostomy management Fitting of pouching system Patient discharge Prepare for discharge Connection to community care And supports Prepare for follow ups
what is the stoma site for colostomy ?
left lower quadrant
can people with a ostomy control over the flow of stool or urine?
no sphincter so no
What type of wounds are they?
Pressure wounds, neuropathetic wounds, diabetic foot ulcers, lower leg, lymphedema, surgical wounds, malignant wounds, skin tears and moisture associated with skin damage
how are stoma sites selected?
- avoid creases, folds and scars - abdomen in multiple positions for adequate adhesion and visibility - trial the site/pouching system under their own clothing - stoma site marking is best practice
what is benefits of ostomy education
- opportunity for patient and family to address concerns - clears up misconceptions about ostomies -allows patients to make informed decsion -allows for stoma site selection
what are the two types of pouching systems?
1 pc vs 2 pc
Whare the six types of stomas?
1. brooked 2. not brooked 3. loop stoma 4. support rods 5. double barrel 6. muscus fistula
what is the output for colostomy?
200-600 ml
what is the frequency to empty pouch in ileostomy?
6-8 times per day
what is output for ileostomy?
650-900 ml 1500= high
what is output minimum for ileal conduit?
800 ml/24
The nurse determines that the goals of dietary teaching have been met when the client with CELRAC disease select which of the following from the menu? A. Scrambled eggs and sausage B. Buckwheat pancakes and syrup C.Oatmeal, skim milk, and orange juice D. Yogurt, strawberries, and rye toast with butter
A
The nurse explained to the client undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is which of the following? A. sigmoid colostomy B. A transverse colostomy C. A descending colon ostomy D. Ascending colostomy
A
what is colostomy ?
A surgically created opening of the colon out onto the abdomen wall. because colon was removed or bypassed
What is NSWOC role in constinence care?
Assessment and type of urinary or fecal incontinence Recommend of conservative measure for management Selection of containment products and devices Referral to sexual health counseling
In contrast to the client with diverticulitis, which of the following is true for the client with diverticulosis? A. Has rectal bleeding B. Often has no symptoms C. Localized cramping pain D. Frequently develops peritonitis
B
What should a client be taught after a HEMORRHOIDECTOMY? A. Take mineral oil before bedtime B. Eat a low fibre diet to rest colon C. Administer oil retention enema to empty the colon D. Use prescribed pain medication before a bowel movement
B
Is ostomy permanent or temporary?
Both
A client with stage one colorectal cancel is scheduled for surgery. Teaching for this client would include an explanation of which of the following? A. That chemotherapy will begin after recovery from the surgery B. That both the chemotherapy and radiation can be used as positive treatment C. That's a follow up colonoscopies Will be needed to ensure that the cancer does not reoccur D. That wound nurse ostomy and constinence Nurse will visit to identify an abdominal site for ostomy
C
Which of the following is a nursing intervention that is most most appropriate to decrease post operative edema and pain after an inguinal herniorrhaphy ? A. Applying a TRUSS to the hernia site B. Allowing the client to stand to void C. Supporting the incision during coughing D. Applying a SCROTAL support with ice bag
D
what is Hartmann's procedure?
Removal of affected sigmoid colon while leaving an over-sewn internal rectal stump; ostomy can be reversed at a later date
what is Proctocolectomy?
Removal of colon and rectum; permanent end ileostomy and perineal incision
what is Low anterior resection?
Removal of rectal cancer, anastomosis of remaining large bowel. Temporary loop ileostomy is created to divert stool from anastomosis
what is Abdominal Perineal Resection?
Removal of rectum and diverting with a colostomy, permanent procedure--> PERINEAL INCISION
What is Anterior pelvic exenteration?
Removal of reproductive organs and bladder with resulting ileal conduit while leaving bowel intact; permanent procedure
What is Posterior pelvic exenteration?
Removal of reproductive organs, affected bowel with resulting fecal ostomy while leaving bladder intact; permanent procedure
WHAT IS Total pelvic exenteration
Removal of reproductive organs, bladder, affected bowel with resulting fecal ostomy as well a urinary ostomy, permanent procedure
What is a colectomy?
Removal of the colon, leaves rectum intact; permanent or temporary ileostomy
What is stoma site usually for a ileostomy?
Right lower quadrant
What is a urinary ostomy?
Surgical procedure to reroute the normal movement of urine when bladder is removed
What is a fecal ostomy?
When bowel is disease or removed the. They would reroute the normal bowel movement contents out of their body in a surgical procedure
What would a NSWOC nurse do?
Wound assessment,determine ethology, treating the cause of wound, patient centred care plan, and dressing selection.
Two days following a colectomy for an abdominal mass, a client reports gas pains and abdominal distension. The nurse plans care for the client based on the knowledge that the symptoms occur as a result of which of the following? a. Impaired peristalsis b. Irritation of the bowel c. Nasogastric suctioning d. Anastomosis site inflammation
a
What is ileostomy?
a surgically created opening into the small intestine through the abdomen because the small intestine or colon was removed
What is an ostomy?
a surgically formed opening from the inside of an organ to the outside for elimination of body waste
A colectomy is scheduled for a client with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this client? a.Instruction on irrigating a colostomy b.Administration of an oral osmotic lavage c.A high-fibre diet the day before surgery d.Administration of IV antibiotics for bowel preparation
b
The nurse is planning care for a client with an abdominal mass and suspected bowel obstruction. Which of the following factors in the client's history increases the client's risk for colorectal cancer? a. Osteoarthritis b. History of rectal polyps c. History of lactose intolerance d. Use of herbs as dietary supplements
b
Which of the following information should be the highest priority information to include in preoperative teaching for a client scheduled for a colectomy? a.How to care for the wound? b.How to deep-breathe and cough? c.The location and care of drains after surgery d.What medications will be used during surgery?
b
what could be reasons for ostomy surgery?
cancer in the rectum, colon, bladder and gyne trauma Diverticulitis Inflammatory Bowel Disease-->Ulcerative colitis or Crohn's disease Congenital Anomalies Genetic conditions
what is the consistency and color of urine from ileal conduit?
clear yellow urine with small amounts of mucus
The nurse asks a client scheduled for colectomy to sign the operative consent as directed in the health care provider's preoperative orders. The client states that the health care provider has not really explained well what is involved in the surgical procedure. Which of the following is the best action by the nurse? a.Ask family members whether they have discussed the surgical procedure with the health care provider. b.Have the client sign the form and state that the health care provider will visit to explain the procedure before surgery. c.Explain the planned surgical procedure as well as possible, and have the client sign the consent form. d.Delay the client's signature on the consent and notify the health care provider about the conversation with the client.
d
what is stoma construction for ileal conduit?
end
what is stome construction in ileostomy?
end or loop
what is the stoma construction for colostomy?
end or loop
when is stoma assessment is done?
every 4 hours for 48 hours then every shift
what is the frequency of pouch emptying?
every few hours and it has a night bag
how long is the stoma swollen for?
first 6-8 weeks after surgery
what is consistency from ileostomy?
lipid to pasty consistency
what is the stoma assessment during pouch change?
location of the lumen mucocutaneous junction peristomal skin function/output pouching system
what is stoma assessment with pouch ?
location on body viability construction height size shape colour output
what are skin complications seen in ostomy?
mechanical trauma, allergic dermatitis, irritant or contact dermatitis, infection, disease, dermatological skin conditions, hernia, and others
can people wth an ostomy feel when stool/gas/ urine is passing through it?
no - no nerve endings in a stoma
what is ileal pouch anal anastomosis?
pelvic pouch procedure and only offered UC
what is the nursing goals for ostomy management?
peristomal/perifistula skin protection containment of effuent, odour control, patient comfort, accurate measurement of effulent, patient mobility, ease of care and cost containment
what does a loop stoma look like?
piggy nose :P
What are challenges of ostomy care?
poorly created or sited ostomy, skin breakdown due o contact with effluent lack of knowledge
what is stoma site for ileal conduit ?
right left quadrant
what are support rods stoma?
stay in place for 5-7 days then removed by NSWOC, It prevents retraction, limit self care, and it is surgeon perferred technique
if your stoma bleeds then what is next action that nurse should take?
stoma bleed easily since there are many small blood vessels close to the surface - nothing
what is a ileal conduit?
surgically created opening to drain urine. section of ileum is used as conduit (pipline_ for the urine to flow out of body. The remaining intestine is reconnected. the new section then sewn shut on one side and ureters are connected. The end of bowl is then brought through the abdominal wall to create stome
what is orthotopic neobladder ?
taking out the bladder and creating a reservoir
what is the consistency for colostomy?
thick paste to semi-formed
will a patient with ileal conduit have stents insitu for the first month?
yes