Ostomy terms and questions

adhesives

material used to attach two objects or surfaces, such as glue

denudation

stripping of superficial skin surface

C

Which of the following should also be included in your patient education? Please select from the options below.A. Colostomy irrigationB. An intermittent catheterization scheduleC. Resumption of normal activities, including travel and sex

A

Which statement indicates that the patient understands the strategies she can use to avoid odorous gas? Please select from the options below.A. "A well-fitted pouching system with a filter helps prevent odor."B. "My friend suggested placing an aspirin tablet inside the ostomy pouch."C. "I'll eat lots of cheese and eggs to minimize the odor."D. "I'll just avoid social situations for an hour or so after I eat gassy foods."

hyperplasia

abnormal increase in the volume of a tissue or organ

hydronephrosis

enlargement of the kidneys as urine collects in the renal pelvis and kidney tissue

ileostomy

surgical opening created in the ileum to bypass the entire large intestine

A

A nurse is obtaining history from a young adult patient who has a colostomy. The patient reports frequent episodes of loose stools over the last month, but has no signs of infection or bowel obstruction. He reports that his concerns about leakage have limited his social activities. Which of the following should the nurse recommend? A) Consume foods that are low in fiber content B) Take an ounce of mineral oil twice a day C) Add buttermilk and cranberry juice in the diet D) Increase water intake to 3-3.5L/day

C

A nurse is providing preoperative teaching for a patient who has colon cancer. The surgeon informed the patient that his entire large intestine and rectum will be removed. The nurse should explain the type of ostomy he will have is: A) a cecostomy B) a loop colostomy C) an ileostomy D) a descending colostomy

B

A nurse is providing preoperative teaching for an older adult patient who has diverticulitis and is scheduled for a creation of a double-barrel colostomy in the sigmoid colon. Which of the following instructions should the nurse include in the teaching? A) Irrigate both stomas periodically to promote drainage B) Tape a dry gauze pad over the distal stoma to collect drainage C) Change the proximal stomas appliance every other day D) Expect liquid stool to drain from both stomas

Cleans the stoma and peristomal skin

A nurse is replacing the ostomy appliance for a patient whose newly created colostomy is functioning. After removing the pouch, which of the following should the nurse do first?

press gently around the barrier for 1 to 2 minutes

A nurse is teaching a patient how to apply an extended-wear skin barrier. Which of the following strategies should the nurse instruct the patient to use for maximal adherence?

B

A nurse is teaching a patient with a new ileostomy about incorporating preventive strategies at home. To prevent excoriation and breakdown of the peristomal skin, the nurse should instruct the patient to: A) apply hydrocortisone cream to the skin when changing the appliance B) empty the pouch when it is no more than half full C) wash the peristomal skin frequently with deodorizing soap and water D) choose a time shortly after a meal for replacing the pouch

A

A patient who has bladder cancer tells the nurse that, of the various urinary diversion options the surgeon presented, she prefers one that will allow her to have some control over urinary elimination. The nurse should explain the option that will allow that isa) a Kock'spouchb) an ileal conduit c) cutaneous ureterostomyd) a nephrostomy

a

After talking with your patient about her reaction to this body image change, she thanks you for taking the time to listen to and encourage her. While she feels better about what life might be like with her new colostomy, she tells you she is still confused about all the different pouch options available. She asks if you could explain the difference between a one-piece and two-piece pouching system. What should you tell her? Please select from the options below.A. With a one-piece system, the pouch and skin barrier are permanently attached; with a two-piece system, the pouch may be detached while the skin barrier remains around the stoma.B. A one-piece system does not include a skin barrier; a two-piece system does include a skin barrier with the pouch.C. A one-piece system allows the skin barrier to remain in place around the stoma for several days; a two-piece system does not allow this.D. With a one-piece system, the pouch must always be used with the manufacturer's skin barrier; with a two-piece system, she can use any skin barrier with any pouch.

D

After the surgeon and the enterostomal therapist leave the room, the patient asks, "Why did the doctor say that I am at risk for this complication?" You explain that the risk of suture-line separation increases with which of the following factors? Please select from the options below.A. Lower abdominal locationB. Antiplatelet medication.C. Cardiovascular diseaseD. Diabetes mellitus

B

What is the best way to help your patient regain a sense of control and improve her self-esteem? Please select from the options below.A. Distract the patient with a book or movie while you provide her ostomy care during her hospital stay.B. Request her participation in her ostomy care as she is physically able.C. Encourage your patient to deny her fears, leaving them behind as she moves forward with her new life.D. Reassure her that she does not need to touch the stoma but encourage her to look at it.

D

What psychosocial assessment indicates a normal response to the alteration in body function your patient has just undergone? Please select from the options below.A. Anxiety and refusal to eatB. Severe depression, sometimes with suicidal ideationC. Confidence that life will be back to "normal" upon discharge homeD. Anger and feelings of loss

A

What type of output is first expected from an ileostomy postoperatively? Please select from the options below.A. Loose, dark green liquid that may contain bloodB. Serous dischargeC. Formed to semi-formed stoolD. Pasty yellow-brown stool

B

When the patient asks you about any other complications that could result from the separation, which of the following should you explain? Please select from the options below.A. FolliculitisB. Stagnated healingC. ProlapseD. Peristomal hernia

C

Which foods should your patient avoid to prevent blockage? Please select from the options below.A. Noodles and white breadB. Cream cheese and bananasC. Fresh tomatoes and celeryD. Lean meats and poultry

C

Which information about peristomal skin care would be correct to tell your patient? Please select from the options below.A. Colostomy patients have a higher incidence of skin problems than ileostomy patients.B. The peristomal skin may be slightly red and excoriated.C. The pouch should be frequently checked for signs of leakage.D. The most common cause of peristomal skin disorders is chronic illness.

B

Which of the following is a likely cause of this electrolyte abnormality? Please select from the options below.A. BleedingB. High-volume effluentC. DehydrationD. Renal failure

A

Which statement would indicate that your patient has a good understanding of how to place a new appliance? Please select from the options below.A. "I should measure the stoma, then cut the appropriate size before removing the adhesive backing. My stoma will shrink over the next several weeks, so I'll need to measure it regularly."B. "I should scrub my skin with warm water and dry it completely before applying the new pouching system. It's important for the skin to be dry before application."C. "After applying the skin barrier, I should use some adhesive remover to be sure any residue is completely gone so that the pouch will adhere properly to the skin barrier. Adherence is important to prevent leakage."D. "After I place the skin barrier, I should maintain gentle finger pressure around it for a few seconds. Then I can make a pinhole the pouch to prevent gas accumulation before snapping it onto the barrier."

D

Which type of ostomy pouching system is appropriate for this patient at this time? Please select from the options below.A. A pouching system without a skin barrierB. A one-piece, closed-end pouching systemC. A two-piece pouching system with a pre-cut skin barrierD. A one- or two-piece pouching system with a cut-to-fit skin barrier

C

While a nurse is teaching a patient how to replace her ostomy pouching system, the patient reports that removing the skin barrier is sometimes painful. Which of the following should the nurse suggest? A) lift up on both sides of the skin barrier simultaneously B) release one corner of the barrier and pull it quickly over the stoma C) push the skin away from the barrier while removing it D) gently roll the barrier end-over-end across the stoma

B

You assess the suture line carefully, but you do not see any bleeding, and it is intact and dry all around the edges Which assessment should be your next step? Please select from the options below.A. Her urine outputB. The stoma

C

You determine that that this is a 5-mm partial separation at the inferior portion of the stoma. Which of the following should you do next? Please select from the options below.A. Allow the separation to remain open to air for several minutes with the pouch off.B. Fill in the "dead space" with skin barrier paste.C. Probe the area to determine the depth of the separation.

B

You have determined that you must assess the patient's abdomen first. You observe, auscultate, and palpate it. You find the abdomen is slightly firm, but not distended. The abdominal incision, closed with staples, is clean, dry, and intact. Bowel sounds are hypoactive in all four quadrants. Which of the following should you assess next? Please select from the options below.A. Her urine outputB. The suture lineC. The stoma

A

You note that the separation is approximately 3 mm deep. What is the best way to treat the separated area? Please select from the options below.A. Protect the area using powder and paste.B. Notify the provider since surgical correction is required.C. Fill in the "dead space" with an antifungal powder, such as miconazole.D. Use a convex appliance and stoma belt to prevent leakage of effluent.

cohesion

ability of the skin barrier to maintain its integrity when exposed to moisture

refitting

adjusting a pouching system to accommodate changes in stoma size or to address other stomal or peristomal issues

luminal bleeding

blood seeping through the opening (lumen) of a stoma

clip

closing device, required for some ostomy pouches

hartmann procedure

common temporary colostomy surgery that involves leaving the distal portion of the colon in place and oversewn for closure to create a Hartmann's pouch

stomal height

degree of profusion of a stoma from the skin

tap

device on a urostomy pouch that permits drainage of the contents

cystectomy

excision or resection fo the bladder

skin barriers

faceplate designed to protect the peristomal skin from the stoma output and to which the pouch is attached

wafer

faceplate or barrier designed to protect the peristomal skin from the stoma output to which the pouch is attached

valsalva maneuver

forceful exhalation against a close glottis, which involves contraction of the abdominal muscles to propel feces out of the body

anastomosis

formation of a connection between two usually distinct structures or portions of a structure

flatus

gas or air generated in the stomach and/or intestines and expelled via the anus

pressure ulcer

impaired skin integrity and/or formation of a wound due to prolonged pressure

allergic contact dermatitis

inflammation fo the skin resulting from contact with an allergen

irritant dermatitis

inflammation of the skin resulting from contact with an irritating substance

kock pouch

internal pouch created from the distal segment of the ileum to serve as a reservoir for stool or urine

stomal prolapse

lengthening of a stoma due to the bowel telescoping out through the stoma

skin stripping

mechanical disruption of the epidermis, as can be caused by adhesives when an ostomy appliance is removed

ureter

narrow tubular duct that transports urine from the kidney to the bladder

stomal stenosis

narrowing of the lumen of the stoma

pouching system

one-piece or two-piece device that includes a skin barrier/wafer and a collection pouch for the diverted output, either stool or urine

filtered pouch

ostomy output collection bag that incorporates an odor filtration apparatus

conduit

passageway

stomal retraction

pulling back of a stoma below skin level

peristomal retraction

pulling in of the skin around a stoma when the stoma is drawn inward below skin level

sigmoid

referring to the portion of the large intestine between the descending colon and the rectum

flange

rim used for attachment to another object, such as an ostomy pouch

mucocutaneous separation

separation of the stoma from the peristomal skin; also called mucocutaneous detachment

peristomal skin

skin surrounding an ostomy

maceration

softening or dissolution of tissue after lengthy exposure to fluid

reservoir

storage place; in the case of IPAA or kocks pouch, an internal reservoir is surgically created

hydrocolloids

substance that forms a gel as fluid is absorbed and is used in some ostomy products to absorb perspiration and other metabolic secretions while preventing fungal and bacterial invasion

cecostomy

surgical creation of an opening from the beginning of the large intestine (cecum) to the abdominal wall

ileal conduit

surgical removal of a section at the end of the small bowel (ileum) and relocation as a passageway for urine from the kidneys to the outside of the body through a stoma

colostomy

surgically created opening (stoma) from the colon (large intestine) to the abdominal wall to allow stool to pass out of the body

urostomy

surgically created opening that diverts urine away from the bladder and out of the body

stoma

surgically created opening, usually referring to one in the abdominal wall

ureterostomy

surgically created ureteral skin opening that diverts urine away from the bladder and out of the body

D

you note that the skin around the stoma appears erythematous but he denies any contact of the skin with fecal matter or mucus. You decide to remove the pouch to assess the stoma more closely only to find a 5 mm mucocutaneous separation. Which of the following should you do first? Please select from the options below.A. Flush the area with normal saline solution.B. Fill in the "dead space" with skin barrier paste.C. Probe the area to determine the depth of the separation.D. Inspect the circumference of the stoma.