caring for the pt with an ileostomy or colostomy – Flashcards
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an artificial opening in an organ of the body, created during an operation such as a colostomy, ileostomy, or gastrostomy; a stoma.
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What is an "ostomy"
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Ileostomy
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Entire colon and rectum are removed Stoma located in right lower quadrant Stool and gas are both constantly released Also called an ileoanal anastomosis Performed in two stages
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What happens in the first stage of the ileostomy
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portion of the colon is removed down to the terminal section of the rectum and above the anal sphincter Several distal loops of healthy ileum tissue are joined to form a pouch Reservoir is connected to the anal cuff Constant flow of liquid discharge from proximal stoma and the patient has no control over the evacuation
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What happens in the second stage of the ileostomy
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Done 2 to 3 months later The two sections of the ileum reunited Which establishes a normal flow of fecal material to the reservoir From the ileum reservoir, the feces is expelled from anus
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colostomy
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Opening between colon and abdominal wall temporarily can be done to allow the intestine to repair itself following the inflammatory disease, after some types of intestinal surgery or following injury
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Permanent colostomy
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Which colostomy is placed when there is a debilitating intestinal disease or cancer requiring removal of the colon and rectum (resection)
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Single Barrel
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which colostomy is placed after traumatic injury or surgical resection
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Double Barrel (2 stomas)
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Which colostomy is placed proximal and distal, The double barrel colostomy is performed most often along the transverse section of the large intestine.
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Loop Colostomy
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Which colostomy is placed temporary and performed more than double barrel
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A single-barrel colostomy
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What kind of colostomy is considered a permanent colostomy?
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discharge is liquid to semi liquid and contains digestive enzymes. There is no bowel regulation.
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What sort of discharge does an ileostomy have?
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- fecal material is liquid to semi liquid requiring frequent emptying to keep the patient dry and to control odor
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What sort of discharge does an ascending Colostomy have?
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semi-formed to formed
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What sort of discharge does a Descending Colostomy have?
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- fecal material is formed. Stool that is semi-solid is more manageable than a liquid stool. A scheduled daily irrigation can establish regularity and help the patient achieve control.
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What sort of discharge does a Sigmoid Colostomy have?
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Complete medical history, obtain information about allergy and diet Assess for where stoma will be located Pre-operative weight Address individual patient's concern (bowel, urine elimination)
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Nursing Interventions for Pre-Operative Ostomy Patient
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Consider consulting the Enterostomal nurse Consider referral to support groups Administer medications to clean bowel Insert NGT (nasograstric tube) Pre-operative medications to prevent infection and give valium to decrease anxiety
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Name some nursing Ostomy Pre-Operative Care
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Location of the stoma is dependent on the area of the intestine affected and the condition of the skin where the stoma needs to be placed.
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Why is it important to assess the skin over the abdomen prior to surgery in which the patient will be given an ostomy?
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Focus is on protecting the skin, appliance selection and psychological needs Check stoma regularly - color, bleeding, edema Normal stoma should be - pink or red Stoma may be larger immediately after surgery Stoma patency - obstructed or unstructured
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What are some Nursing Interventions for Post-Operative Ostomy Patient
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Address diet and exercise regime before discharge Laxatives and suppositories must be approved by MD community resources, ADLs, travel needs, clothing and sexual concerns
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What are some Ostomy Post-Operative pt teaching?
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No, alcohol has a drying effect we don't need to use on the stoma
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Are alcohol pads used for colostomy care?
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yes
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Should a pt with an ileostomy avoid enteric coating?
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Avoid gas-forming foods Eat slowly and chew food well Chlorophyll deodorizes the feces Do not restrict fluids Eliminate foods which may cause diarrhea Add bulk and water
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What are some dietary considerations for a pt with an ostomy?
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False. Although the location of the stoma along the intestines will determine the content of the feces, the patient can control the odor and the form by what they eat and how well they are able to regulate the elimination process.
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True or False. A patient with an ostomy looses control of the content of the feces.
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Q 8 hours until the stoma remains pink X 3 days.
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How often should the nurse assess and document the appearance of the stoma?
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The stoma should be pink or red. A dusky blue stoma indicates ischemia A brown-black stoma indicates necrosis Moist and shiny Painless Slight bleeding when cleaned Assess and document the appearance of stoma
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Describe a healthy stoma
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The stoma is ischemic.
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What does a stoma with a dusky appearance, indicate?
