caring for the pt with an ileostomy or colostomy – Flashcards

question
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)
answer
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
answer
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.
answer
What does a stoma with a dusky appearance, indicate?
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question
an artificial opening in an organ of the body, created during an operation such as a colostomy, ileostomy, or gastrostomy; a stoma.
answer
What is an "ostomy"
question
Ileostomy
answer
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
question
What happens in the first stage of the ileostomy
answer
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
question
What happens in the second stage of the ileostomy
answer
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
question
colostomy
answer
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
question
Permanent colostomy
answer
Which colostomy is placed when there is a debilitating intestinal disease or cancer requiring removal of the colon and rectum (resection)
question
Single Barrel
answer
which colostomy is placed after traumatic injury or surgical resection
question
Double Barrel (2 stomas)
answer
Which colostomy is placed proximal and distal, The double barrel colostomy is performed most often along the transverse section of the large intestine.
question
Loop Colostomy
answer
Which colostomy is placed temporary and performed more than double barrel
question
A single-barrel colostomy
answer
What kind of colostomy is considered a permanent colostomy?
question
discharge is liquid to semi liquid and contains digestive enzymes. There is no bowel regulation.
answer
What sort of discharge does an ileostomy have?
question
- fecal material is liquid to semi liquid requiring frequent emptying to keep the patient dry and to control odor
answer
What sort of discharge does an ascending Colostomy have?
question
semi-formed to formed
answer
What sort of discharge does a Descending Colostomy have?
question
- 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.
answer
What sort of discharge does a Sigmoid Colostomy have?
question
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)
answer
Nursing Interventions for Pre-Operative Ostomy Patient
question
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
answer
Name some nursing Ostomy Pre-Operative Care
question
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.
answer
Why is it important to assess the skin over the abdomen prior to surgery in which the patient will be given an ostomy?
question
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
answer
What are some Nursing Interventions for Post-Operative Ostomy Patient
question
Address diet and exercise regime before discharge Laxatives and suppositories must be approved by MD community resources, ADLs, travel needs, clothing and sexual concerns
answer
What are some Ostomy Post-Operative pt teaching?
question
No, alcohol has a drying effect we don't need to use on the stoma
answer
Are alcohol pads used for colostomy care?
question
yes
answer
Should a pt with an ileostomy avoid enteric coating?
question
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
answer
What are some dietary considerations for a pt with an ostomy?
question
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.
answer
True or False. A patient with an ostomy looses control of the content of the feces.
question
Q 8 hours until the stoma remains pink X 3 days.
answer
How often should the nurse assess and document the appearance of the stoma?
question
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
answer
Describe a healthy stoma
question
The stoma is ischemic.
answer
What does a stoma with a dusky appearance, indicate?