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PNUR 154 - Integrated Nursing Practice > Class 7 - Ostomies > Flashcards

Class 7 - Ostomies Flashcards

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1
Q

what is an ostomy

A

it is a surgical procedure to divert wastes from the body

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2
Q

what is a stoma

A

the opening created surgically in the abdominal wall for an ostomy

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3
Q

what is a colostomy

A

and excretory opening in the colon (large bowel)

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4
Q

what is an ileostomy

A

an excretory opening in the ileum (small bowel)

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5
Q

what is a urostomy

A

an excretory opening that redirects urine away from the bladder.

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6
Q

what factors are used to choose a stoma site

A
  • location of rectus muscle
  • type of ostomy
  • adequate adhesive surface
  • avoid skin folds, scars, beltline, – umbilicus & bony
    prominence
  • visibility to patient
  • supportive devices present
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7
Q

what would cause the need for a colostomy

A
  • trauma to small/large intestine
  • diverticular disease
  • obstruction
  • cancer
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8
Q

there are 5 sites for colostomies, where are the sites

all are along the large intestine

A
  • cecum
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid
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9
Q

what are the characteristics of an healthy stoma

A
  • color should be red
  • location of lumen is on the top of the stoma
  • location on body is on a smooth surface
  • level of protrusion 2.5 cm
  • shape of stoma should be round
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10
Q

what skin considerations should you be aware of

A
  • stool contains enzymes and is caustic to the skin
  • essential to have all peri-stomal skin protected and a well
    fitting appliance
  • consider the use of an “extended wear” appliance that is
    more resistant to ileostomy type drainage.
  • ileostomies will require a “drainable” system that will
    allow for frequent emptying
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11
Q

under what circumstances would you use a cutaneous ureterostomy

A
  • ureteral damage or stricture from distal obstruction
  • palliative treatment
  • pouching challenges as ostomy is flush & small in
    diameter
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12
Q

for a ileostomy what is the output, color and consistency

A

output - 500-700mLs/daily
color - varying shades of brown
consistency - paste like

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13
Q

for a colostomy what is the output, color and consistency

A

output - 1-3 formed stools daily
color - varying shades of brown
consistency - semi-formed to
formed

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14
Q

for a ileal conduit what is the output, color and consistency

A

output - wide range, usually btw
1000-2000mLs/daily
color - yellow with mucous shreds
consistency - liquid

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15
Q

what types of things will the patient need to be taught when having an ostomy

A
  • stoma characteristics & function
  • self care ( emptying &/appliance change)
  • skin care
  • diet & fluids
  • lifestyle issues
  • other( specific to type of ostomy)
  • best time to of day to change appliance
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16
Q

what are the pricinples of pouching

A
  • skin must be protected from effluent damage.
  • stoma must be protected from trauma.
  • peri-stomal skin must be protected from mechanical
    trauma.
  • skin must be protected from damage caused by products
    used for pouching & skin protection.
17
Q

what are the pouching basics

A

Stoma is on a flat firm abdomen?
*flexible system

Stoma on a soft abdomen?

* firm faceplate helpful
* belts may be helpful

Stoma that is flush or retracted?

* convex barrier/faceplate
* stoma paste, barrier strips etc.

Stoma that is in a crease?
*flexible system so system can
“fold” with the pt

Stoma powder
*only to be used on denuded
/eroded skin

Stoma paste/strip paste
*assists in filling in defects/
gullies

Skin gel wipes
      *minimizes stripping of skin
      *most contain alcohol which 
         may be painful to open skin
      *NOT an adhesive
      *not effective against 
         ileostomy type drainage
18
Q

what are some dietary considerations for ostomies

A

*adequate fiber and fluids after discharge.
*ileostomy patients want to ensure salt and water intake
is adequate but high fiber diet is not recommended.
*measures to control gas formation
*urostomies patient’s encourage fluids such as cranberry
juice and water

19
Q

what are some special considerations for ostomies

A
  • carry an extra appliance
  • moistened paper towel or wipes in Ziploc bag
    -consider use of spray deodorants if having to change
    ileostomy or colostomy appliance while out
    -wear a medic alert bracelet
20
Q

Why are there risks of skin breakdown around a stoma site

A
  • glues & adhesives being applied to the skin
  • rubbing of the skin while cleansing
  • irritations from leakage
  • ill fitting devices
21
Q

describe the consistency and drainage that you would get from a descending or sigmoid colostomy

A
  • descending produces increasingly solid fecal drainage
  • sigmoid is usually formed solids
  • discharge can be regulated, there is some control
22
Q

describe the consistency and drainage that you would get from a transverse colostomy

A
  • produces unpleasant smelling, mushy drainage b/c some
    of the liquid has been absorbed
  • there is no control with this type of colostomy
23
Q

describe the consistency and drainage that you would get from a ileostomy

A
  • produces liquid fecal drainage

- drainage is constant and there is no control

24
Q

what are some concerns that you may hear that a patient has with an ostomy

A
  • ileostomy: skin irritation, leakage of devices

- colostomy: has a bad smell b/c more bacteria is present

25
Q

how frequently do you change the drainage bag and what is the best time to do it

A
  • some are changed everyday, some are done every 3 days and some are once a week
  • it is best to change the pouch when the bowel is less active, so usually before breakfast is a good time before any food or drink is ingested.
26
Q

describe the characteristics of a normal healthy stoma; 2 post surgery and 1 year post surgery

A

2 days post surgery
- dark red, swollen and bruised

1 year later
- pink, moist, skin around the stoma should be just like the rest of the skin on the body

PNUR 154 - Integrated Nursing Practice (4 decks)

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