Colostomy care, Medicine adminstration Flashcards
ostomy
artificial opening in an organ of the body, created surgically
Types of ostomies
colostomy (ascending, transverse, descending, sigmoid, loop); ileostomy; ureterostomy Consistency of stool and frequency of stool production depends on the ostomy location, diet, and hydration status.
Transverse colostomy
This type of colostomy is located in the upper abdominal region, on the right side or the middle of the body. Transverse colostomies are usually performed on a temporary basis, but they may also be permanent.
when is a transverse colostomy given
Doctors will choose a transverse colostomy if the lower half of the bowel needs a rest or to be permanently bypassed.
Sigmoid colostomy
Located at the bottom of the large intestine, sigmoid colostomies are the most common. Because of its location near the rectum, there is still some functioning colon, so the waste produced is firmer and more normal in consistency than with other colostomy types. As with a descending colostomy, single-barrel is more common, though a double-barrel procedure is also a possibility. A loop-sigmoid colostomy is also a possibilit
Descending colostomy
This surgery is performed when the blockage or cancer is located on the lower left side of the abdomen (or descending colon). In this surgery, the stoma placement results in waste close to normal in firmness because it’s already traveled through most of the colon.
Ascending colostomy
Located on the right side of your abdomen, this type of colostomy is rare. During this procedure, most of your colon will likely be removed, so waste is liquid with this stoma
mucous fistula
attaches a disconnected part of your intestine to a surgically created small opening in the skin on your belly (stoma). This connection helps people with certain bowel diseases pass mucous (intestinal secretions) out of the stoma instead of the anus.
Hartmanns procedure
a type of colectomy that removes part of the colon and sometimes rectum The remaining rectum is sealed, creating what is known as Hartmann’s pouch. The remaining colon is redirected to a colostomy. It can be reversed later.
Indications
Colon cancer
Bladder cancer
Invading gynecological or prostate cancer
Crohn’s disease
Ulcerative colitis
Diverticulitis
Bowel trauma
Stoma
A stoma is an opening on the abdomen. It looks like a small, pinkish, circular piece of flesh sewn to your body. It may lie fairly flat on the body or protrude out.
what foods should people with ostomies avoid
beans, cabbage, onions, and spicy foods. Some foods can cause cramping or may be difficult to pass through an ostomy if they are not chewed well. These include nuts, popcorn, and corn. Also, be aware of which foods may cause diarrhea or constipation. It is important that you stay hydrated, especially if you have an ileostomy, because stool is usually more watery.
what medications work the best
liquid because they absorb faster
when should you empty the ostomy bag
when it is less then half way 2/3
what is a patient teaching about input and output
Learn how to plan your meals and fluid intake to cut down on the output of your ostomy ahead of a big or lengthy event. This may include a long work meeting or car or plane trip.
Activities that they should be able to participate in
People with ostomies go to work, play sports, and engage in sexual activity. Reasonable activity will not hurt you or your stoma. Sweating may cause the tape that holds your pouch in place to loosen. If this happens, you might consider buying a specialized pouch for working out.
What products should you avoid around ostomy
products that contain alcohol as they can cause dry skin. Do not use skin products made with oil. They will make it difficult for the pouch to stay attached
what effects the output
Amounts of stool and gas that go into the pouch will vary based on the type of ostomy and your diet.
When assessing the Stoma look at
size, shape, colour, edema, bleeding
Abnormal stoma findings indicate
abnormal findings may indicate poor blood supply, obstruction, excessive tension, stomal trauma, GI bleeding, etc
Peristomal skin skin should be free of
erythema, irritation, breakdown
Does the stoma change during healing?
Size and shape of stoma will change as it heals, especially over the first 4-6 weeks
what is a main goal of ostomy teaching
for them to be as independent as they can be
The pouch needs to be
Personal capability
Security and proper fit
Stoma size changes
Closed or drainable
Skin stripping
Odor control
Skin excoriation
Changing timeline
Ballooning
when their is gas in the ostomy bag
Ischemia/Necrosis
loss of blood flow can cause death of tissue
Retraction
when the stoma retracts
Parastomal hernia
a type of incisional hernia that allows protrusion of abdominal contents through the abdominal wall defect created during ostomy formation
Prolapse
occurs when your pelvic floor muscles are damaged or weakened to the point where they can no longer provide support.
foods that tend to be more gassy include
beans, certain fruits (apples and pears), certain veggies (asparagus, broccoli, cauliflower, and carrots), dairy, grains, nuts, and carbonated beverages.
10 rights of medication administration
Right medication
Right dose
Right time
Right route
Right client
Right reason
Right client education
Right documentation
Right to refuse
Right assessment/evaluation
3 checks of med admin
Before you remove from the cupboard or medication cart
When you remove the drug from the container
After withdrawing the medication
Right dose
May be unit dispensed from pharmacy
May be stocked in bulk
Is the dose a safe dose for your patient?
Is it the current order?
Calculations
Calculation for dosage
desired dose/Availible dose x Vehicle =Amount
Right time
Check time
Correct frequency
Confirm last dose given
Right route
Enteral (Oral, Sublingual, Buccal, Gastrostomy Tubes)
Percutaneous (Topical)
Pulmonary (Inhalation)
Parenteral (Subcutaneous, Intramuscular, Intradermal, Intravenous)
Oral medications include
Tablets
Scored tablets
Capsules
Enteric coated tablets
Time release capsules
Liquid meds are for
Use for infants/children
Preferred over pills for enteral medication administration
If confused patients chew their medications
Swallowing issues
Thickened liquid diet
Topical medication
Topical administration is the application of a drug directly to the surface of the skin
Where can topical meds be administrated
eye vagina
nose urethra
ears colon
Types of topical meds
Ointments
Creams
Lotions
Transdermal
Inhalation meds include
Nebulizer
MDI
Parental drug admin
Any drug administration outside of the GI tract
Typically, this route involves the use of needles
Medication is injected into the circulation or into tissues
Right client
ID Band
Name
Personal identification number
Birth date
“What’s your name?”
LTC photo
Identified visually by staff who know them.
where to check for Allergies
Check MAR
Ask patient
Look for Red ID band
Right reason
What is the resident’s history?
Why is the resident taking this medication?
Should the resident still be taking it?
Right education
Why are they receiving it?
What to expect?
Precautions?
Interactions (Drug-drug interactions/Drug-food interactions)
Adverse effects
Report changes
Recognize significant adverse effects
Right to Refuse
If patient declines medication administration, inquire why client would like to decline a medication and document their reasoning.
If patient has questions about medication, explain possible therapeutic and adverse effects and purpose for administering this medication.
When taking medication history, be sure to ask specifics about dosage, frequency, route of administration, prescriber, and duration of use.
If medication order is unclear, contact original prescriber before administering medication.
Right Documentation
MAR (Medication Administration Record)
Progress notes for exceptions to the routine and any PRN medications.
Special problems
New symptoms
Patient’s statements
Patient tolerance
Be sure to have the right chart
Be specific and accurate
High Alert Medications
High-alert medications are drugs that have been identified as having a higher risk of significant patient harm if they are used in error.
-Look alike, sound alike
