Exam 1: Ostomies

Question 1

What is an Ileostomy ?

Answer 1

The colon, rectum, and part of the ileum have been removed, and the rest of the Ileum Is brought out through the abdomen

Question 2

Ileum = ?

Answer 2

End of the small intestine

Question 3

An ileostomy will most likely have what type of output ?

Answer 3

Liquidy

• b/c a lot of water absorption occurs in the Large Intestine

Question 4

Ilieostomies are most common in what health problems ?

Answer 4

• UC
• Crohn’s
• Familial Polyps

Question 5

What do we want to encourage in pt’s with an Ileostomy?

Answer 5

Encourage fluid intake !!

Question 6

True or False: Depending on where the Ostomy is located will determine how Liquidly or formed the stool is ?

Answer 6

True

Question 7

A Colostomy is defined as what ?

Answer 7

Opening from the colon

Question 8

A person with an colostomy in the ascending colon will have what type of output ?

Answer 8

Semi Liquid

• Increase/encourage fluids

Question 9

A person with a colostomy in the Transverse colon will have what type of output ?

Answer 9

Semi liquid / Semi formed

• possibly need to increase fluids

Question 10

A person with a colostomy in the sigmoid colon will have what type of output ?

Answer 10

Formed

• B/c the majority of the water has been absorbed from the stool

Question 11

True or False: Pt’s with long term ostomies, typically only have 1 ?

Answer 11

True

Question 12

Is it true that some people won’t even look at their stoma in the hospital & thats okay! ?

Answer 12

Yes

Question 13

True or False: We don’t want to force people to look at their stoma if their not ready ?

Answer 13

True

Question 14

True or False: Even if the pt isn’t ready to look at their stoma in the hospital, we still need to make sure that somebody is responsible for the care post-op, whether thats a family member or friend, etc. ?

Answer 14

True

Question 15

What does Preoperative care for an stony look like ?

Answer 15

• Psychological preperation
• WOCN (Wound Ostomy Care Nurse)
• Stoma Marking

Question 16

Who picks the stoma marking prior to surgery ?

Answer 16

The Ostomy nurse picks where the stoma will go on the patient.

• They will talk with the pt prior and talk about clothing, daily activities, etc. to determine the best place for the stoma to be !

Question 17

True or False: Pt’s may not consent to Preoperative Ostomy care right away, it may take some time ?

Answer 17

True

Question 18

What general postoperative things do we want to be thinking about with an Ostomy ?

Answer 18

• VS
• Pain
• Fluid status
• Psychological and emotional support for the patient

Question 19

True or False: Edema is normal Post-op ?

Answer 19

True

Question 20

What is the normal color of the Stoma ?

Answer 20

Rosy pink to Beefy Red

Question 21

True or False: We want to protect the skin post-op, by keeping stool from eating away at the skin around the stoma ?

Answer 21

True

Question 22

True or False: We want to have a good fit with the stoma appliance postoperatively and always ?

Answer 22

True

Question 23

Generally, how much skin do we want between the stoma and the edge of the wafer ?

Answer 23

1/8 to 1/4

Question 24

True or False: We want to make the fit as tight as we can without pinching the stoma ?

Answer 24

True

Question 25

True or False: Postoperatively the area around the stoma will be very edematous, and we have to remind the pt. that the swelling will go down ?

Answer 25

True

Question 26

True or False: Postoperatively the stoma will protrude about 2cm away from the abdominal wall ?

Answer 26

True

Question 27

postoperatively the stoma is usually brick red & moist ?

Answer 27

yes

Question 28

True or False: a small amount of bleeding at the stoma is normal postoperatively ?

Answer 28

True

Question 29

With a stoma, what do we want to monitor for postoperatively ?

Answer 29

want to monitor for ischemia & necrosis of the stoma * we want to make sure the stoma is being perfused !

Question 30

What signs would tell us if a stoma is showing signs of ischemia & necrosis ?

Answer 30

- Dark red, purple, black color - Firm - Flaccid - unusual bleeding

Question 31

What is Mucocutaneous separation ?

Answer 31

Breakdown of suture line securing the stoma to the abdominal wall - usually it will just need to be sutured back together * When in doubt call the provider or ask an experienced nurse!

Question 32

When do we typically want to empty an Ostomy?

Answer 32

When the bag is about 1/3 full - We don't want it pulling away and putting pressure on the wafer and skin

Question 33

Generally we want people with Ostomies to consume how much fluid ?

Answer 33

3L

Question 34

True or False: The pt's will need to play around with foods in the beginning ?

Answer 34

True

Question 35

True or False: In regards to Ostomy self care, initially somebody will need to do the care, and then eventually in most cases the pt. will need to learn to do it themselves ?

Answer 35

True

Question 36

True or False: WOCN's are wonderful resource people ?

Answer 36

True

Question 37

What are effects of food on stoma output ?

Answer 37

- Odor producing - Gas producing - Diarrhea - Potential obstruction in ileostomy

Question 38

What are examples of foods that are odor producing on stoma output ?

Answer 38

- Garlic - Onions - Eggs - Fish

Question 39

What are examples of foods/drinks that are gas producing on stoma output ?

Answer 39

- Beans - Brocoli - Cauliflower - Carbonated beverages

Question 40

What are examples of foods that may need to be avoided to reduce the risk of potential obstruction of the ileostomy ?

Answer 40

- Nuts - Seeds - Popcorn - Sausage/meets with casings

Question 41

What are examples of foods that may cause Diarrhea in someone with a stoma ?

Answer 41

- ETOH - Coffee - Spicy foods

Question 42

True or False: The ileum is more narrow than the colon ?

Answer 42

True

Question 43

What are pt. teaching points for pt's with an Ostomy ?

Answer 43

- Principles of stony & appliance care - Dietary guidelines (need to experiment w/ foods) - Fluid guidlines (depends on consistency of stools) - Resources for psychological & emotional adjustment - Importance of follow-up care - Fluid deficits - Fever - Skin irritation - Stoma problems - inversion, eversion, discoloration, abscess, or infection

Question 44

True or False: If pt's are dehydrated they'll most likely start with a low grade fever ? and pt's with a low grade fever will often be treated with fluids which will help ?

Answer 44

True