Exam 1: Ostomies Flashcards
What is an Ileostomy ?
The colon, rectum, and part of the ileum have been removed, and the rest of the Ileum Is brought out through the abdomen
Ileum = ?
End of the small intestine
An ileostomy will most likely have what type of output ?
Liquidy
- b/c a lot of water absorption occurs in the Large Intestine
Ilieostomies are most common in what health problems ?
- UC
- Crohn’s
- Familial Polyps
What do we want to encourage in pt’s with an Ileostomy?
Encourage fluid intake !!
True or False: Depending on where the Ostomy is located will determine how Liquidly or formed the stool is ?
True
A Colostomy is defined as what ?
Opening from the colon
A person with an colostomy in the ascending colon will have what type of output ?
Semi Liquid
- Increase/encourage fluids
A person with a colostomy in the Transverse colon will have what type of output ?
Semi liquid / Semi formed
- possibly need to increase fluids
A person with a colostomy in the sigmoid colon will have what type of output ?
Formed
- B/c the majority of the water has been absorbed from the stool
True or False: Pt’s with long term ostomies, typically only have 1 ?
True
Is it true that some people won’t even look at their stoma in the hospital & thats okay! ?
Yes
True or False: We don’t want to force people to look at their stoma if their not ready ?
True
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. ?
True
What does Preoperative care for an stony look like ?
- Psychological preperation
- WOCN (Wound Ostomy Care Nurse)
- Stoma Marking
Who picks the stoma marking prior to surgery ?
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 !
True or False: Pt’s may not consent to Preoperative Ostomy care right away, it may take some time ?
True
What general postoperative things do we want to be thinking about with an Ostomy ?
- VS
- Pain
- Fluid status
- Psychological and emotional support for the patient
True or False: Edema is normal Post-op ?
True
What is the normal color of the Stoma ?
Rosy pink to Beefy Red
True or False: We want to protect the skin post-op, by keeping stool from eating away at the skin around the stoma ?
True
True or False: We want to have a good fit with the stoma appliance postoperatively and always ?
True
Generally, how much skin do we want between the stoma and the edge of the wafer ?
1/8 to 1/4
True or False: We want to make the fit as tight as we can without pinching the stoma ?
True
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 ?
True
True or False: Postoperatively the stoma will protrude about 2cm away from the abdominal wall ?
True
postoperatively the stoma is usually brick red & moist ?
yes
True or False: a small amount of bleeding at the stoma is normal postoperatively ?
True
With a stoma, what do we want to monitor for postoperatively ?
want to monitor for ischemia & necrosis of the stoma
- we want to make sure the stoma is being perfused !
What signs would tell us if a stoma is showing signs of ischemia & necrosis ?
- Dark red, purple, black color
- Firm
- Flaccid
- unusual bleeding
What is Mucocutaneous separation ?
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!
When do we typically want to empty an Ostomy?
When the bag is about 1/3 full
- We don’t want it pulling away and putting pressure on the wafer and skin
Generally we want people with Ostomies to consume how much fluid ?
3L
True or False: The pt’s will need to play around with foods in the beginning ?
True
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 ?
True
True or False: WOCN’s are wonderful resource people ?
True
What are effects of food on stoma output ?
- Odor producing
- Gas producing
- Diarrhea
- Potential obstruction in ileostomy
What are examples of foods that are odor producing on stoma output ?
- Garlic
- Onions
- Eggs
- Fish
What are examples of foods/drinks that are gas producing on stoma output ?
- Beans
- Brocoli
- Cauliflower
- Carbonated beverages
What are examples of foods that may need to be avoided to reduce the risk of potential obstruction of the ileostomy ?
- Nuts
- Seeds
- Popcorn
- Sausage/meets with casings
What are examples of foods that may cause Diarrhea in someone with a stoma ?
- ETOH
- Coffee
- Spicy foods
True or False: The ileum is more narrow than the colon ?
True
What are pt. teaching points for pt’s with an Ostomy ?
- 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
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 ?
True
