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Nursing Fundamentals II > GI - Ostomy & Enema > Flashcards

GI - Ostomy & Enema Flashcards

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1
Q

Bowel

A

refers to the intestines

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2
Q

Bowel elimination

A

final step in the process of digestion

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3
Q

Colostomy

A

the most common stoma made from the large intestine

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4
Q

Ileostomy

A
  • ostomy made in the small intestine

- liquid stool most of the time

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5
Q

Effluent

A

the drainage that comes from the stoma

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6
Q

Ostomy

A
  • an opening made to allow passage of feces

- surgical opening

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7
Q

Impaction

A
  • a collection of hardened feces in the rectum or sigmoid

- leading cause of bowel obstruction

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8
Q

Ostomate

A

a person who has an ostomy

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9
Q

Pouch

A
  • device that collects the effluent

- make sure that face plate and appliance match in size

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10
Q

Excoriation

A
  • any superficial loss of substance such as that produced on the skin
  • face plate is suppose to fix this
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11
Q

Irrigation

A

to introduce fluid

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12
Q

Urostomy

A

into the bladder

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13
Q

Double barrel colostomy

A

temporary, transition of ascending and transverse

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14
Q

Ascending Colon

A

portion of the large intestine that travels up the right side

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15
Q

Transverse Colon

A

mid-portion of the large intestine that goes across abdomen

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16
Q

Descending Colon

A

portion of large intestine that travels down the left

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17
Q

Small Intestine

A

attached to the stomach and the large intestine

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18
Q

Reasons for Bowel Ostomy

A
  • An ostomy may be needed when a portion of the colon is diseased and can no longer function related to:
  • Trauma - bullet, etc…
  • Disease - Chron’s or ulcertaive colitis
  • Cancer - sometimes temporary
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19
Q

External stoma

A

opening into the intestine

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20
Q

Internal pouch

A
  • internal reservoir where rectum would be-formed by folding loops of small intestine and stitching, and internal walls are removed
  • stimulate pouch to evacuate
  • still see some leakage
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21
Q

patient concerns

A
  • Psychosocial burden (self image)
  • Afraid of odor (change often, charcoal filter, parsley)
  • Afraid of caring for ostomy
  • Afraid of accidental drainage
  • Sexual relationship concerns
  • Swimming (use a rubber band belt to hold it on better)
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22
Q

things to remember for ostomy

A
  • Eat at a regular time each day
  • 4-6 smaller meals may help establish a regular bowel pattern
  • Main dinner at noon may decrease BM at night
  • Introduce one food at time
  • Chew food completely for digestion
  • What gave you gas, constipation and diarrhea before will do the same now
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23
Q

Will fresh fruit cause loose stools?

A

yes

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24
Q

How much water should a person drink with an ostomy?

A

Drink 2-3 quarts of water a day

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25
Q

How long should someone with a new ostomy avoid high fiber foods?

A

6-8 weeks

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26
Q

Ileostomy Concerns

A
  • Need fluids, K, Na
  • For 4-6 weeks after surgery, limit foods that caused problems prior to surgery
  • Stay hydrated
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27
Q

Foods that are poorly digested

A
  • May block a narrow stoma:
  • Cabbage, lettuce, celery, coconut, nuts, corn, olives, cucumbers, peas, dried fruits, pickles, green peppers, pineapple
28
Q

Foods that thicken stool

A

Applesauce, pasta, bananas, creamy peanut butter, breads, starchy foods, cheeses

29
Q

Foods that cause diarrhea

A

Apple juice, prune juice, grape juice, highly seasoned foods

30
Q

Foods that will increase odor

A

beans, fish, eggs, coffee, onions, beer, asparagus, mustard, cabbage, broccoli

31
Q

Foods that will cause gas

A

cabbage, onions, fish, broccoli, carbonated beverages, radishes, pickles, cucumbers, large amounts of sweets or vegetables, milk, prunes, apricots, raisins, bananas, wheat products, pan fried foods

32
Q

Reduce Gas

A
  • Avoid swallowing air: gum chewing, straws, cigarettes
  • Eat slowly
  • Avoid gulping
33
Q

Reduce Odor

A
  • Buttermilk, yogurt, cranberry juice, parsley, spinach

- Charcoal tablets

34
Q

What should a stoma look like?

A
  • deep red

- look pale pink or bluish - call the dr

35
Q

What do you use to clean a stoma?

A

warm water

36
Q

Irrigation of colostomy

A
  • Fill enema bag-1000cc
  • Prime tubing
  • Hang enema bag shoulder high
  • Sit on toilet or in front on chair
  • Irrigation sleeve
  • Lubricate cone
  • Slow or stop flow if cramping
  • 15 minutes most of fluid should pass
  • Clamp end and empty in 45 minutes
37
Q

Nursing Diagnosis for colostomy

A
  • Alteration in elimination
  • Ineffective Coping
  • Alteration in Nutrition
  • Altered Role Performance
  • Body Image Disturbance
38
Q

Nursing for colostomy

A
  • Remember your attitude will greatly effect your patient.
  • Teaching skin care is paramount.
  • Be a patient advocate-look for support groups for your patient.
39
Q

Large enema fluid volume

A
  • Infant: 50-150
  • Toddler: 250-350
  • Child: 300-500
  • Adolescent: 500-750
  • Adult 750-1000
40
Q

soup suds enema

A

soap sud enema, mix with enema, more irritation to colon, more results

41
Q

what temp should the fluid be for an enema?

A

Temp of water should be lukewarm (too hot or cold can cause cramping, damage to rectal tissues, and extreme shock

42
Q

what position should the patent be in for an enema?

A

sims; left side

43
Q

how high should the solution be for a large flow enema?

A

12-18 inches above patient

44
Q

what should the patient do when you insert the enema?

A

take a deep breath

45
Q

how far should the large flow enema be inserted?

A

3-4 inches

46
Q

what can be done to minimize cramping?

A
  • instill fluid slowly
  • lower solution
  • stop flow
47
Q

how long should a patient try to hold in the enema?

A

10-15 minutes

48
Q

cleansing enema

A

Irritates the colon and rectum, thus stimulates peristalsis

49
Q

cleansing enema - soap suds

A

dilute 3-5 ml in 1000ml water

50
Q

cleansing enema - saline

A
  • use smaller volume of fluid
  • draws fluid into the colon from body tissues (hypertonic)-use commercially prepared enema
  • 120 ml and instruct to hold 5-7 minutes
51
Q

cleansing enema - tap water

A
  • caution-is hypotonic

- rapid evacuation

52
Q

Retention Enemas

A
  • Solution is retained for a period of time.

- Mineral oil, olive oil, cottonseed oil, liquid petrolatum

53
Q

retention enema - emollient

A
  • Retain for 30-60 minutes
  • Oil-lubricates the rectum and colon protecting the intestinal mucous membrane
  • Feces absorb oil and become softer and easier to expel
54
Q

retention enema - nutritive

A
  • provides nourishment in temporary or emergency situations: dextrose solution
  • last ditch effort to give nutrition to someone who is really sick
55
Q

distention enema

A

Provides relief from flatus and improves the ability to expel flatus

56
Q

distention enema - return flow

A
  • mild colonic irritation
  • 100-200ml of enema
  • administer then lower and solutions drains back into container-repeat 5-6 times
  • changing solution as needed
  • stimulates peristalsis and relieves flatus
57
Q

who would you give a distention enema to?

A

post-op with peristalsis, abdominal surgery

58
Q

distention enema - carminative

A
  • 1-2-3 = 30 g magnesium-60 grams of glycerin-90 ml of water
  • Milk and molasses (180-240ml of equal amounts)
  • Usually from pharmacy
  • Impaction or significant impaction
59
Q

medicated enema

A
  • Reduces bacteria or removes potassium

- Try to retain for 20 to 30 minutes

60
Q

medicated enema - Kayexalate

A
  • removes excess K by exchange for NA ions
  • acute or chronic renal failure
  • potassium way above 5
  • tap water enema
  • clings to side of colon and gets rid of extra K
  • common in emergency room and long term
61
Q

medicated enema - neomycin

A
  • antibiotic solution to reduce bacteria before bowel surgery
  • bowel prep for surgery, reduce infection prior to surgery
62
Q

Administering Suppository

A
  • Lubricate tip, instruct patient to breathe through mouth to relax anal sphincter
  • Insert suppos-pointed end-beyond internal sphincter-3-4 inches
  • Push suppos against side of rectal wall and do not place in fecal mass (cannot be absorbed)
63
Q

Autonomic Hyperreflexia

A
  • Goose pimples, pounding headache, hypertension, perspiration above level of spinal injury, may lose some level of consciousness
64
Q

what causes autonomic hyperreflexia?

A
  • Caused by digital stimulation

- Finger into rectum, putting in enema tube

65
Q

how to treat autonomic hyperreflexia?

A
  • Stop digital stimulation
  • Apply Nupercainal and Xylocaine ointment around anus and rectum as ordered
  • Wait around 10 minutes for symptoms to subside
66
Q

Vagal Response

A
  • Decreased pulse rate
  • Decreases conductivity at S-A node
  • Decreases the rate of firing
  • Momentarily and usually returns
  • Palpitations
  • Faint
67
Q

fecal impaction

A
  • Obtain baseline BP and pulse
  • Position on left side and explain
  • Double glove-lubricate
  • Have pt take deep breath, on exhale gently insert finger (index)
  • Gently remove stool by breaking up mass
  • There might be some bleeding and should discontinue quickly
  • Allow pt to rest

Nursing Fundamentals II (13 decks)

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