GI - Ostomy & Enema Flashcards
Bowel
refers to the intestines
Bowel elimination
final step in the process of digestion
Colostomy
the most common stoma made from the large intestine
Ileostomy
- ostomy made in the small intestine
- liquid stool most of the time
Effluent
the drainage that comes from the stoma
Ostomy
- an opening made to allow passage of feces
- surgical opening
Impaction
- a collection of hardened feces in the rectum or sigmoid
- leading cause of bowel obstruction
Ostomate
a person who has an ostomy
Pouch
- device that collects the effluent
- make sure that face plate and appliance match in size
Excoriation
- any superficial loss of substance such as that produced on the skin
- face plate is suppose to fix this
Irrigation
to introduce fluid
Urostomy
into the bladder
Double barrel colostomy
temporary, transition of ascending and transverse
Ascending Colon
portion of the large intestine that travels up the right side
Transverse Colon
mid-portion of the large intestine that goes across abdomen
Descending Colon
portion of large intestine that travels down the left
Small Intestine
attached to the stomach and the large intestine
Reasons for Bowel Ostomy
- 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
External stoma
opening into the intestine
Internal pouch
- 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
patient concerns
- 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)
things to remember for ostomy
- 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
Will fresh fruit cause loose stools?
yes
How much water should a person drink with an ostomy?
Drink 2-3 quarts of water a day
How long should someone with a new ostomy avoid high fiber foods?
6-8 weeks
Ileostomy Concerns
- Need fluids, K, Na
- For 4-6 weeks after surgery, limit foods that caused problems prior to surgery
- Stay hydrated
Foods that are poorly digested
- May block a narrow stoma:
- Cabbage, lettuce, celery, coconut, nuts, corn, olives, cucumbers, peas, dried fruits, pickles, green peppers, pineapple
Foods that thicken stool
Applesauce, pasta, bananas, creamy peanut butter, breads, starchy foods, cheeses
Foods that cause diarrhea
Apple juice, prune juice, grape juice, highly seasoned foods
Foods that will increase odor
beans, fish, eggs, coffee, onions, beer, asparagus, mustard, cabbage, broccoli
Foods that will cause gas
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
Reduce Gas
- Avoid swallowing air: gum chewing, straws, cigarettes
- Eat slowly
- Avoid gulping
Reduce Odor
- Buttermilk, yogurt, cranberry juice, parsley, spinach
- Charcoal tablets
What should a stoma look like?
- deep red
- look pale pink or bluish - call the dr
What do you use to clean a stoma?
warm water
Irrigation of colostomy
- 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
Nursing Diagnosis for colostomy
- Alteration in elimination
- Ineffective Coping
- Alteration in Nutrition
- Altered Role Performance
- Body Image Disturbance
Nursing for colostomy
- Remember your attitude will greatly effect your patient.
- Teaching skin care is paramount.
- Be a patient advocate-look for support groups for your patient.
Large enema fluid volume
- Infant: 50-150
- Toddler: 250-350
- Child: 300-500
- Adolescent: 500-750
- Adult 750-1000
soup suds enema
soap sud enema, mix with enema, more irritation to colon, more results
what temp should the fluid be for an enema?
Temp of water should be lukewarm (too hot or cold can cause cramping, damage to rectal tissues, and extreme shock
what position should the patent be in for an enema?
sims; left side
how high should the solution be for a large flow enema?
12-18 inches above patient
what should the patient do when you insert the enema?
take a deep breath
how far should the large flow enema be inserted?
3-4 inches
what can be done to minimize cramping?
- instill fluid slowly
- lower solution
- stop flow
how long should a patient try to hold in the enema?
10-15 minutes
cleansing enema
Irritates the colon and rectum, thus stimulates peristalsis
cleansing enema - soap suds
dilute 3-5 ml in 1000ml water
cleansing enema - saline
- 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
cleansing enema - tap water
- caution-is hypotonic
- rapid evacuation
Retention Enemas
- Solution is retained for a period of time.
- Mineral oil, olive oil, cottonseed oil, liquid petrolatum
retention enema - emollient
- 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
retention enema - nutritive
- provides nourishment in temporary or emergency situations: dextrose solution
- last ditch effort to give nutrition to someone who is really sick
distention enema
Provides relief from flatus and improves the ability to expel flatus
distention enema - return flow
- 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
who would you give a distention enema to?
post-op with peristalsis, abdominal surgery
distention enema - carminative
- 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
medicated enema
- Reduces bacteria or removes potassium
- Try to retain for 20 to 30 minutes
medicated enema - Kayexalate
- 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
medicated enema - neomycin
- antibiotic solution to reduce bacteria before bowel surgery
- bowel prep for surgery, reduce infection prior to surgery
Administering Suppository
- 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)
Autonomic Hyperreflexia
- Goose pimples, pounding headache, hypertension, perspiration above level of spinal injury, may lose some level of consciousness
what causes autonomic hyperreflexia?
- Caused by digital stimulation
- Finger into rectum, putting in enema tube
how to treat autonomic hyperreflexia?
- Stop digital stimulation
- Apply Nupercainal and Xylocaine ointment around anus and rectum as ordered
- Wait around 10 minutes for symptoms to subside
Vagal Response
- Decreased pulse rate
- Decreases conductivity at S-A node
- Decreases the rate of firing
- Momentarily and usually returns
- Palpitations
- Faint
fecal impaction
- 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
