lab quiz 6 Flashcards
ostomy (stoma)
- opening through the abdominal wall
- May be temporary or permanent, continent or incontinent
ileostomy
ileum (small bowel)
colostomy
colon (ascending, transverse, descending, sigmoid)
urostomy
urinary diversion; constructed from a section of the intestine that creates a storage reservoir or conduit for urine
Ureterostomy or ileal conduit
permanent incontinent urinary diversion created by transplanting the ureters into a closed-off part of the intestinal ileum and bringing the other end out onto the abdominal wall
Nephrostomy
tubes tunneled through the skin and into the renal pelvis
ileostomy output
liquid to semiliquid
ascending colostomy output
semiliquid
transverse colostomy output
semiliquid to semi-formed
sigmoid colostomy output
formed
ileostomy indications
UC, crohn’s, familial polyposis, trauma, cancer, diseased/injured colon
ascending colostomy indications
Perforating diverticulum in lower colon, trauma, rectovaginal fistula, inoperable tumors in the colon, rectum, or pelvis
transverse colostomy indications
Perforating diverticulum in lower colon, trauma, rectovaginal fistula, inoperable tumors in the colon, rectum, or pelvis
sigmoid colostomy indications
Perforating diverticulum in lower colon, trauma, rectovaginal fistula, inoperable tumors in the colon, rectum, or pelvis
ostomy appliances
- Pouch and clip
- Clean towels and wipes
- Stoma powder
- Stoma paste or ring seal
- Wafer and scissors
- Measuring cards and pens
ostomy appliances: pt considerations
- Location, type, and size of stoma
Amount of drainage
Physical activities
Patient dexterity
Cost of supplies
ostomy appliances: options
- 1 or 2 piece
- Flat vs convex
- Precut
- Irrigated closure vs clips
- Open vs closed
- Vented
ostomy care: pt education
- Supplies needed
- Walk-through ostomy care
- Before discharge, make sure pt knows the full care routine
- Diet and fluid intake
- complications/pitfalls of ostomies
- Discuss resuming activities
- Arrange follow-up
- Ensure pt knows when to seek medical care
ileostomy/colostomy care guidelines
- Empty pouch when ⅓ to ½ full
- Burp bag when needed
- Use supplies as indicated
- Change appliance every 3-7 days or as needed
- Assess the stoma and peristomal skin closely; be sure to monitor for skin breakdown
Urostomy care
change every 4-6 days or as needed, monitor for skin breakdown or irritation, assess stoma often, do not remove stents, monitor for infection (cloudy/mucousy urine)
nephrostomy care
never kink, compress, or clamp tubing, check urine output every hour, do not instill more than 5mL of sterile saline if irrigating
Ostomy irrigation
- Not done routinely, it can regulate output
- Supplies: silicone cone, plastic tubing, irrigation fluid bag (warm water)
Nutrition support
- Follow post-op recommendations
- Ensure adequate fluid
- Reduce intake of gas-forming foods
- Monitor for food blockages (can occur with ileostomies, encourage intake of problematic foods in small amounts, adequate chewing, and proper hydration, fiber may need to be limited)
Psychological support
- Provide support before and after surgery
- Encourage self-care and resumption of normal activities
- Monitor for changes that may impact self-care (dexterity, vision changes, weight loss/gain)
Complications
Skin irritation and breakdown
- Use caution when removing ostomy pouches
- Change appliances more frequently or consider changing the type of appliance
- Refer to WOCN
