Ostomy and Skin Disorders Flashcards
When inspecting the stoma, what are normal findings we can expect in the initial postoperative assessment?
beefy red, swelling, small amount of bleeding
What are some abnormal findings we would want to report to the physician post operatively for a patient that has had a colostomy? (in regards to impaired circulation to stoma AND risk of infection/peritonitis?
very pale, bluish, or black stoma = impaired circulation
abdominal distention/discomfort and abnormal vital signs.
When placing a pouch, why is it so important to measure the stoma carefully, especially in the first 6-8 weeks postoperatively?
the size of the stoma changes over time
how and why would we want to ensure a good seal on the pouch around the stoma?
so it doesn’t leak, reduces the risk of infection and skin breakdown.
What is a j-pouch anal anastomosis?
a new rectum created from the terminal ileum.
why is the j-pouch an advantage?
it allows for near normal bowel elimination
what are some teaching instructions we want to give our patient regarding post-operative -ostomy surgery regarding bathing, activity and diet?
avoid heavy lifting drink plenty of fluids no tight clothes you can shower avoid foods that cause excessive gas or odor
what is something thing we can teach patients who are concerned about odor due to their colostomy?
rinse the pouch with a vinegar solution. avoid foods that cause gas or have an strong odor.
what are some interventions we would want to include for a female patient regarding sexual dysfunction following ostomy surgery?
empty bag and tape it down before sexual intercourse, pouch covers available, experiment with positions
what are some teaching points we want to emphasize if a woman is of child bearing age and has an ostomy?
she can still have children does not interfere with pregnancy or delivery
why do we use paste with the wafer around the stoma?
prevents skin breakdown and leakage
what is a possible adverse reaction to paste that you use with the wafer around a stoma?
rash
What is a stoma prolapse?
protruding stoma
is a prolapsed stoma usually an emergency?
not usually, as long as it still passes stool or gas
what are some teaching points regarding travel with your ostomy patient?
bring lots of supplies in your carry on and avoid food that give gas or diarrhea while traveling.
What are some expected findings in immediate postoperative care of a patient with ileal conduit?
absent bowel sounds, mucous in urine, small amount of blood in drainage
what are some findings we should report in the immediate postoperative care of a patient with ileal conduit?
distended rigid abdomen
are suppositories safe to use in a colostomy?
yes
Why would the patient with an ileostomy be at risk for metabolic acidosis?
the stool is more watery, they lose bicarbonate in their stool
Why would we not use Karaya products with a urostomy?
Karaya breaks down with urine
what is a United Ostomy Association volunteer? how do they help a patient with a new ostomy?
They have to have an ostomy themselves. They help with advice, support and information to those with new a new ostomy.
What are some signs and symptoms that our post operative ostomate is having fluid or electrolyte imbalances?
changes in mental status, hypotensive, tachycardic, hypokalemic, metabolic acidosis
fecal matter around the stoma can cause?
skin breakdown, bacterial or fungal infections, yeast and odor
what are some expectations we would teach our patent about drainage from their ileostomy in the immediate post operative period?
drainage may not start for 24-48 hours and the first drainage may have blood or mucous and be very liquid.
What are the major considerations regarding the placement of the stoma?
ease of self-care and allowance for a good seal.
What are some normal age related changes we see in skin as we become older?
wrinkles, age spots, balding, graying, brittle nails, increased hair growth in nose, eyebrows and ears, skin tags -seborrheac keratosis
Up to _____ % of blood can be contained in our skin.
10
Why would a patient just returned from surgery be cool and pale?
loss of blood and blood is shunted to other organs and constriction
What are some precautions we would have a patient receiving phototherapy take?
don’t go in the sun as much, use sunscreen, protective clothing
What interventions can we suggest/perform for pruritus that do not require a physician order?
lotion and lubricants if skin is intact
What are some implementations we can provide for patients with atopic dermatitis?
wear lose clothing, avoid irritants, wash clothes before you wear them, use mild detergents, room temp water 68 -75 degrees, avoid sweating.
what conditions would exclude a patient from receiving phototherapy?
herpes, skin cancer, cataracts and lupus
a patient with impaired skin integrity is at high risk for ___________. What are some signs and symptoms that this may be occurring.
infection - signs and symptoms would be fever
what are some things we want to teach our patient that has a new RX for methotrexate sodium to relive psoriasis?
they will need periodic blood tests and it is used to treat many kinds of disorders
when teaching our patients about dermatitis, causes and irritants, what are some key points?
not contagious - not caused by poor hygiene
where is candida albicans commonly found, especially on obese patients?
skin folds
what are some important teaching points we would want to emphasize to a patient on Accutane? especially a young female patient
use birth control, do not get pregnant
what are some myths about causes of acne? what are some truths?
not caused by fatty foods, diet, poor hygiene and facial scrubs don’t work
truth - popping may cause it to spread
is herpes cured by medication?
no - medication only controls it, it can lie dormant and reoccur.
what virus causes chicken pox and shingles?
varicella - chicken pox
herpes zoster - shingles because you had chicken pox
what test would be performed to determine the specific herpes virus is present?
Tzanck smear
what are some interventions we can perform for a patient with a herpes virus that is experiencing pain?
pain meds - antiviral meds or distraction
What makes T-cell lymphoma different from squamous cell and basal cell carcinomas?
t- cell not related to sun exposure.
why would we want to report sooty sputum to a physician immediately if a patient presents with burns?
inhalation injury
What is a risk factor of eschar formation in burn patients? What assessments would we perform regarding this?
decreased circulation - assess cap refill, temp and pulse
