Ostomy and Skin Disorders

Question 1

When inspecting the stoma, what are normal findings we can expect in the initial postoperative assessment?

Answer 1

beefy red, swelling, small amount of bleeding

Question 2

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?

Answer 2

very pale, bluish, or black stoma = impaired circulation

abdominal distention/discomfort and abnormal vital signs.

Question 3

When placing a pouch, why is it so important to measure the stoma carefully, especially in the first 6-8 weeks postoperatively?

Answer 3

the size of the stoma changes over time

Question 4

how and why would we want to ensure a good seal on the pouch around the stoma?

Answer 4

so it doesn’t leak, reduces the risk of infection and skin breakdown.

Question 5

What is a j-pouch anal anastomosis?

Answer 5

a new rectum created from the terminal ileum.

Question 6

why is the j-pouch an advantage?

Answer 6

it allows for near normal bowel elimination

Question 7

what are some teaching instructions we want to give our patient regarding post-operative -ostomy surgery regarding bathing, activity and diet?

Answer 7

avoid heavy lifting
drink plenty of fluids
no tight clothes
you can shower
avoid foods that cause excessive gas or odor

Question 8

what is something thing we can teach patients who are concerned about odor due to their colostomy?

Answer 8

rinse the pouch with a vinegar solution. avoid foods that cause gas or have an strong odor.

Question 9

what are some interventions we would want to include for a female patient regarding sexual dysfunction following ostomy surgery?

Answer 9

empty bag and tape it down before sexual intercourse, pouch covers available, experiment with positions

Question 10

what are some teaching points we want to emphasize if a woman is of child bearing age and has an ostomy?

Answer 10

she can still have children does not interfere with pregnancy or delivery

Question 11

why do we use paste with the wafer around the stoma?

Answer 11

prevents skin breakdown and leakage

Question 12

what is a possible adverse reaction to paste that you use with the wafer around a stoma?

Answer 12

rash

Question 13

What is a stoma prolapse?

Answer 13

protruding stoma

Question 14

is a prolapsed stoma usually an emergency?

Answer 14

not usually, as long as it still passes stool or gas

Question 15

what are some teaching points regarding travel with your ostomy patient?

Answer 15

bring lots of supplies in your carry on and avoid food that give gas or diarrhea while traveling.

Question 16

What are some expected findings in immediate postoperative care of a patient with ileal conduit?

Answer 16

absent bowel sounds, mucous in urine, small amount of blood in drainage

Question 17

what are some findings we should report in the immediate postoperative care of a patient with ileal conduit?

Answer 17

distended rigid abdomen

Question 18

are suppositories safe to use in a colostomy?

Answer 18

yes

Question 19

Why would the patient with an ileostomy be at risk for metabolic acidosis?

Answer 19

the stool is more watery, they lose bicarbonate in their stool

Question 20

Why would we not use Karaya products with a urostomy?

Answer 20

Karaya breaks down with urine

Question 21

what is a United Ostomy Association volunteer? how do they help a patient with a new ostomy?

Answer 21

They have to have an ostomy themselves. They help with advice, support and information to those with new a new ostomy.

Question 22

What are some signs and symptoms that our post operative ostomate is having fluid or electrolyte imbalances?

Answer 22

changes in mental status, hypotensive, tachycardic, hypokalemic, metabolic acidosis

Question 23

fecal matter around the stoma can cause?

Answer 23

skin breakdown, bacterial or fungal infections, yeast and odor

Question 24

what are some expectations we would teach our patent about drainage from their ileostomy in the immediate post operative period?

Answer 24

drainage may not start for 24-48 hours and the first drainage may have blood or mucous and be very liquid.

Question 25

What are the major considerations regarding the placement of the stoma?

Answer 25

ease of self-care and allowance for a good seal.

Question 26

What are some normal age related changes we see in skin as we become older?

Answer 26

wrinkles, age spots, balding, graying, brittle nails, increased hair growth in nose, eyebrows and ears, skin tags -seborrheac keratosis

Question 27

Up to _____ % of blood can be contained in our skin.

Answer 27

10

Question 28

Why would a patient just returned from surgery be cool and pale?

Answer 28

loss of blood and blood is shunted to other organs and constriction

Question 29

What are some precautions we would have a patient receiving phototherapy take?

Answer 29

don’t go in the sun as much, use sunscreen, protective clothing

Question 30

What interventions can we suggest/perform for pruritus that do not require a physician order?

Answer 30

lotion and lubricants if skin is intact

Question 31

What are some implementations we can provide for patients with atopic dermatitis?

Answer 31

wear lose clothing, avoid irritants, wash clothes before you wear them, use mild detergents, room temp water 68 -75 degrees, avoid sweating.

Question 32

what conditions would exclude a patient from receiving phototherapy?

Answer 32

herpes, skin cancer, cataracts and lupus

Question 33

a patient with impaired skin integrity is at high risk for ___________. What are some signs and symptoms that this may be occurring.

Answer 33

infection - signs and symptoms would be fever

Question 34

what are some things we want to teach our patient that has a new RX for methotrexate sodium to relive psoriasis?

Answer 34

they will need periodic blood tests and it is used to treat many kinds of disorders

Question 35

when teaching our patients about dermatitis, causes and irritants, what are some key points?

Answer 35

not contagious - not caused by poor hygiene

Question 36

where is candida albicans commonly found, especially on obese patients?

Answer 36

skin folds

Question 37

what are some important teaching points we would want to emphasize to a patient on Accutane? especially a young female patient

Answer 37

use birth control, do not get pregnant

Question 38

what are some myths about causes of acne? what are some truths?

Answer 38

not caused by fatty foods, diet, poor hygiene and facial scrubs don’t work
truth - popping may cause it to spread

Question 39

is herpes cured by medication?

Answer 39

no - medication only controls it, it can lie dormant and reoccur.

Question 40

what virus causes chicken pox and shingles?

Answer 40

varicella - chicken pox

herpes zoster - shingles because you had chicken pox

Question 41

what test would be performed to determine the specific herpes virus is present?

Answer 41

Tzanck smear

Question 42

what are some interventions we can perform for a patient with a herpes virus that is experiencing pain?

Answer 42

pain meds - antiviral meds or distraction

Question 43

What makes T-cell lymphoma different from squamous cell and basal cell carcinomas?

Answer 43

t- cell not related to sun exposure.

Question 44

why would we want to report sooty sputum to a physician immediately if a patient presents with burns?

Answer 44

inhalation injury

Question 45

What is a risk factor of eschar formation in burn patients? What assessments would we perform regarding this?

Answer 45

decreased circulation - assess cap refill, temp and pulse