Topic 7: Bowel Resection & Ostomy Surgery

Question 1

ostomy

Answer 1

surgically created opening on the abdomen that allows the discharge of body waste when the normal elimination route is not possible, feces drain through the stoma and not the anus

Question 2

Ileostomy stool consistency

Answer 2

· Liquid to semiliquid stool

Question 3

ascending ostomy stool consistency

Answer 3

· Semiliquid stool

Question 4

transverse ostomy stool consistency

Answer 4

· Semiliquid to semi-formed stool

Question 5

sigmoid ostomy stool consistency

Answer 5

· Formed stools

Question 6

End Stoma

Answer 6

stoma made by dividing the bowel and bringing out the proximal end as a single stoma making a colostomy or ileostomy

Question 7

loop stoma

Answer 7

made by bringing a loop of bowel to the abdomen surface and then opening the anterior wall of the bowel to provide fecal diversion

Question 8

double-barreled stoma

Answer 8

HCP divides the bowel and both proximal and distal ends are brought through the abdominal wall as 2 separate stomas

Question 9

pre-op care

Answer 9

· Psychologic preparation and emotional support because of changed in body image and elimination
· WOCN should choose the site where the ostomy will be and mark abdomen before the surgery
· Site should be flat as it makes it easier to create a good seal and avoid leakage

Question 10

Post-Op Care

Answer 10

· Assess incision for suture integrity and s/s/ of inflammation and infection
· Reinforce dressing, change them often during the first several hours post-op
· Assess all drainage for amount, color, consistency
· Assess for bleeding, odor, edema, erythema, fever, and high WBC count
· Assess stoma,
· Gas is excessive during the first two weeks, assure patients this is temporary
· Assess for fluid and electrolyte imbalances

Question 11

what color is drainage usually after surgery

Answer 11

serosanguineous

Question 12

what should a stoma look like

Answer 12

should be rosy, pink to red and mildly swollen

Question 13

what does a dusky blue stoma indicate

Answer 13

ischemia

Question 14

what does a brown/black stoma indicate

Answer 14

necrosis

Question 15

Nursing Management: Ostomy Care

Answer 15

· Assess and document stoma and peristomal skin appearance
· For a new patient with a new ostomy, assess patient’s psychologic preparation for ostomy care
· Choose appropriate ostomy pouching system for patient
· Place ostomy pouching system for a new ostomy
· Monitor volume, color, odor of ostomy drainage
· Develop plan of care for skin care around ostomy
· Teach ostomy care and skin care to patient and caregiver
· Irrigate new colostomy if indicates
· Teach appropriate diet choices

Question 16

what can be delegated to a UAP for ostomy care

Answer 16

o Empty ostomy bas and measure liquid contents
o Place ostomy pouch system for an established ostomy, assist stable patient with colostomy irrigation

Question 17

how can patients with an ostomy reduce the chance of blockage

Answer 17

chew food very well

Question 18

when can the patient resume ADLs after a colostomy

Answer 18

· ADLs within 6-8 weeks, BUT should avoid heavy lifting

Question 19

colostomy and water

Answer 19

· Swimming is not a problem with ostomy pouch intact
· Patient can shower and bather with or without the pouching system in place

Question 20

what foods should the patient avoid with an ileostomy

Answer 20

o Foods like nuts, raisins, popcorn, coconut, mushrooms, olives, stringy vegetables, foods with skins, dried fruit and meat with casing must be chewed extremely well before swallowing

Question 21

what should be demonstrated back to the nurse when patient performs ostomy self-care

Answer 21

o Remove the old skin barrier, cleanse skin, correctly apply new skin barrier
o Apply, empty, clean, and remove the pouch
o Empty the pouch before it is 1/3 full to prevent leakage

Question 22

when should the ostomy pouch be emptied

Answer 22

Empty the pouch before it is 1/3 full

Question 23

what GAS forming foods should be avoided

Answer 23

beans, beer, cabbage family, carbonated beverages, cheeses (strong), onions, sprouts

Question 24

what DIARRHEA forming foods should be avoided

Answer 24

alcohol, beer, cabbage family, coffee, fruits (raw), green beans, spicy foods, spinach

Question 25

what ODOR producing food should be avoided

Answer 25

alcohol, asparagus, broccoli, cabbage, eggs, fish, garlic, onions