Week 10 (Ostomy) & Week 11 (IV Part 2) Flashcards
Define an Ostomy
Artificial opening of the intestinal mucosa or segment of ureter
- brought out to the abdominal wall
- in order to material to drain (feces or urine)
Define a Stoma
The piece of intestine or ureter that is brought out to the patient’s abdomen
What is the drainage called that drains from a stoma?
Effluent
What is an ileal conduit?
Small urine reservoir created from a small segment of bowel (usually the ileum)
- bypass the bladder
What is a urostomy?
A stoma for the urinary system
- bypasses the bladder or the ureters
Is an ileal conduit and a urostomy, a continent or incontinent system?
Incontinent
- patient has no control over the output of urine
Give an example of a continent system for a bladder diversion
- how it is accomplished?
Kock or Indiana pouch
- patient inserts a catheter into their stoma to drain the urine periodically throughout the day
- 3 loop S and the 2 loop J ileoanal pouches provide continence by using the patient’s ANAL sphincter
Define an enterostomy
ANY surgical procedure that produces an artificial stoma in a portion of intestine
- through the abdominal wall
Describe the consistency of effluent that will pass from an ileostomy
Liquid stool (contains digestive enzymes) - from the ileum
Describe the consistency of effluent that will passs from a colostomy
Generally thicker, semi-formed stool
- from the colon
What is different with a loop colostomy?
Loop colostomys have two openings (stomas)
- proximal end drains stool
- distal end drains mucus
- often a rod is placed through the bowel for support
- stomas are RIGHT BESIDE each other (hard to distinguish)
What is a double-barrel colostomy?
Bowel is surgically severed and the two ends are brought to the abdomen
- consists of two DISTINCT stomas
Why is a double-barrel colostomy used? Is it permanent?
Temporary
- used to let the lower portion of the bowel relax after tumor removal
What is an end colostomy?
- stoma from the proximal end of the bowel
- distal portion of the bowel is either removed or sewn closed
What are the 3 types of continent colostomies?
- J Pouch
- S Pouch
- W Pouch
How does a continent colostomy function?
The anal sphincter valve is used to create a pouch inside the body by the abdominal wall
- patient would drain the pouch 3-4 times a day
How often should the skin barrier of an ostomy pouching system be changed?
Every 3 - 5 days
What are key points of post-op nursing care for an ostomy?
- listen for bowel sounds
- look at skin for leakage or breakdown
- look at stoma for color, swelling, trauma, and healing
What color should a healthy stoma be?
Moist and reddish pink
Approximately how long will it take for the stoma to start functioning following an ostomy surgery?
Approx 5 - 7 days
What is a prolapsed stoma?
Occurs when the bowel protrudes through the stomal opening in the skin to a greater extent than was anticipated
What are some common post-op complications in regards to ostomies?
- skin irritation
- paralytic ileus
- electrolyte imbalances
- infection
- bowel obstruction
- hemorrhage
- necrosis
True or False:
Pouching an ostomy is considered a sterile procedure
False
Define a proctocolectomy
Removal of the rectum with all or part of the colon (large intestine)
What are the features of ulcerative colitis?
- affects only colon (distal end)
- affected area is continuous
- involves shallow injury to mucosa
What are the features of Crohn’s disease?
- can affect anywhere
- terminal ileum most commonly affected
- segmented inflammatory reaction
What is a fistula?
Two sections of bowel that are connected together
True or False:
To minimize skin irritation, it is important to change the entire pouching system daily so that the area is as clean as possible
False
- the pouch and flange can be kept intact for 3 - 5 days before it needs changing
What do you need to consider when pouching an ostomy (2)?
- Character of fecal effluent
2. Location and condition of the stoma
Define stoma (according to NURS 2020 quiz)
A stoma is a creation of an opening where the intestine is brought through the abdominal wall and sutured to the skin
- may be permanent or temporary
- fecal matter is diverted through the stoma
What are the two common types of ostomies?
- Ileostomies
2. Colostomies
Why are stomas created (4)?
- Cancer
- Diverticulitis
- Trauma
- Crohn’s disease
When is the best time to change a pouch?
In the morning
- before the gut starts to digest food
When is it appropriate to use ostomy powder?
Used to absorb moisture on the skin prior to applying an ostomy appliance
When is it recommended to use an ostomy paste?
When a stronger seal under the flange is required
- if the abdomen is misshaped or if appliance is difficult to apply
What 5 things need to be included in your documentation after pouching an ostomy?
- Condition of the stoma
- Condition of peristomal skin
- Appliance used
- Output (effluent)
- Patient’s coping abilites
What are three considerations when pouching a ureterostomy?
- Plan to change the appliance first thing in the morning
- Assess for signs and symptoms of UTI
- Use a drainable bag
True or False:
Holding the patient’s abdominal skin while removing the pouch helps to avoid skin irritation
True
True or False:
At night, the ureterostomy pouch should be connected to a bedside urinary bag for continuous drainage
True
How often should an ureterostomy pouch be emptied?
4 - 6 times a day
- to prevent any additional strain on the flange from a filled ostomy bag
A patient is diagnosed with colorectal cancer. What type of ostomy is the client most likely to have after surgery?
End colostomy (permanent colostomy)
What two parts of the IV tubing must remain sterile?
- Spike
2. End of tubing - luer lock
What is the rationale for filling the drip chamber before running solution into the tubing?
Avoids getting air into the tubing
How do you remove air that is trapped in the back check valve?
Turn back check valve upside down
- open roller clamp and allow fluid to run through it
- if air bubbles become lodged, tap the valve with the end of a pen
How do you remove air that is trapped between the upper port and the back check valve?
- Clamp off tubing
- Kind tubing just BELOW the port
- Swab upper port with alcohol swab
- Insert sterile luer tip needle and pull back on the plunger (drawing in air and fluid)
- When all air is removed, un-kink the tubing
- Regulate flow using rollar clamp
How do you remove air that is trapped between the upper and lower ports?
- Slowly regulate the roller clamp to move the air and fluid to approx. 2 inches above the bottom port
- Kink the tubing below the bottom port
- Move the roller clamp wide open
- Swab the bottom port with alcohol
- Insert a sterile luer lock needle into the port and draw out the air and fluid
- Close clamp, un-kink tubing and regulate flow using roller clamp
After all the air is removed from the tubing, what do you place on the end of the tubing to maintain sterility?
A dead ender
What are the three pieces of information that need to be on an IV tubing label?
- Start date and time
- End date and time
- Initials
