Week 6: Ostomies, Rectal Tubes, Rectal Medications and Enemas Flashcards
1
Q
Types of Ostomies
A
- Colostomy
- Ascending colostomy
- Cecumstomy
- Ileostomy
- Urostomy
2
Q
What is a colostomy
A
when the colon (large intestine) is brought through the abdominal wall
3
Q
What is an ileostomy
A
when the ileum is brought through the abdominal wall
4
Q
Colostomy indications
A
Bowel obstruction
abdominal trauma
perforated diverticulum
obstructing colorectal cancer
5
Q
Colostomy types of drainage
A
semi-liquid to pasty, semi formed or formed stools
6
Q
Colostomy Nursing Care
A
- Assessment of the stoma
- Assessment of peri-stomal skin
- protecting the skin and stoma from trauma and effluent
- changing the pouching system
- Providing patient teaching on self care
- Assisting the patient to adapt psychologically to a changed body
- Documentation
7
Q
Diet for colostomy
A
since most of the intestine remain intact:
- people do not need to make major changes to diet
- continue to eat a nutritious diet
- continue to include fibre in the diet
8
Q
Hydration for colostomy
A
increase fluid intake
the more bowel that is removed, the more the patient should increase fluid intake
9
Q
Ileostomy indications
A
to protect distal anastomosis in post op low anterior resection
ulcerative colitis
chrons disease
10
Q
Ileostomy types of drainage
A
post op 1200-1800mL/day bilious output
later average of 800ml/day
11
Q
Ileostomy Nursing care
A
- Assessment of intake/output and fluid/electrolyte balance
- Assessment of stoma
- Assessment of peri-stomal skin
- protecting skin and stoma from trauma, effluent
- Changing pouching system
- Proving patient teaching on self care
- Assisting in patient psychologically adapting
- Documentation
12
Q
Diet for people with an ileostomy
A
since food does not pass through the large intestine:
- low residue diet initially
- insoluble fibre containing foods introduced slowly
- goal to return to a normal pre surgical, nutritious diet
13
Q
Hydration for ileostomy
A
increase fluid intake to replace lost fluid (may need 2-3 litres per day)
people also lose electrolytes so increase intake of high potassium foods
14
Q
Foods to avoid with an ileostomy
A
popcorn
nuts and seeds
corn
bran
celery
sausage casing
15
Q
How to minimize gas with colostomy/ileostomy
A
Cut down on:
- peas beans legumes
- cabbage veggies
- eggs
- beer and carbonated drinks
other:
- chew food well
- avoid drinking straws
- avoid chewing gum
- use a pouch with a filter
16
Q
How to minimize odors for people with a colostomy
A
Avoid fish, eggs, onions, garlic, asparagus, cheese, fried foods
use pouch deodorizers
charcoal filters in the pouch
17
Q
Why do ileostomies have less odor
A
fewer bacteria are present
18
Q
Urostomy indications
A
Cancer of the bladder
neurogenic bladder
congenital anomalies
strictures
trauma to the bladder
chronic infections with decreased renal function
19
Q
Urostomy types of drainage
A
urine, mucus
20
Q
Most common types of urostomy
A
ileal conduit
21
Q
what is an ileal conduit
A
one end of the segment of the ileum is attached to the ureters and the other end is used to make the stoma
22
Q
Urostomy Nursing Care
A
- assessment of the stoma
- Assessment of peristomal skin
- frequent pouch emptying to prevent leaking
- changing pouching system
- providing patient self care teaching
- assisting with psychological changes
- Documentation
23
Q
Diet for urostomy
A
no dietary restriction just continue with nutritious diet
24
Q
hydration urostomy
A
increase fluid intake to keep urine dilute and minimize the formation of kidney stone (2-3L/day)
25
what is a increased risk with urostomy
UTI due to stasis in the urinary diversion
26
How to minimize odor for a pt with a urostomy
change pouch on regular basis
if the pouch begins to leak, change it right away
leep teh tap on the bottom of the pouch clean and dry
drink 2-3L of water/day
cleanse night drainage bag (soap and water, then vinegar and water and hang to dry)
27
What to document each time an ostomy is changed?
Volume, colour, consistency
condition of peristomes skin
stomas size
stoma shape
stoma colour
stoma height
products used
presence of stents, catheters, rods, or brisges
pre and post opt teaching
28
Types of Ostomy Surgery
Bowel resection
Hartman's resection
Loop Ostomy
Double barrel stoma
Urostomy
29
What is a bowel resection
diseased/damaged section of the bowel is removed
does not necessarily result in the creation of an ostomy (may be possible to rejoin the bowel)
30
What is Hartmann's procedure
distal portion of the bowel left in place
may be reversed at a later time
Stage 1: creation of the ostomy
Stage 2: reversal of the ostomy
31
What is a loop ostomy?
Bowel is not completely cut through a loop of bowel is brought to the skin
usually temporary
32
What is a loop ostomy with a bridge
right after surgery, the patient will have a bridge or rod to prevent the stoma from slipping back into the abdomen
usually removed after 3-7 days
33
What is a loop colostomy
mature loop ostomy
bridge is removed
2 opening
1. proximal drains stool
2. distal drains mucus (called a mucous fistula)
34
What is a double barrel stoma
similar to a loop ostomy but the bowel has been cut into 2 sections
35
What is a urinary diversion surgery
1. Urostomy: after surgery the patient will usually have stents for 5-7 days
2. Cutaneous ureterostomy
3. Nephrostomy
36
What is a post of approach to new ostomy patients
very important to convey acceptance of the patient and the ostomy
be careful of your expression - dont give the impression you are disgusted
be aware that the drainage from new ostomies may smell really bad
37
Immediate Post op care for ostomies
first few days emptied in bed:
more risk for spills
position ostomy bag to the side
rinse pouch with warm water
clean the edges well before closing
38
What nutrition is post surgery
reduced diet or NPO, but as peristalsis reuturns diet will be advanced
pts do not normally need TPN or tube feeds
39
What is stoma ischemia or necrosis
stoma Is black from dead tissue instead of pink or red
refer immediately to ET nurse and notify surgeon
40
What is stoma prolapse
is circulation is good, may be managed by ET nurse:
- reduce swelling
- use of support garments
-use of larger pouch
if circulation is compromised, may require surgery
41
What is mucocutaneous separation
usually managed by ET nurse using wound principals
42
What is irritant dermatitis
caused by leakage of stool or urine on the skin
consult ER nurse
change pouching system before leaks for prevention
clean and dry skin well, apply stoma adhesive powder on raw areas
43
What is contact dermatitis/allergy
This is a sensitivity or allergy to one of the products
consult ET nurse, there are many products made out of different materials
then treat the excoriated area to promote healing
44
What is folliculitis
inflammation of the hair follicles - present as a bumpy. red rash
usually due to a staph infection
often due to shaving hairier when removing the ostomy appliance and hair pulls out
45
What is Candida albicans infection
yeast infection
reddened moist tender
may have patchy white areas
treat with an antifungal medication
46
What is antifungal powder used for (Nystatin powder)
yeast infections
usually initiated by ET nurse
need doctors order - its a medication
47
What is stenosis
narrowing of the stoma or intestinal lumen
may result in bowel obstruction
minor stenosis may be managed with a low residue diet and increased fluids
serious stenosis requires surgery
48
Retracted stoma in a skin crease
consult with ET nurse
may need to use stoma paste or barrier strips
may need a convex skin barrier and stoma belt
49
Types of ostomy appliances
bag with attached flange
bag with detachable flange
moldable opening vs curable opening
reusable (can empty bag of contents) vs disposable
50
Two piece ostomy pouches
Many pouches now have a very low profile
after surgery we dont want to press too hard therefore low pressure adapters are used
51
One piece ostomy pouch
Can come with:
pre sized holes
cut to fit holes
moldable holes
52
Close ended pouch
used for sigmoid colostomies where the stool is well formed, and teh person may only have 1 bowel movement per day (or less)
also comes in 2 pieces where only the pouch is removed and discarded each time
53
Steps to emptying ostomy
1. Empty
2.Rinse
3. Clean edges
4. Close
54
What can urostomy's use at night
can be hooked up to a straight drainage system (like a catheter)
55
Stomadhesive powder
not a medication - doesnt need a doctors order
any knowledgable RN can use
helps to keep skin dry and keep pouching system well adhered to the skin
56
Stoma Paste
used to fill in gaps and creases
to get a good seal and protect the skin
not everyone needs paste
57
What are barrier strips and rings
like stoma paste, used to fill in gaps and creases
58
Steps to changing an ostomy pouch
hand hygiene
position pt
determine how long in place
assess for pain
assemble supplies
clean pad down and gloves
assess for leakage
assess for amount in bag
remove old one and cleanse area
cut opening on skin barrier if needed
apply prouct
apply pouch
59
What is a hernia
A loop of intestine protrudes through the abdominal wall
surgery if blood supply is compromised
60
What is a hernia belt
applies support around th stoma
skin barrier then belt and pouch snaps to skin outside barrier
61
Stoma cap
can only be used for people who have formed bowel movements at specific times of the day
can be used for bathing, swimming or sex
62
ostomy irrigation
goal is to train the bowel to empty at the same time everyday
habituation of the bowel takes 3 to 6 weeks
not all pts can be managed with irrigations
63
What meds should be avoided with ileostomies
enteric coated tablets and extended release medications
64
What medications are good for ileostomies
liquid medications or to crush tablets
65
What medications may be used to slow peristalsis
Lotomil or Loperamide
66
What medications may be helpful to manage high output from ileostomies
Psyllium or other fibre products
67
What is a high enema
30-45 cm above anus
68
What is a regular enema
30 cm above anus
69
What is a low enema
7.5 cm above anus
70
What are cleansing enemas
1. Hypertonic saline or sodium phosphate
2. Hypotonic - tap water
3. Isotonic - NS (SAFEST)
4. Soap suds - Castile soap and tap water
usually warmed solution (750-1000mL)
71
What is a carminative enema
to stimulate peristalsis and expel flatus (60-80mL)
72
What is an oil retention enema
lubrication of the rectum and colonl faces absorb the oil and become softer and easier to pass
retained 30 mins to 1 hour
73
what is a medication enema
Antibiotic (reduce bacteria before surgery)
antiheliminitic (kill worms/parasites
Kayexelate (reduces dangerously high serum potassium levels
74
What is a return flow enema
to expel flatus and relieve abdominal distension
100-200mL fluid in/out of rectum/colon repeated 5-6 times
75
What are potential enema complications
mucosal irritation
puncture of the colon
dehydration
fluid electrolyte imbalance
circulatory overload
decreased bowel/sphincter tone with overuse
76
How should a patient be positioned for an enema
left side with right knee flexed
77
what are suppositories used for
constipation
softening the feces
stimulate nerve ending in the rectal mucosa
releasing carbon dioxide to distend the rectum
78
potential suppository complications
trauma to the anal sphincter or rectum
79
How to use bowel protocol
1. complete bowel assessment
2. Determine level at which to start
3. document all bowel medications and interventions administered and bowel movement information on mar and notes
4. subsequent rectal/abdominal examinations to be documented on mar and notes
80
Rectal tube indications
to divert and contain liquid stools
81
Rectal tube goals
decrease incidence of skin breakdown
reduce risk of infection
protect wounds
improve patient comfort
maintain pt dignity
82
Criteria for insertion of a rectal tube
1. all options for diarrhea have been considered
2. fecal incontinence bag/appliance has been attempted + unsuccessful
3. 3 episodes of real incontience of liquid stool in a 12hr period
4. liquid or semi liquid stools longer than 36 hours
5. pt is not mobile to make it to bathroom
83
Rectal tube contraindications
lower large bowel, rectal, anal surgery within the last year
recta or anal injury or severe hemorrhoids
fecal impaction
pediatric patients
severe rectal or anal strictures or stenosis
suspected or confirmed rectal mucosa impairments/rectal or anal tumour
any indwelling, external or internal rectal device
any need to rectal or anal procedures
any sensitivity to allergy to components within the kit
84
potential complications with rectal tubes
trauma/hemorrhaging
rectal ulceration secondary to pressure necrosis
