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NRSG 202 > Week 6 - Ostomies, Rectul Tubes, Rectal Meds, Enemas > Flashcards

Week 6 - Ostomies, Rectul Tubes, Rectal Meds, Enemas Flashcards

1
Q

A physician’s order is required for RNs or LPNs to insert what?

A

Flexi-seal device (rectal tube) into appropriate patient

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2
Q

What are the different types of ostomies?

A
  • colostomy
  • ascending colostomy
  • cecumstomy
  • Ileostomy
  • urostomy
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3
Q

in regards to the different types of ostomies describe a colostomy

A
  • transverse/ descending more common

- colon (large intestine) brought through abdominal wall

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4
Q

in regards to the different types of ostomies describe a ascending colostmoy

A

rare

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5
Q

in regards to the different types of ostomies describe a cecumstomy

A

rare/ seen in spina bifida

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6
Q

in regards to the different types of ostomies describe an ileostomy

A

when the ileum is brought through the abdominal wall

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7
Q

in regards to the different types of ostomies describe a urostomy

A
  • 15-20cm segment of ileum converted into conduit

- ureteres anastomosed to one end

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8
Q

What are the indications for a colostomy?

A

emergency/ temporary

  • bowel obstruction
  • abdominal trauma
  • perforated diverticulum

permanent
- obstructing colorectal cancer

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9
Q

What are the types of drainage in regards to colostomy

A
  • semi-liquid to pasty

- semi-formed or formed stool

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10
Q

in regards to nursing care describe the assessment of the stoma

A
  • should be pink/ red, vascular, bleeds easily

- first 72hrs post-op necrosis likely occurs

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11
Q

what is included in the nursing care for a colostomy?

A
  • assessment of stoma
  • assessment of peri-stomal skin
  • protecting the skin and stoma from trauma and effluent
  • empty when 1/3 full or full of gas to prevent leaking
  • change pushing system
  • provide patient teaching on self-care
  • assist patient to adapt psychologically to changed body
  • documentation
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12
Q

in regards to nursing care describe protecting the skin and stoma from trauma and affluent

A

choice of pouching systems and skin protection products

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13
Q

in regards to nursing care describe changing the pouching system

A
  • depends on stools/ pouching system used (every 3-5 days)
  • either before breakfast or 1-2hrs after
  • establish bowel control with irrigation
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14
Q

describe the diet for people with a colostomy

A
  • do not need to make major changes to diet
  • continue to eat nutritious diet
  • continue to include fibre in diet
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15
Q

describe hydration for people with a colostomy

A
  • increase fluid intake

- more bowel removed more fluid should be taken in

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16
Q

What are the indications for an ileostomy?

A

temporary
- protect distal anastomosis in post-op low anterior resection

permanent

  • ulcerative colitis
  • Crohn’s disease
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17
Q

What are the types of drainage in regards to an ileostomy?

A
  • post-op 1200-1800ml/day bilious output

- later average 800ml/day

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18
Q

describe nursing care for ileostomies

A
  • assessment of intake/output and fluid/ electrolyte balance
  • assessment of stoma
  • assessment of peri-stomal skin
  • protect skin/ stoma from trauma
  • empty pouch when 1/3 full
  • change pouch system
  • patient teaching on self-care
  • assist patient to adapt psychologically to changed body
  • documentation
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19
Q

in regards to nursing care for an ileostomy describe the assessment of the stoma

A
  • should be pink/red, vascular, bleeds easily
  • first 72hrs post-op necrosis most likely to occur
  • increased swelling 4-6 weeks after surgery
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20
Q

in regards to nursing care for an ileostomy describe protecting the skin and stoma from trauma, effluent

A
  • stool from ileostomy extremely irritating to skin

- choice of pouching system/ skin protection products

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21
Q

in regards to nursing care for an ileostomy describe changing the pouching system

A
  • drainable pouch usually changed every 3-5 days

- either before breakfast or 1-2hrs after

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22
Q

describe a diet for people with an ileostomy

A

food does not pass through large intestine

  • low residue diet initially
  • insoluble fibre-containing foods introduced slowly
  • increase intake of high potassium foods
  • goal to return to a normal pre-surgical, nutritious diet
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23
Q

describe hydration for people with an ileostomy

A
  • increase fluid intake to replace lost fluids (2-3L/day)
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24
Q

What are some foods to avoid, reduce or eat with caution for people with an ileostomy?

A
  • popcorn
  • nuts and seeds
  • corn
  • bran
  • celery
  • sausage casing
  • drink plenty of fluids if eating these
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25
Q

How do people with ileostomies minimize gas?

A
  • cut down on certain foods
  • chew food well
  • avoid drinking from straw
  • avoid chewing gum
  • use pouch with filter
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26
Q

in regards to cutting down gas for people with ileostomies what foods should they cut down on?

A
  • peas
  • beans
  • legumes
  • veggies in cabbage family (broccoli, cauliflower, Brussel sprouts)
  • eggs
  • beer/ carbonated drinks
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27
Q

How do you minimize odors for people with a colostomy?

A
  • avoid foods that cause odor
  • pouch deodorizers
  • charcoal filters in pouch
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28
Q

What foods should people with ileostomies avoid if they are trying to minimize odours?

A
  • fish
  • eggs
  • onions
  • garlic
  • asparagus
  • cheese
  • fried foods
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29
Q

What are the indications for a urostomy?

A
  • cancer of the bladder
  • neurogenic bladder
  • congenital anomalies
  • strictures
  • trauma to bladder
  • chronic infection with decreased renal function
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30
Q

in regards to urostomies describe the type of drainage that would come out

A
  • urine

- mucous

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31
Q

what is the most common type of urostomy?

A

ileal conduit

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32
Q

describe the ileal conduit

A

one end of segment of ileum attached to ureters and other end used to make stoma

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33
Q

describe the nursing care for a patient with a urostomy

A
  • assessment of stoma
  • assessment of peri-stomal skin
  • frequent emptying of pouch
  • changing pouch system
  • provide patient teaching on self-care
  • assist patient to adapt psychologically to changed body
  • documentation
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34
Q

in regards to nursing care for a patient with a urostomy describe changing the pouching system

A
  • usually every 2-7days
  • before fluids in am or 2hrs after fluids
  • fitted 7-10 days after surgery for permanent appliance
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35
Q

describe the diet/ hydration for a person with a urostomy

A
  • no dietary restrictions
  • increase fluid intake to keep urine dilute/ minimize formation of kidney stones
  • 2-3L/ day recommended
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36
Q

What are people with a urostomy at an increased risk for?

A

urinary tract infection due to stasis in urinary diversion

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37
Q

How do you minimize the order for a client with a urostomy?

A
  • change pouch regularly
  • change pouch if leaking
  • keep tap on bottom of pouch clean/ dry
  • drink 2-3L/day
  • cleanse night drainage bag
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38
Q

For people with a urostomy what do they use to clean their night drainage bag?

A
  • soap
  • water
  • vinegar/ water
  • hang to dry
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39
Q

What do you need to document each time a pouch is changed for an ostomy?

A
  • volume, color, consistency of drainage
  • condition of peristomal skin
  • stoma size
  • stoma shape
  • stoma colour
  • stoma height
  • products used and any accessories
  • presence of stents, catheters, rods, bridges
  • pre and post-op patient teaching
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40
Q

What are the different types of ostomy surgeries?

A
  • bowel resection
  • Hartman’s resection
  • loop ostomy
  • double barrel stoma
  • urostomy
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41
Q

in regards to the different types of ostomy surgeries describe a bowel resection

A
  • diseased/ damaged section of bowel removed

- does not necessarily result in creation of ostomy

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42
Q

describe the creation of an end ostomy

A
  • single stoma to drain fecal matter

- can be in small or large intestine

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43
Q

in regards to the different types of ostomy surgeries describe a Hartmann’s procedure

A
  • distal portion of bowel left in place
  • may be reversed at a later time
  • stage 1: creation of ostomy
  • stage 2: reversal of ostomy
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44
Q

in regards to the different types of ostomy surgeries describe a loop ostomy

A
  • bowel is not completely cut through a loop of of bowel is brought to skin
  • temporary
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45
Q

in regards to the different types of ostomy surgeries describe a loop ostomy with a bridge

A
  • right after surgery patient will have bridge/ rod to prevent stoma from slipping back into abdomen
  • rod usually removed after 3-7 days
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46
Q

in regards to the different types of ostomy surgeries describe a loop colostomy

A
  • mature loop ostomy bridge removed

2 openings

  • proximal drains stool
  • distal drains mucous
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47
Q

in regards to the different types of ostomy surgeries describe a double-barrel stoma

A
  • similar to loop ostomy

- bowel has been cut into 2 sections

48
Q

post-op urostomy surgery how Long will a patient usually have stents for?

A

5-7 days

49
Q

what are some post approaches to new ostomy patients nurses should be aware of?

A
  • very important to convey acceptance of patient/ ostomy
  • be careful with expression
  • be aware drainage may smell really bad
50
Q

describe immediate postop care for clients with an ostomy

A
  • first few days ostomy emptied while patient in bed
  • more risk for spills
  • position ostomy bag to side
  • rinse pouch with warm water
  • clean edges well before closing
51
Q

What is the nutrition after surgery for patients with an ostomy?

A
  • patient on reduced diet (NPO) as peristalsis returns diet will be advanced
  • patients do not normally need TPN or tube feeds
52
Q

What are the different stoma complications that can arise?

A
  • ischemia/ necrosis
  • stoma prolapse
  • mucocutaneous separation
  • irritant dermatitis
  • contact dermatitis/ allergy
  • folliculitis
  • Candida albicans infection
  • stenosis
  • retracted stoma in skin crease
53
Q

in regards to the different stoma complications, describe ischemia/ necrosis

A
  • stoma should be pink/ red

- refer immediately to ET nurse and notify surgeon

54
Q

in regards to the different stoma complications, describe stoma prolapse

A

if circulation good may be managed by ET nurse

  • reduce swelling
  • use of support garments
  • use of larger pouch

circulation compromised may require surgery

55
Q

in regards to the different stoma complications, describe mucocutaneous separation

A
  • areas of separation at 2-3 o’clock

- managed by ET nurse using principles of wound care

56
Q

in regards to the different stoma complications, describe irritant dermatitis

A
  • caused by leakage of stool/ urine on skin
  • consult ET nurse
  • prevention > change pouching system before leaking
  • management > clean/ dry skin well, apply stomadhesive powder on raw areas
57
Q

in regards to the different stoma complications, describe contact dermatitis/ allergy

A
  • sensitivity/ allergy to one of the products
  • consult ET nurse
  • treat excoriated area to promote healing
58
Q

in regards to the different stoma complications, describe folliculitis

A
  • inflammation of hair follicles

- due to staph infection, shaving hair, removing ostomy appliance pulls hair out

59
Q

in regards to the different stoma complications, describe candida albicans infection

A
  • yeast infection
  • reddened, moist, tender
  • patchy white areas
  • treat with anti fungal medication
60
Q

describe anti fungal powder

A
  • need doctor order
  • initiated by ET nurse
  • sprinkled on skin
61
Q

in regards to the different stoma complications, describe stenosis

A
  • narrowing of stoma/ intestinal lumen
  • may result in bowel obstruction
  • minor stenosis managed with low-residue diet/ increased fluids
  • serious stenosis requires surgery
62
Q

in regards to the different stoma complications, describe retracted stoma in skin crease

A
  • consult ET nurse
  • may need stoma paste or barrier strips
  • may need convex skin barrier/ stoma belt
63
Q

What are the different types of ostomy appliances?

A
  • bag c attached flange
  • bag c detachable flange
  • moldable opening vs. cutable opening
  • reusable
64
Q

describe drainable two-piece ostomy pouches

A
  • low profile

- after surgery don’t want to push to hard so low pressure adapters used

65
Q

when do you not need to wear a low pressure adapter anymore?

A

after stoma healed

66
Q

what can a drainable one-piece ostomy pouch come with?

A
  • pre-sized holes
  • cut-to-fit holes
  • moldable holes
67
Q

when is a closed-ended pouch used?

A
  • sigmoid colostomies
  • stool well formed
  • person only have 1 bowel movement per day or less
68
Q

how can closed-ended pouches also come?

A
  • 2-piece system

- only pouch removed and discarded each time

69
Q

What are the steps in emptying an ostomy?

A
  • empty
  • rinse
  • clean edges
  • close
70
Q

describe urostomy appliances

A
  • have all same options as colostomy bags

- have urine drain at bottom

71
Q

whats something nifty about urostomy appliances that you can do at night?

A
  • hook up to straight drainage system like catheter

- may need an adapter

72
Q

describe stomadhesive powder

A
  • not medication/ no prescription needed
  • any RN can use
  • helps keep skin dry/ keep pouching system well adhered to skin
73
Q

describe stoma paste

A
  • used to fill gaps/ creases
  • get a good seal/ protect skin
  • not everyone needs paste
74
Q

describe barrier strips and rings

A
  • like stoma paste

- used to fill in gaps/ creases

75
Q

describe a hernia

A
  • loop of intestine protrudes through the abdominal wall
  • conservative treatment = support
  • surgery if blood supply is compromised
76
Q

describe a hernia belt

A
  • applies support around stoma
  • skin barrier wafer of ostomy pouch goes on first then hernia belt
  • pouch snaps on the skin barrier wafer outside belt
77
Q

when can stoma caps be used?

A
  • people who have formed bowel movements at specific times
  • bathing
  • swimming
  • sex
78
Q

What is the goal of ostomy irrigation?

A
  • train bowel to empty at the same time every day
79
Q

are there any restrictions with colostomies and medications?

A
  • fewer restrictions since part of large intestine remains
80
Q

what are the restrictions in regards to medications for ileostomies?

A
  • avoid enteric coated tablets/ extended release meds
  • take liquid medication or crush tablets
  • observe for incompletely dissolved pills
81
Q

why might lomotil or loperamide be used when someone has an ostomy?

A

used to slow peristalsis

82
Q

why might psyllium or other fibre products be used when someone has an ostomy?

A

helps manage high output from ileostomies

83
Q

What hight are high, regular and low enemas hung?

A

high - 30-45cm above anus
regular - 30cm above anus
low - 7.5cm above anus

84
Q

what does a cleansing enema promote?

A

complete evacuation of rectum by stimulating peristalsis with large volumes of fluid

85
Q

what are the different types of cleansing enemas?

A
  • hypertonic
  • hypotonic
  • isotonic
  • soap suds
  • usually warmed sollution
86
Q

how much solution should be put in an adult in regards to cleansing enemas?

A

750-1000mL

87
Q

in regards to cleansing enemas what are the different hypertonic solutions that can be used?

A
  • saline

- sodium phosphate

88
Q

in regards to cleansing enemas what are the different hypotonic solutions that can be used?

A
  • tap water
89
Q

in regards to cleansing enemas what are the different isotonic solutions that can be used?

A

normal saline (safest)

90
Q

in regards to cleansing enemas what are the different soap suds solutions that can be used?

A

Castile soap and tap water

91
Q

what are the different types of eneams?

A
  • cleansing
  • carminative
  • oil retention
  • medication
  • return flow
92
Q

in regards to the different types of enemas, describe carminative enemas and provide some examples

A
  • stimulate peristalsis and expel flatus

ex. mg, glycerin, and water

93
Q

in regards to the different types of enemas, describe oil retention enemas. How Long do they need to be retained for?

A
  • feces absorbs oil and becomes softer and easier to pass

- retained for 30mins-3hrs

94
Q

in regards to the different types of enemas, what are some examples of medication enemas and what do they kill?

A

antibiotic - reduces bacteria in bowel

antihelminitic - kills worms, parasites

kayexalate - reduces dangerously high serum potassium levels

95
Q

in regards to the different types of enemas, describe return flow enemas and describe procedure

A
  • expel flatus and relieve abdominal distension

- 100-200ml fluid in/out of rectum/colon repeated 5-6 times

96
Q

What are some potential enema complications?

A
  • mucosal irritation
  • puncture of the colon
  • dehydration
  • fluid electrolyte imbalances
  • circulatory overload
  • decreased bowel/ sphincter tone with overuse
97
Q

when is a rectal exam needed?

A
  • prior to administering enema for constipation

- nurse needs to check for stool in rectum

98
Q

describe rectal med suppositories

A

small torpedo shaped pellets that melt at body temperature

99
Q

what are some examples of rectal med suppositories? when are they used?

A

glycerin - stool softener

bisacodyl - stimulant

acetaminophen - fever, mild-mod pain

diphenhydrinate - nausea/vomiting

valtaren - anti-inflammatory

opium and belladonna - bladder spasms

100
Q

what is the indication for suppositories used as laxative?

A

constipation

- infrequent/ hard stools

101
Q

what is the action for suppositories used as laxative?

A
  • soften feces
  • stimulate nerve endings in rectal mucosa
  • releasing carbon dioxide to distend rectum
102
Q

what is the administration for suppositories used as laxative?

A

best results when retained for up to 30mins

103
Q

what are the potential complications for suppositories used as laxative?

A

trauma to the anal spinster or rectum

104
Q

what is the nursing care for suppositories used as laxative?

A
  • position patient on left side
  • assist as needed
  • documentation
105
Q

what are the indications for a bowel protocol?

A
  • prevent opioid-induced constipation
  • manage constipation where dietary measures have failed
  • previous laxative treatment unsatisfactory
106
Q

what are the contraindications for bowel protocol?

A
  • ileostomy
  • blood in stool/ rectum
  • absence or bowel sounds
  • complete bowel obstruction
  • diarrhea
  • abdominal/ rectal mass unknown origin palpated
  • impaction if present, clear impaction prior to initiating
  • if in doubt contact MD
107
Q

how do you use a bowel protocol?

A
  • complete bowel assessment
  • determine level to start at/ document on MAR
  • document all bowel medications/ interventions
  • subsequent rectal/ abdominal examinations documented
108
Q

when using a bowel protocol how do you determine the level to start at?

A
  • based on bowel pattern
  • time since last BM
  • bowel medication use prior to admin
109
Q

What are the indications for rectal tube use?

A

divert/ contain liquid stool

110
Q

What is the goal of rectal tube use?

A
  • decrease incidence of skin breakdown
  • reduce risk of infection
  • protect wounds
  • improve patient comfort
  • maintain patient dignity
111
Q

What is the criteria for inserting a rectal tube?

A
  • all options for diarrhea have been considered
  • fecal incontinente bag/ appliance has been attempted
  • 3 episodes of fecal incontinence of liquid stool in 12hr period
  • liquid/ semi-liquid stool anticipated for +36hrs
  • patient not mobile
112
Q

what are contraindications for a rectal tube use?

A
  • lower large bowel, rectal, anal surgery within 1yr
  • rectal/anal injury
  • severe hemorrhoids
  • fecal impaction
  • paediatric patient
  • severe rectal/ anal stricture or stenosis
  • suspected/ confirmed rectal mucosa impairment
  • indwelling, external, internal rectal device
  • any need for rectal/ anal procedures
  • any sensitivity/ allergy to components with kit
113
Q

What are potential complications for a rectal tube use?

A
  • rectal trauma/ hemorrhaging

- rectal ulceration secondary to pressure necrosis

114
Q

in regards to nursing care for a rectal tube describe insertion

A
  • assess for fecal impaction/ adequate sphincter tone
  • lubricate/ insert tube well inside rectal vault
  • position device along length of patients leg/ bag below level of patient
115
Q

in regards to nursing care for a rectal tube describe maintenance

A
  • anal skin care
  • change bag prn
  • irrigate as needed with 60mL tap water through port
116
Q

in regards to nursing care for a rectal tube describe removal

A
  • deflate balloon and gently pull out

NRSG 202 (11 decks)

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