Lower GI: Ostomies

Question 1

What are ostomies?

Answer 1

• Surgical procedures that reroute part of the intestine through the abdominal wall, forming a stoma.
• Location of stoma dictates name.

Question 2

What are the two main types of ostomies?

Answer 2

• Ileostomy

* Colostomy

Question 3

What are the two types ileostomies?

Answer 3

• Ileostomy (at the ileum)

* Jejunostomy (at jejunum)

Question 4

Describe an ileostomy?

Answer 4

• Created from the ileum
• Stoma will be located in the LRQ
• Bowel movements are loose/watery
• Ileostomy bag required
• Skin care essential

Question 5

Describe jejunostomy.

Answer 5

• Created from the jejunum
• Stoma will be located in the URQ
• Bowel movements are loose/watery
• Ileostomy bag required
• Skin care essential

Question 6

What are the four types of colostomies?

Answer 6

• Ascending
• Transverse (double-barreled)
• Descending
• Sigmoid

Question 7

Describe the ascending colostomy.

Answer 7

• Created at the ascending colon
• May be located in RLQ or RUQ pending where colon was removed
• Stool will be loose, but slightly firmer than from ileostomy
• Colostomy bag required
• Skin care essential

Question 8

Describe the transverse (double-barreled) colostomy.

Answer 8

• Two stomas are created at the transverse colon
• Proximal will drain feces, distal will drain mucous
• Often used in such emergencies as intestinal obstruction or perforation as it can be created quickly
• Stool will be semi-solid
• Colostomy bag required
• Skin care risk not as critical as ascending, but still necessary to prevent breakdown

Question 9

Describe the descending colostomy.

Answer 9

• Created at the descending colon
• May be located in LUQ or RLQ pending where colon was removed
• Stool will formed
• Colostomy bag required
• Skin care required, but less at risk for breakdown

Question 10

Describe the sigmoid colostomy.

Answer 10

• Created at section of colon between descending and rectum
• Located at RLQ
• Stool will formed
• Colostomy bag may not be required
• Stool formed and movements can be regulated
• Skin care as necessary

Question 11

Describe J-tube.

Answer 11

• Created @ the jejunum
• Tube will be located in the LUQ
• Used to deliver food/medicine for those not healthy enough to eat by mouth
• Skin and j-tube care required

Question 12

What should a healthy stoma look like?

Answer 12

• A healthy stoma is pinkish-red and moist.
• Your stoma should stick out slightly from your skin.
• It is normal to see a little mucus. Spots of blood or a small amount of bleeding from your stoma is normal.

Question 13

If a stoma is a dusky (darker)-red, what should the nurse do?

Answer 13

• Inform doc, possible circulation issue

Question 14

What is the process of attaching a colostomy/ileostomy bag?

Answer 14

• Clean stoma area
• Apply skin-prep (breathable skin adhesive)
• Apply skin protector
• Apply bag to skin protector

Question 15

A fresh stoma should start to shrink how long post surgery?

Answer 15

• 3-7 days

Question 16

When measuring the stoma, for skin protector placement, how much space do you want between the stoma and the skin protector opening?

Answer 16

• 4mm

Question 17

When changing a colostomy bag, what should you do before throwing it out?

Answer 17

• Make sure you have a replacement bag on hand

Question 18

What is the procedure when a doctor orders dilation of stoma to ensure patency?

Answer 18

• Put on clean gloves
• Jelly on pinky and insert into stoma
• Repeat for ring finger
• Repeat with middle finger

Question 19

True or False

You should empty the colostomy bag after eating.

Answer 19

• False, should be before meal

Question 20

When does a colostomy bag need to be emptied, changed?

Answer 20

• Empty when 1/3 full

* Change ever 2-4 days

Question 21

If an enema is requested through the stoma, what needs to be kept in mind?

Answer 21

• Do not use normal enema kit as you could perforate colostomy
• Request a “cone shaped” enema kit

Question 22

Why should a pt with colostomy avoid raw veggies and skins/peeled fruit?

Answer 22

• They are gas producing

Question 23

Why should a pt with colostomy avoid dairy, high fiber, beans, wild rice and the like?

Answer 23

• They can block up the intestines

Question 24

Why should a pt with colostomy avoid high fat/fried food?

Answer 24

• They are difficult to digest and will produce fatty/foul smelling stool

Question 25

Why should a pt with colostomy avoid onions and garlic?

Answer 25

• Odor can escape stoma

Question 26

Why should a pt with colostomy include yogurt, cranberries, bananas, white rice, buttermilk, tapioca and white toast?

Answer 26

• They are helpful in thickening stool and minimizing odors

Question 27

What is a Kock pouch/ileostomy?

Answer 27

• An internal reservoir for stool storage, made from ileum and attached to the abdominal wall by a special stoma/one-way valve
• No bag required.
• Emptied by inserting a catheter through this stoma

Question 28

What is the education required for the Kock pouch?

Answer 28

• How to do self catheter to empty

* Proper cleaning with clean gloves (don’t need to be sterile) between each use

Question 29

What are bezoars?

Answer 29

• Solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage.
• Bezoars usually form in the stomach, sometimes in the small intestine or, rarely, the large intestine
• Would need to be removed surgically

Question 30

What is a Jejostomy (J) pouch?

Answer 30

• This is done if the entire colon has been removed
• Similar to the Kock pouch, an internal reservoir is created with the intestines and is attached at the anal sphincter allowing normal bowel movement of semi-solid stool