GI - Ostomy & Enema Flashcards Preview

Nursing Fundamentals II > GI - Ostomy & Enema > Flashcards

Flashcards in GI - Ostomy & Enema Deck (67):
1

Bowel

refers to the intestines

2

Bowel elimination

final step in the process of digestion

3

Colostomy

the most common stoma made from the large intestine

4

Ileostomy

- ostomy made in the small intestine
- liquid stool most of the time

5

Effluent

the drainage that comes from the stoma

6

Ostomy

- an opening made to allow passage of feces
- surgical opening

7

Impaction

- a collection of hardened feces in the rectum or sigmoid
- leading cause of bowel obstruction

8

Ostomate

a person who has an ostomy

9

Pouch

- device that collects the effluent
- make sure that face plate and appliance match in size

10

Excoriation

- any superficial loss of substance such as that produced on the skin
- face plate is suppose to fix this

11

Irrigation

to introduce fluid

12

Urostomy

into the bladder

13

Double barrel colostomy

temporary, transition of ascending and transverse

14

Ascending Colon

portion of the large intestine that travels up the right side

15

Transverse Colon

mid-portion of the large intestine that goes across abdomen

16

Descending Colon

portion of large intestine that travels down the left

17

Small Intestine

attached to the stomach and the large intestine

18

Reasons for Bowel Ostomy

- An ostomy may be needed when a portion of the colon is diseased and can no longer function related to:
- Trauma - bullet, etc…
- Disease - Chron's or ulcertaive colitis
- Cancer - sometimes temporary

19

External stoma

opening into the intestine

20

Internal pouch

- internal reservoir where rectum would be-formed by folding loops of small intestine and stitching, and internal walls are removed
- stimulate pouch to evacuate
- still see some leakage

21

patient concerns

- Psychosocial burden (self image)
- Afraid of odor (change often, charcoal filter, parsley)
- Afraid of caring for ostomy
- Afraid of accidental drainage
- Sexual relationship concerns
- Swimming (use a rubber band belt to hold it on better)

22

things to remember for ostomy

- Eat at a regular time each day
- 4-6 smaller meals may help establish a regular bowel pattern
- Main dinner at noon may decrease BM at night
- Introduce one food at time
- Chew food completely for digestion
- What gave you gas, constipation and diarrhea before will do the same now

23

Will fresh fruit cause loose stools?

yes

24

How much water should a person drink with an ostomy?

Drink 2-3 quarts of water a day

25

How long should someone with a new ostomy avoid high fiber foods?

6-8 weeks

26

Ileostomy Concerns

- Need fluids, K, Na
- For 4-6 weeks after surgery, limit foods that caused problems prior to surgery
- Stay hydrated

27

Foods that are poorly digested

- May block a narrow stoma:
- Cabbage, lettuce, celery, coconut, nuts, corn, olives, cucumbers, peas, dried fruits, pickles, green peppers, pineapple

28

Foods that thicken stool

Applesauce, pasta, bananas, creamy peanut butter, breads, starchy foods, cheeses

29

Foods that cause diarrhea

Apple juice, prune juice, grape juice, highly seasoned foods

30

Foods that will increase odor

beans, fish, eggs, coffee, onions, beer, asparagus, mustard, cabbage, broccoli

31

Foods that will cause gas

cabbage, onions, fish, broccoli, carbonated beverages, radishes, pickles, cucumbers, large amounts of sweets or vegetables, milk, prunes, apricots, raisins, bananas, wheat products, pan fried foods

32

Reduce Gas

- Avoid swallowing air: gum chewing, straws, cigarettes
- Eat slowly
- Avoid gulping

33

Reduce Odor

- Buttermilk, yogurt, cranberry juice, parsley, spinach
- Charcoal tablets

34

What should a stoma look like?

- deep red
- look pale pink or bluish - call the dr

35

What do you use to clean a stoma?

warm water

36

Irrigation of colostomy

- Fill enema bag-1000cc
- Prime tubing
- Hang enema bag shoulder high
- Sit on toilet or in front on chair
- Irrigation sleeve
- Lubricate cone
- Slow or stop flow if cramping
- 15 minutes most of fluid should pass
- Clamp end and empty in 45 minutes

37

Nursing Diagnosis for colostomy

- Alteration in elimination
- Ineffective Coping
- Alteration in Nutrition
- Altered Role Performance
- Body Image Disturbance

38

Nursing for colostomy

- Remember your attitude will greatly effect your patient.
- Teaching skin care is paramount.
- Be a patient advocate-look for support groups for your patient.

39

Large enema fluid volume

- Infant: 50-150
- Toddler: 250-350
- Child: 300-500
- Adolescent: 500-750
- Adult 750-1000

40

soup suds enema

soap sud enema, mix with enema, more irritation to colon, more results

41

what temp should the fluid be for an enema?

Temp of water should be lukewarm (too hot or cold can cause cramping, damage to rectal tissues, and extreme shock

42

what position should the patent be in for an enema?

sims; left side

43

how high should the solution be for a large flow enema?

12-18 inches above patient

44

what should the patient do when you insert the enema?

take a deep breath

45

how far should the large flow enema be inserted?

3-4 inches

46

what can be done to minimize cramping?

- instill fluid slowly
- lower solution
- stop flow

47

how long should a patient try to hold in the enema?

10-15 minutes

48

cleansing enema

Irritates the colon and rectum, thus stimulates peristalsis

49

cleansing enema - soap suds

dilute 3-5 ml in 1000ml water

50

cleansing enema - saline

- use smaller volume of fluid
-draws fluid into the colon from body tissues (hypertonic)-use commercially prepared enema
-120 ml and instruct to hold 5-7 minutes

51

cleansing enema - tap water

- caution-is hypotonic
- rapid evacuation

52

Retention Enemas

- Solution is retained for a period of time.
- Mineral oil, olive oil, cottonseed oil, liquid petrolatum

53

retention enema - emollient

- Retain for 30-60 minutes
- Oil-lubricates the rectum and colon protecting the intestinal mucous membrane
- Feces absorb oil and become softer and easier to expel

54

retention enema - nutritive

- provides nourishment in temporary or emergency situations: dextrose solution
- last ditch effort to give nutrition to someone who is really sick

55

distention enema

Provides relief from flatus and improves the ability to expel flatus

56

distention enema - return flow

- mild colonic irritation
-100-200ml of enema
-administer then lower and solutions drains back into container-repeat 5-6 times
- changing solution as needed
-stimulates peristalsis and relieves flatus

57

who would you give a distention enema to?

post-op with peristalsis, abdominal surgery

58

distention enema - carminative

- 1-2-3 = 30 g magnesium-60 grams of glycerin-90 ml of water
- Milk and molasses (180-240ml of equal amounts)
- Usually from pharmacy
- Impaction or significant impaction

59

medicated enema

- Reduces bacteria or removes potassium
- Try to retain for 20 to 30 minutes

60

medicated enema - Kayexalate

- removes excess K by exchange for NA ions
- acute or chronic renal failure
- potassium way above 5
- tap water enema
- clings to side of colon and gets rid of extra K
- common in emergency room and long term

61

medicated enema - neomycin

- antibiotic solution to reduce bacteria before bowel surgery
- bowel prep for surgery, reduce infection prior to surgery

62

Administering Suppository

- Lubricate tip, instruct patient to breathe through mouth to relax anal sphincter
- Insert suppos-pointed end-beyond internal sphincter-3-4 inches
- Push suppos against side of rectal wall and do not place in fecal mass (cannot be absorbed)

63

Autonomic Hyperreflexia

- Goose pimples, pounding headache, hypertension, perspiration above level of spinal injury, may lose some level of consciousness

64

what causes autonomic hyperreflexia?

- Caused by digital stimulation
- Finger into rectum, putting in enema tube

65

how to treat autonomic hyperreflexia?

- Stop digital stimulation
- Apply Nupercainal and Xylocaine ointment around anus and rectum as ordered
- Wait around 10 minutes for symptoms to subside

66

Vagal Response

- Decreased pulse rate
- Decreases conductivity at S-A node
- Decreases the rate of firing
- Momentarily and usually returns
- Palpitations
- Faint

67

fecal impaction

- Obtain baseline BP and pulse
- Position on left side and explain
- Double glove-lubricate
- Have pt take deep breath, on exhale gently insert finger (index)
- Gently remove stool by breaking up mass
- There might be some bleeding and should discontinue quickly
- Allow pt to rest