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NURS 205 > lecture 16: Ostomy Care > Flashcards

lecture 16: Ostomy Care Flashcards

1
Q

role of the NSWOC in continence care

A
  • assessment and identification of various types of urinary and fecal incontinence and bladder & bowel dysfunction
  • recommendation of conservative measure to manage incontinence
  • selection of containment products/devices
  • referral to other services
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2
Q

role of NSWOC in ostomy care pre-operatively

A
  • counseling
  • family support
  • stoma site selection and marketing
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3
Q

role of NSWOC in ostomy care post-operatively

A
  • assess stoma visibility
  • assess ostomy management
  • fitting of pouching system
  • patient education
  • prepare for discharge
  • connection w community care and supports
  • funding
  • ongoing assessment in community
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4
Q

what is an ostomy

A

surgical opening oten exteriorized for the elimination of body waste

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5
Q

what is a fecal ostomy

A

surgical procedure that reroutes the normal movement of bowel contents out of the body when the bowel is diseased or removed

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6
Q

urinary ostomy

A

surgical procedure that reroutes the normal movement of urine when the bladder is removed

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7
Q

what are the 3 most common ostomies

A
  1. colostomy
  2. ileostomy
  3. urostomy
  • can be temp or permanent
  • usually digestive and urinary tracts
  • any part of the anatomy
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8
Q

what is an ileostomy

A
  • surgically created opening into the small intestine through the abdomen
  • small intestine and colon have been removed or bypassed
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9
Q

what stoma site, output, and construction does an ileostomy have

A

site: RLQ
construction: end or loop
output: 650ml-900ml (liquid to pasty consistency)

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10
Q

when do you usually empty pouch for an ileostomy

A

empty 6-8 times per day

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11
Q

what is a colostomy

A
  • surgically created opening into large intestine through abdomen
  • section of colon have been removed or bypassed
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12
Q

colostomy site, output, and construction

A

site: LLQ
construction: end or loop
output: 200-600ml (thick paste to semi-formed)

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13
Q

when do you empty colostomy pouch

A

1-2 times per day

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14
Q

what is a ileal conduit (urostomy)

A
  • surgically created opening to drain urine
  • section of ileum is used as a pipeline for urine to leave body, then remaining intestine is reconnected
  • new section is sewn shut on one side, and ureters are connected. end of bowel brought through abdominal wall to create stoma
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15
Q

urostomy site, construction, output

A

site: RLQ
construction: end
output: min 800ml/24hr
(clear yellow urine w small amounts of mucus)

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16
Q

how often should you empty a urostomy pouch

A

every few hrs

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17
Q

reason for ostomy surgery

A
  1. CANCER
    - colon, rectum, bladder, gyne
  2. TRAUMA
    - stabbing, accident
  3. DIVERTICULITIS
  4. INFLAMMATORY BOWEL DISEASE
    - ulcerative colitis
    - crohn’s disease
  5. GENETIC CONDITIONS
  6. CONGENITAL ANOMALIES AND NEONATE COMPLICATIONS
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18
Q

5 anatomic ostomy locations

A
  • transverse colostomy
  • right colostomy
  • ileostomy
  • jejunostomy
  • left colostomy
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19
Q

describe stomas

A
  • no nerve endings in the stoma, ppl w an ostomy cannot feel when gas/stool/urine is passing
  • thin layer of mucus coats bowel
  • oval or round, can be swollen for 1st 6-8 weeks after surgery
  • bleeds easily
  • stitches dissolve in 2-3 weeks
  • stoma should be red, warm, moist
20
Q

no sphincter =

A

no control over flow of stool or urine

21
Q

types of stomas

A
  • brooke ostomy
  • end ostomy
  • double-barrel
  • mucus fistula
  • loop ostomy
  • vent “blow-hole”
22
Q

how are support rods used in the surgeries

A
  • surgeon preference/technique
  • stay in place for 5-7 days then removed by NSWOC or surgeon
  • prevent retraction and allow mucocutaneous junction to heal
  • limit patient involvement/self-care
23
Q

hartmann’s procedure

A

removal of affected sigmoid colon while leaving an over-sewn internal rectal stump; ostomy can be reversed at a later date

24
Q

abdominal perineal resection

A

removal of rectum and diverting w a colostomy, permanent procedure

25
Q

colectomy

A

removal of colon, leaves rectum intact; permanent or temporary ileostomy

26
Q

proctocolectomy

A

removal of colon and rectum; permanent end ileostomy and perineal incision

27
Q

ileal pouch anal anastomosis

A
  • pelvic pouch procedure or j-pouch constructed of ileum and sewn to the anal canal
  • only offered for ulcerative colitis and FAP, not Crohn’s
28
Q

low anterior resection

A
  • removal of rectal cancer and anastomosis of remaining large bowel
  • temporary loop ileostomy is created to divert stool rom anastomosis
29
Q

total pelvic exenteration

A

removal of reproductive organs, bladder, affected bowel w resulting fecal ostomy as well a urinary ostomy, permanent procedure

30
Q

anterior pelvic exenteration

A

removal of reproductive organs and bladder w resulting ileal conduit while leaving bowel intact; permanent procedure

31
Q

stoma site selection

A
  • identifies areas to avoid
  • allows for visualization of the abdomen in multipple positions for adequate adhesion and visibility
  • allows for “trial” for patient under their own clothing
  • marking is best practice!
32
Q

stoma assessment is done

A

Q4hr x Q48hr then Qshift

33
Q

stoma complications: necrosis

A

impaired blood low to/from the stoma that changes viability and causes stoma death

34
Q

stoma complications: mucocutaneous separation

A

dehiscence btwn stoma and peristomal skin

35
Q

stoma complications: prolapse

A

stoma becomes longer/sticks up further than normal

36
Q

stoma complications: retraction

A

stoma no longer protrudes and is sunken into the abdomen

37
Q

stoma complications: stenosis

A

lumen/stoma opening becomes narrowed

38
Q

stoma complications: laceration

A

cut on stoma

39
Q

stoma complications: malignancy

A

tumor growth on the stoma or surrounding skin

40
Q

peristomal skin complications

A
  • mechanical trauma
  • skin allergens
  • irritant or contact dermatitis
  • infection
  • diseases and dermatological skin conditions
  • hernia
41
Q

what do we do when we see paristomal skin breakdown? if leakage occurs what do we not do? what are the next steps if you were an RN seeing this?

A
  • do not ignore skin breakdown
  • if leakage occurs, do not reinforce a leaking system
  • re-fit accordingly
  • seek assistance from NSWOC nurse
42
Q

challenges in ostomy care in general

A
  • poorly created or sited ostomy
  • skin breakdown due to contact w effluent
  • lack of knowledge about peristomal skin disorders and ostomy management
  • delay in obtaining intervention from NSWOC/ostomy nurse
  • expensive
  • limited help available
43
Q

nursing goals for ostomy managemet

A
  • skin protection
  • containment of effluent
  • odour control
  • patient comfort
  • accurate measurement of effluent
  • pt mobility
  • ease of care
  • cost containment
44
Q

ostomy supplies

A
  • skin barriers (flat vs convex)
  • pouching sys (1 pc vs 2 pc, type of pouch)
  • belts
  • convex inserts/built-in/rings
  • pouch covers
  • bedside drainage sys
  • clamp
  • deodorants
45
Q

life after ostomy surgery

A
  • pt’s usually back to work 4-6 weeks after surgery
  • independent w emptying and changing the pouch
  • fluid intake
  • med changes
  • minor clothing alterations or preferences
  • minor diet alterations
  • need to rebuild core and pelvic floor strength
46
Q

most common cause of skin breakdown is due to…

A

leakage and frequent changes

47
Q

would you add additional adhesives onto peristomal skin conditions

A

no!

NURS 205 (18 decks)

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