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NURS 522 > nurs 522 postoperative care of patient with fecal urinary diversion > Flashcards

nurs 522 postoperative care of patient with fecal urinary diversion Flashcards

1
Q

Ileal Conduit

A

RLQ
Due to invasive bladder cancer, neurogenic bladder, refractory interstitial cystitis
Proximal end of small bowel closed, distal end creates stoma, ureters inserted into sewn end of conduit

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2
Q

Sigmoid Conduit

A

LLQ
Pre-existing small bowel disease, damage to small bowel 2nd to pelvic radiation
Proximal end of small bowel closed, distal end creates stoma, ureters into tense muscular is of sigmoid conduit = antireflux
Stents from renal pelvis to 4” beyond stoma opening
Not a reservoir

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3
Q

Ileal / Sigmoid Conduit Management

A

Urine samples taken from stents

Clean w/ white vinegar daily

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4
Q

Vesicostomy

A

Above pubic bone
Due to spina bifida (myelomeningocele), Prune Belly Syndrome, bladder exstrophy
Temporary
Bladder sutured to ABD skin as flush stoma
Urethra may or may not be closed off
Use wicking diaper

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5
Q

Ureterostomy

A

Uncommon
At anatomic location of ureter: btwn last rib and iliac crest (posterior)
2nd to megaureter
R, L, B/L ureters sutured to skin surface
May become retracted or stenotic

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6
Q

Uretero-sigmoidostomy

A

No stoma
2nd to bladder exstrophy in newborns or bladder cancer
Ureters implanted into sigmoid colon
Urine mixes w/ feces, expelled via anus

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7
Q

Indiana Pouch (Cutaneous Continent Diversion)

A

RLQ
Bladder cancer, neurogenic bladder, colon cancer
ABD reservoir from distal ileum and ascending colon
Stoma w/ FLAP valve = 0 reflux
Urine stored in reservoir/emptied w/ catheter
600 - 1000 mL capacity

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8
Q

Kock Pouch

A 
RLQ
Bladder cancer, neurogenic bladder
ABD reservoir from distal ileum and ascending colon
Stoma w/ NIPPLE valve = 0 reflux
Continence mechanism 2nd nipple valve
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9
Q

Roy Adaptation Model

A

People as adaptive systems w/ biological and physical processes used to adjust
Level of adaptation affect’s ability to respond + or - to situation

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10
Q

Orem’s Self-Care Theory

A

Meeting self-care needs of pt while assisting to develop self-care behaviors
Wholly compensatory, Partly compensatory, Supportive Education System

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11
Q

PLISSIT Model

A 
Permission (Giving permission)
Limited Information (provide and understand limited info)
Specific Suggestions (beyond WOC scope)
Intensive Therapy (beyond WOC scope)
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12
Q

Indications for Urinary Diversion

A

Bladder removed or bypassed
Temp. if urologic procedures
Perm. if removal of bladder
Most common for transitional cell cancer of bladder
Less common for neurogenic bladder, prostate cancer, interstitial cystitis, radiation cystitis, exenteration 2nd to rectal or cervical cancer

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13
Q

Urine eliminated via: urethra

A

Orthotopic neobladder

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14
Q

Urine eliminated via: continent catheter stoma on skin

A

Indiana pouch
Mitrofanoff
Kock pouch

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15
Q

Urine eliminated via: incontinent stoma on skin

A

Ileal or colon conduit
Urostomies
Vesicostomy

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16
Q

Cystectomy

A

Removal of bladder

Radical cystectomy if lymph node dissection

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17
Q

Bladder Cancer

A

Transitional cell (urothelial) carcinoma #1
3:1 male to female ratio
Diagnosis by resection of tumor
Gross hematuria, urgency/freq/pain w/ urination

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18
Q

Bladder Cancer Management

A
  • grade/noninvasive: chemo

+ grade/recurrent/invasive: Radical cystectomy

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19
Q

Bladder Cancer Risks

A

Smoking, paint and dye chemicals, chronic indwelling cath

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20
Q

Radical Cystectomy

A

Males: Bladder, prostate, pelvic lymph removed
Female: Bladder, uterus, fallopian tubes, ovaries, and anterior vagina

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21
Q

Ileal Conduit

A

Incontinent
Proximal small intestine closed, ureters implanted, distal end to skin
Bladder CA, urinary fistula, neurogenic bladder, refractory cystitis, inability to manage continent reservoir
(+)Simple, - complications
(-)Prior radiation, obesity, renal deterioration, pouching system required

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22
Q

Colon Conduit

A

Incontinent
Colon closed, ureters implanted, distal end to skin
Bladder CA, urinary fistula, neurogenic bladder, refractory cystitis, inability to manage continent reservoir, small bowel disease, pelvic radiation
(+) - risk of stomal stenosis
(-) Renal deterioration, pouching system, large stoma

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23
Q

Orthotopic Neobladder

A

ContinentIleum used, ureters implanted, distal connected to urethra to allow voiding
Bladder CA, urinary fistula, neurogenic bladder, refractory cystitis
Cancer-free urethra/functional sphincter needed
(+) Improved cosmesis, 0 stoma, void via urethra
(-) Renal deterioration incomplete emptying, incontinence possible

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24
Q

Indiana Pouch

A

Continent
Ileocecal used, ureters implanted, ileocecal valve used for continence, Catheterization via ABD wall stoma
Bladder CA, urinary fistula, neurogenic bladder, refractory cystitis
(+) 0 pouch, small stoma
(-) Renal deterioration, pt capable of self-cath, inability to cath is emergency

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25
Q

Neurogenic Bladder

A

Impairment of central and peripheral nervous system
2nd to stroke, MS, SCI, DM, post-surgical injury
s/s: incontinence, retention, + pressure storage of urine
Urinary diversion last resort

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26
Q

Radiation Cystitis

A

Radiation induced damage to bladder and sphincter
s/s: incontinence, bleeding, pain w. bladder filling
Ileal conduit

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27
Q

Interstitial Cystitis

A

s/s: pelvic/bladder pain, urgency, frequency, nocturia
Ulcerations, petechial hemorrhages on xray
If refractory: urinary diversion
Pain not cured by surgery

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28
Q

Suprapubic catheter

A

Change Q4 weeks
If strictures or failed reconstruction
Some pt have urinary diversion to avoid indwelling cath

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29
Q

Pouchitis

A 
Urine changes (odor, color, hematuria, mucous), pain, fever, malaise, difficult catheterizations
tx: antibiotics, irrigation
30
Q

Hyperchloremic metabolic acidosis w/ hypokalemia

A

2nd to prolonged urine contact w/ mucosa
Na/Cl reabsorbed via bowel wall
Bicarb/K lost

31
Q

Prune Belly Syndrome

A

Absence, deficiency, hypoplasia of ABD musculature
Co-existing disorders: hypotonic bladder and dilated ureters
s/s: prune-like ABD skin
tx: Prevent UTI, vesicostomy, ureterostomy, pyelostomy, continent urinary diversion

32
Q

Mitrofanoff Continent Diversion

A

Allows bladder drainage if voiding/self-cath not possible
0 pouch or indwelling cath
Creates channel into bladder for self-cath
Made from appendix or small bowel, 1 end tunneled into bladder wall to create valve, other end passes into ABD wall for stoma
RLQ
For spina bifida, prune belly, exstrophy of bladder, neurogenic bladder

33
Q

Myelomeningocele

A

Open neural tube defect, spina bifida
s/s: depend on location, hydrocephalus, bladder/bowel dysfunction
tx: bladder decompression w/ intermittent cath, vesicostomy, continent urinary diverson, anticholinergics

34
Q

Neurogenic Bladder

A

At or below micturition center (S2-S4)
SCI or myelomeningocele= flaccid or atonic bladder
Pyelonephritis (kidney infections)

35
Q

Neurogenic Bladder: Surgical Interventions

A
  1. Ileal or sigmoid conduit w/o removal of bladder or urethra 2. Continent ABD reservoir (Indiana pouch, Mitrofanoff)
    If bladder not removed, annual cystoscopy due to production of mucus
36
Q

Bladder Exstrophy

A

Bladder and urethra didn’t close in utero = bladder mucosa open in lower ABD
w/ anorectal/genital malformations, pelvic bone separation tx: closure of bladder, temp ureteral stents and suprapubic urinary drainage, reconstruction of abnormalities

37
Q

Ureterosigmoidostomy

A

Ureters implanted into sigmoid colon
0 stomaUrine and stool mix and passed through anus
Option if bladder exstrophy
Complications: metabolic abnormalities, ureteral obstruction, pyelonephritis, colon/rectal cancer

38
Q

Posterior Urethral Valves

A

Newborn males
Folds of tissue obstruct urine flows/s: ABD mass, recurring UTI
tx: Urinary tract decompression w. vesicostomy, ureterostomy, pyelostomy, resection or ablation of valves

39
Q

Solid skin barrier

A

Protects from effluent
Integrated into most pouching systems
Apply gentle pressure to apply

40
Q

Stoma paste

A 
Fills in uneven areas
Prevents effluent passing under seal
Contains alcohol
Use as caulk
Touch with moist fingers only
41
Q

Stoma powder

A

Absorbs moisture
Provides surface to apply pouch
Too much may cause seal failure
Sprinkle liberally and brush off excess

42
Q

Stoma ring

A 
Enhances seal
Provides soft convexity to flat system
Improves seal
0 alcohol
May be too high to allow effluent to flow into pouch
43
Q

Stoma strip

A

Enhance seal as second barrier
Small pieces may fill in uneven areas
Requires manual dexterity
Will not cause irritation

44
Q

Elastic barrier strips

A

Enhance seal on outer edge of pouching system

May help if peristomal skin shifts (ex. hernia)

45
Q

Stoma liquid

A

Protect skin from stripping
Seals skin barrier to enhance seal
May have alcohol
Allow to dry prior to applying pouch

46
Q

Temporary fecal diversions

A

Hartmann’s pouch and loop ileostomy/colostomy

Allows bowel to heal

47
Q

Hartmann’s pouch

A

Resection of bowel, closure of fecal stump, end colostomy
Done in emergency
Stool/mucus per anus
Temporary

48
Q

Loop stoma

A

Loop of bowel through ABD wall w/ opening 4 stool

Mucous fistula to - chance of dehiscence

49
Q

Colostomy irrigation

A

If left sided colostomy- pouch changes
+ flatulence
Goal: stool-free, pt can wear stoma cap

50
Q

Colostomy irrigation: indications/complications

A

Descending/sigmoid colon have - peristalsis, can hold stool longer, formed stool
Non-return of fluid, vasovagal response, ABD cramping
0 use if stenosis, hernia, prolapse, Crohn’s disease

51
Q

Colostomy odor and flatus

A

Oral deodorizers = green/black stool

Buttermilk, parsley, cranberry juice, yogurt

52
Q

Foods that cause gas

A 
Asparagus
Beans
Beer
Cabbage
Carbonated drinks
Hard boiled eggs
Fish
Melon
Milk
Onions
Spicy foods
53
Q

Ostomy and Constipation

A

Rare w/ ileostomy due to storage capacity
Mild: + fluid/fiber/exercise
Stool softeners if taking pain meds

54
Q

Ostomy and Diarrhea

A

Causes: osmotic, mechanical, secretory, pharmacological + banana, cheese, applesauce, marshmallow, rice, pasta, tapioca

55
Q

Ileostomy

A

Colon/rectum may be removed = - absorption = dehydration/obstruction
+Na intake: broth, canned veg, tomato juice
+K intake: Banana, potato, peppers, chicken, beef, spinach

56
Q

Ileostomy Obstruction

A

Partial: distention, cramps/pain, stoma edema, watery oupout
tx: warm bath, heating pad, lie on rt, massage, knee-chest
Complete: -BM, N/V, stoma edematx: NPO, go to ED

57
Q

Ileal lavage

A

If obstruction not resolved

Insert cath into stoma, instill 10-20 mL saline (repeat)

58
Q

Ileostomy and medications

A

0 enteric-coated or sustained-release if + output or short bowel
Suboptimal drug absorption

59
Q

Ileal Conduit

A

= hyperchloremic metabolic acidosis/malabsorption
Urinary calculi possible
Crystals on skin = urinary alkalosis
0 specific diet: + fluids, unsweetened cranberry juice (unless on warfarin)

60
Q

Ileal Conduit and Stents

A

Maintain patency
Allow ureteral/conduit anastamosis to healIn place 7-10 days
Not emergent if fall out

61
Q

Assessment of Incision

A

Palpate for healing ridge, temp, oozing

Space btwn incision and stoma 4 pouching

62
Q

Stoma measuring

A

Changes size 6-8 weeks post-surgery

63
Q

Urostomy output

A

1500-2000/24 hrs

64
Q

Acidic urine

A

Resists UTI

Dilute urine = acidic

65
Q

Convexity

A

Moves downward around base of stoma
Causes stoma to protrude
May cause separation of mucocutaneous junction

66
Q

Soft ABD muscle tone

A

Firm barrier

67
Q

Firm ABD muscle tone

A

Soft/flexible barrier

68
Q

Ostomy belt

A

Used only if stoma at belt line
Pouching system needs belt tabs
Binder may be used if stoma not at belt line

69
Q

Partial Blockage Management

A 
Grape juice
Warm bath
No solid foods
Peristomal massage
Roll back and forth
Ileostomy lavage
ER if full blockage
70
Q

Ileostomy management

A

Monitor for dehydration
Obstruction
B12 supplements

71
Q

Ileal Conduit

A

Keep urine dilute for acidity w/ cranberry juice

Hyperchloremic metabolic acidosis

72
Q

Pouch-o-gram

A

Scheduled prior to takedown

Dye study to ensure suture lines healed

NURS 522 (3 decks)

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