WEEK 11 Flashcards
(47 cards)
What is a urinary diversion?
When is it done?
2 kinds?
= surgical rerouting urine from kidneys to site other than bladder
• Usually done when bladder tumour necessitates cystectomy, managing pelvic malignancy, birth defects, strictures, trauma to ureters + urethra, neuogenic bladder, chronic infection + intractable interstitual cystitis
TWO KINDS
1) Cutaneous urinary diversion (incontinent)
2) Continent urinary diversion (portion of intestine makes reservoir)
Removal of the bladder?
= cystectomy
What is an incontinent urinary diversion?
Examples?
- No control over passage of urine – requires ostomy bag
* Examples: ureterostomy, nephrostomy, vesicostomy, ileal conduits
Nephrostomy =?
Vesicostomy = ?
urine diverted from kidneys to stoma (see figure 42.20 p. 1342)
used when bladder intact but cannot void through ureter (d/d neurogenic bladder or obstruction); ureters connected to bladder still + bladder wall attached to opening in skin below navel
Most common type of urinary diversion?
Describe this kind.
Advantage?
ILEAL CONDUIT: aka ilieal loop
o Segment of ileum removed + intestinal ends anastamosed; one end of removed section closed with sutures, other end creates stoma in abdominal wall; ureters implanted in this pouch and urine drains from here
• Loop of sigmoid colon can also be used
• Ileostomy bag collects urine
oEasier to fit pouch than ureterostomy + mucosal layer in intestine helps protect from bacteria
WHat are continent diversions?
2 types?
• Pt control through either intermittent catheterization of internal reservoir (Indiana pouch) or strained voiding (neobladder)
From med surg:
o (urinary reservoir made from intestine which has sm reservoir that has sm stoma, a catheter is inserted to empty the urine from the ppouch 4-6x daily)
o Orthotopic neobladder (uses intestinal pouch to replace the bladder which is in same place as orig bladder was→an void normally. The pt will have freq incontinence and needs bladder training schedule
1) Describe an indiana pouch
2) Neobladder?
1) ureters attached to ileum shaped into reservoir pouch – catheter put through abdominal wall to empty (q4hrs)
2) piece of ileum replaces diseased or damaged bladder; sutured to urethra allowing person to urinate regularly
What kind of nursing assessments need to be done with urinary diversions?
- Assess I/O
- Changes in urine colour, odor, clarity? – mucous sheds common for those with ileal diversion
- Condition of stoma + surrounding skin
- Need right fit! Compromise to skin integrity if not d/t irritation
- Coping – sexual + body image issues
Changing urinary diversion pouch similar to bowel diversion except…. (2 ways, one pertains to immediately after sx)
o Empty continually → dry gauze placed under stoma during change to catch urine
o Immed after sx, may have ureteralstents present + protruding from stoma – remain 10-14 days
What is an ostomy?
How are bowel diversion ostomies classified?
- Ostomy = sx constructed artificial excretory opening
- Named according to anatomical loc
- Classified according to temporary/permanent + nature of construction of the stoma
SToma = ?
opening created in abdominal wall by ostomy
When are temporary + permanent bowel ostomies used?
- Temporary – for traumatic injuries or inflm conditions of bowel; allow distal section rest
- Permanent – for nonfunctional rectum or anus as result of birth defect or disease (ex: CA)
Ileostomies
How does it work?
What risk does it pose?
How is odour?
drains from distal end of SI; liquid fecal drainage, constant + cannot be regulated; contains enzymes so more risk of skin breakdown; odour minimal (less bacteria)
o Ascending colostomy very similar except odour is issue (can have deodorant in appliance)
transverse + descending colostomy
How does these differ in terms of fecal matter?
o Transverse = malodorous mushy drainage, usually no control
o Descending = more formed
• Sigmoidoscopy:
Stool characterisitcs?
Advantages of this?
usually fully formed stool, frequency can be regulated…don’t have to wear applicance at all times + odour controlled
Overall: • Location influences character of drainage – farther = more formed and more control over frequency
Will stool characteristics from a colostomy ever change?
• If in place for longer, colon will begin to compensate + stool becomes more formed
Which type of ostomy is particularly irritating the skin?
Ileo
What should an ostomy bag do?
What does it consist of?
- Ostomy appliance should protect skin, collect stool + control odour
- Appliance consists of skin barrier + pouch (as one piece or two – two has flange)
Are ostomy bags open or closed?
• Can be closed or drainable – drainable used for those who empty >2 times/day, closed more common for sigmoidoscopy (empty 1-2X/day)
How can the issue of odour be addressed for ostomy?
- Odours very important to pt self esteem – need right appliance to control; some allow odourless gas to pass through filter
- Once pt ambulatory, taught to work with ostomy in bathroom to avoid odours
How often are ostomy bags changed?
Emptied?
- Ostomy pouch applied for up to 7 days, changed before leakage occurs
- Assess skin – if erythema, erosion or ulcerated, change bag q24-48hrs
- More freq changes better is pt has pain or discomfort
- Empties when 1/3 to ½ full
What is colostomy irrigation?
- Similar to enema
- Used only for sigmoid or colostomy
- Purpose: extends bowel enough to stimperitalsis + cause evacuation → once regular evac pattern achieved, don’t have to wear pouch anymore
- Not currently taught routinely to clients
- Up to client to use irrigation or other method to achieve reg daily evac pattern – some prefer to use dietary method (as irrigation can take up to 1h/day)
- Done at same time each day
- For most ppl, 300-500mL enough to stimevac, some up to 1L as fluid often lost during procedure (can use cone on irrigation catheter to help this)
Those who perform colostomy irrigation for long time more prone to?
peristomal hernias, bowel perforation + electrolyte imbalance (with 500mL-1L infusions)
Sx is primary treatment method of colonic + rectal CA
What possible sx procedures are done?
o Segmented resection w anastomosis (remove tumour, portion of bowel on either size, blood vessels + lymph nodes)
o Abdominoperineal resection w permanent sigmoid colostomy – aka Miles resection (remtumour, portion of sigmoid colon, all of rectum and anal sphincter)
o Temporary colostomy followed by segmental reection and anastomosis and subsequent anatomosis of colostomy, allowing initial bowel decompression + bowel prep before resection
o Permanent colonostomy or ileostomy for palliation of unresectable obstructing lesions
o Construction of coloanal reservoir called colonic J pouch → 2 step process: loop ileostomy to diverse intestinal flow, and newly constructed J pouch (made from 6-10cm of colon) reattached to anal stump; then ileostomy reversed + continence preserved
