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Ostomies
WOCN program
Question | Answer |
---|---|
what are the conditions that can result in the creation of an ileostomy? | colorectal cancer, UC, CD, NEC |
what two types of stomal construction are possible with an ileostomy? How do they differ? | loop and end |
where is the usual abdominal location of an ileostomy? | RUQ |
describe the symptoms of food blockage/obstruction | no output, nausea/vomiting, distension, crampingAbsence of stoma output for 4-6 hours, or watery, foul-smelling clear output |
how can food blockage/obstruction be prevented? | Monitor response to new foods Eat smaller, more frequent meals Omit high-fiber foods for the first six (6) weeks after surgery Add high-fiber foods one at a time in small amounts Chew food well and drink plenty of fluids |
what are the conditions that can result in a colostomy | cancer, CD, obstruction, trauma |
where is the abdominal location of a transverse colostomy? sigmoid colostomy? | transverse either RUQ or LUQ, sigmoid, LLQ |
what is the difference between a hartmann's pouch and an APR? | with an APR no pouch is left |
who are the candidates for a low anterior resection? | rectal cancer |
who are candidates for a continent fecal diversion procedure IPAA? | UC, FAP |
what type of ostomy are Crohn's patients eligible for | subtotal colectomy, ileocecectomy , proctocolectomy with ileostomy |
identify patient criteria for the Kock ileostomy procedures | must be able to access the stoma, have cognitive and dexterity to do it |
identify the portions of the anatomy that are removed for a kock pouch | entire colon |
identify the portions of the anatomy that are removed for an IPAA | colon and rectum removed |
describe how continence is maintained with a KOCK pouch | pt is taught to access the pouch thru the stoma every 2 hrs to start then gradually increase the time as the pouch increases in capacity |
describe how continence is maintained with an IPAA | sphincter is left in place |
describe the complications that can occur with an IPAA | pouchitis, bowel obstruction, anastomotic leak, infection UTI, impotence, retrograde ejaculation and dyspareunia, pelvic sepsis |
describe the complications that can occur with a Kock pouch | nipple intusseseption |
what functional results should the person with an IPAA expect immediately after ileostomy take-down? Long term? | 10 or more BM's with some incontinence esp at night, at 1 year 4-8 BMs with little or no incontinence |
what long term functional results should the person with a Kock pouch expect | increased capacity |
name two important criteria to teach the person with an IPAA to achieve positive outcomes and improved quality of life | sexual function, pouchitis, diet to reduce or thicken stool, perianal skin care, antidiarrheals, stool bulking agents |
explain ileal conduit | |
Indiana pouch | catheterizable urinary stoma made from ileum, colon and ileocecal valve |
explain neobladder | created from ileum, use their own urinary sphincter and abdominal pressure and valsalva, scheduled voiding q2-3hr do IC if needed continence in 6-12 months |
what type of ostomy are patients with mucosal ulcerative colitis eligible for | restorative proctocolectomy with IPAA, total proctocolectomy with end ileostomy or Kock pouch |
what type of ostomy are patients with toxic colitis or indeterminate colitis eligible for | total abd. colectomy or Hartmans pouch |
LAR | done for mid or upper rectal or distal colon cancers |
total proctocolectomy | all of colon and rectum is resected |
ileo-rectal anastomosis | |
continent ileostomy | Kock pouch |
colonic j-pouch | part of the IPAA or created during LAR |
subtotal colectomy | not all of the colon is resected |
pyoderma gangrenosum | red open lesions, raised, irregular with purplish margins |
chemical irritant dermatitis | |
allergic dermatitis | |
caput medusa | peristomal varies caused by portal hypertension |
pseudoverrucous lesions | painful wart like in appearance, caused by overhydration |
food bolus assessment and management | if no output go to ED, if a little output try interventions |
parastomal hernia assessment and management | most common with colostomy, use belt if it can be reduced |
colostomy irrigation | |
ileal lavage | instillation of NS in small amounts at a time using a catheter within 6 inches of the stoma should be painless |
indiana pouch care | irrigate three times QID during the first several post op days. foley is placed in channel and capped, for 2-3 weeks to maintain channel potency |
Indiana pouch teaching | self cath on an increasing time schedule, leave Malecot cath in until pt is independent with IC, carry catheters and zip lock bag with them |
teaching for illeal obstruction prevention | avoid stringy fibrous foods- any food that stays hard if left overnight in water Peels, nuts, popcorn, meat casings, stringy veg's chew thoroughly introduce new foods slowly |
ill obstruction definition | undigested food accumulates at the fascia level of the ileum need to take a thorough nutritional history should get and flat plate X-ray, CT OR mechanical: a band of adhesions, hernia, twist or kink or volvulus excess edema insert pinky finger to assess |
signs of ileal obstruction | abd. cramping, none or sm watery output that is foul smelling, silent or high pitched BS, hx of ingesting fibrous food possible and distention |
conservative management | walk, avoid solid foods, warm bath, massage abdomen, warm fluids if there is output: if ex's worsen or no improvement in 24 hrs see MD or ED |
medical management | IV fluids, workup to determine cause, possible pain meds, antiemetics, NG tube if hx indicates food blockage, do lavage |
ileal lava procedure | 18-24 fr, irrigation set (or cut hole in top of pouch), instill 40-60 cc at a time- never more than 100cc at a time, 250-500 is max total instill NS while advancing cath can insert full length but then it is not a food bolus |