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Unit 1
Advanced procedures
| Question | Answer |
|---|---|
| What are the two types of dialysis? | Hemodialysis and peritonal dialysis |
| Reasons for stomas (3) | some type of disease process (ex bowel or diverticulitis), trauma to gi tract, congenital defect |
| What is a temporary stoma for? | injury or inflammation/disease |
| What is a permanent stoma for? | more serious things such as cancer or things that wont change |
| Factors taken into consideration before stoma is placed (4) | pts weight, anatomical land mark, scares, ease of access/self care |
| What are the 4 types of stomas? | Ileostomy, continent (cough) iliostomy, ascending colostomy, transverse colostomy, descending/sigmoid colostomy |
| Ileostomy def | placed in ilium; LRQ of abdomine; liquid drainage in lg intestine. have to wear appliance all the time |
| potential complications of ileostomy (3) | precaution for skin breakdown d/t digestive enzymes - make sure it fits properly; will have small amt of odor; nutrition and fluid and electrolyte balance |
| Continent (cough) Iliostomy def | dont need drainage b/c its internal not external; have to empty cath at least 3-5 times per day; not option for everyone - only certain pts |
| Ascending colostomy def | middle or right side of anatomy; drainage still liquid - same as ileostomy - digestive enzymes in lg intestine but more odor and more temporary |
| Transverse colostomy def | middle of abdomine; move mushy b/c absorption takes place and still need appliance; odor problem increases, less risk of enzymes and temporary |
| Descending/Sigmoid portion of colon def | usually done for cancer - LLQ of colon, stole more solid and consistent; stomas can be regulated or controlled b/c of consistency; still wear appliance but output is more formed - maybe once/day and pt has the option |
| How to construct stomas (3 options) which is least/most common and which are temporary? | Loop ostomy, double barreled colostomy, single barreled/end. Loop and double barreled are temporary and single barreled/end is most common. Loop is least common |
| Loop ostomy def | loop abdomine - has rod in it. holds out of abdomine/opening - emergency situation. 24-72 hours after they do surgery in order to drain. loop sticks out of abdominal wall - opening drains stole |
| Double barreled colostomy def | totally cuts through intestine - distal/proximal; temporary |
| Single barreled/end | 1 stoma; LLQ; distal part in tact |
| Nursing care for stoma | post-op - pts have NG tube, IV's, wound checks, vitals & assess stoma. Check color, size, peri-stomal skin & drainage. Size - stoma will start to shrink after 4-6 weeks - resize. clean with water not lotion soap. |
| Observe drainage time span | iliostomy - 1st 24-48 hours should have drainage. colostomy - 5-6 days should have drainage. Check frequency when appliance is 1/3-1/2 full empty b/c it will leak. Irrigation is for pts with descending/sigmoid colon only. |
| Teaching ostomy care | before surgery starts. how to catherize care. diet - liquid then soft. colostomy pts encourage fiber. avoid gas forming foods, foods that cause odor, and encourage odor reducing foods |
| Psychological support (5) | body image change, lots of questions, avoid things that hard stoma, referral to support groups, encourage to verbalize fears |
| How long can appliances for ostomy be left in place? How much length can be left for sizing? | 3-7 days; 1/4-1/2 inch |
| Urinary diversions def | formation of alternative route to assist body in elimination of urine |
| Reasons for urinary diversions (7) | malignancy of urinary tract, radiation damage to bladder, congenital or birth defects, trauma, obstruction, neurogenic bladder dysfunction, chronic UTI or pylonephritis |
| Types of diversions (7) | Nephrostomy tube, cystostomy, iloal conduit (brickers loop), cutaneous ureterostomy, ureterosigmoidostomy, vesicostomy, kock pouch |
| Nephrostomy | opening into kidney. permanent b/c of infection. temp for blockage. 2 sources of drainage. NI - sterile technique, sutures in place, monitor for obstruction, if clot gently push out, can irrigate w sterile solution max amt 5ml, hourly output for 1st 24 hr |
| Cystostomy | same as suprapubic, into bladder, disadvantage - infection, temp, prostate/bladder surgery, NI - requires sterile technique, can be irrigated w/lg amts up to 200ml. if permanent skin seals leaving dressing off b/c of infection risk so clean on daily basis |
| Iloal conduit (Brickers loop) | Pipeline passage drains urine. takes section of ileum from GI tract move over to reach ureter & attach then divert. Permanent. pts w/o bladder - cystectomy. not unusual to have mucus membrane in urine |
| Cutaneous ureterostomy | take ureter to surface of skin. 2 sources of output. done bilaterally. 1 or 2 stomas. appliance on all of the time. sterile technique. permanent but sometimes temp |
| Ureterosigmoidostomy | ureter into sigmoid then ostomy. risk for infection. electrolyte issue b/c of decreased reabsorption. increase UTI risk. stool very watery. done for pts who need to rest bladder. no external appliance but also last resort b/c of infection risk |
| Vesicostomy | attach bladder to abdominal wall and form stoma out of anterior wall. difficult to get good appliance b/c of clothing. temporary. easy to suture. continent diversion. pts cath themselves & dont have to wear appliance. urine stays in bladder until drained. |
| Kock pouch | continent diversion. contain urine by taking section of ileum, pouch and urine stays in pouch until it comes out. cath every 4-6 hours can hold 100ml of urine. self cath w/ clean technique. not high risk for infection. permanent. limited # of pts |
| Nursing care for urinary diversions (5) | urinary diversion post-op care, observe output every hour for 1st 24hrs, 1/3-1/2 for emptying, psychological support, complications include infection, edema, stricture (prolonged contact of skin w alkaline urine) therefore push fluids |
| Uretral catheter | directed into ureter, placed by cystostomy & thread into ureter & splint opening. left in place for pts with kidney stones. forms innerlining and allows stones to pass. if external foley cath & stint run along side - need output |
| Hemodialysis | artifical semi-permeable membrane that acts like the kidney. Filter pts AB circulates while chemical waste & extra fluid are drawn out. Uses dialsyate solution going through dialyzer around fibers. Hard on cardiac system - shift in electrolyte balance |
| What are the 2 processes being used for Hemodialysis? | Diffusion & Ultrafiltration |
| What is ultrafilteration? | fluid is drawn across semi-permeable membrane and goes from high hydrostatic pressure to lower. each pt has own prescription of dialysis.type, length of time (avg 4-5hrs), BF rate, dialsylate flow rate, dialsylate composition. 3 days/wk, consistent, life |
| How big are the needles for dialysis and how long is the healing time for fistulas? | 16 gauge; 6-8 weeks. check daily b/c its their life line |
| How do you check the patency of fistula? What are the 2 terms associated with it and their definitions | Listen w/stethoscope over site and hear blood called bruit. Palpate area and feel blood rushing through which is called the thrill. feel the thrill |
| What are the 3 types of dialysis associated with peritoneal diaylsis? | Continuous ambulatory peritonal dialysis (CAPD), Intermittent peritonal diaysls (IPD), Continuous cycling peritonal dialysis (CCPD) |
| CAPD | pts can do at home; keep track of I&O b/c output should be more |
| IPD | done via machine 3-4 times per week. usually 10+ hours usually overnight |
| CCPD | hooks up at night and comes off in the morning; usually done with kids |
| Advantages of PD (3) | Quick to be initiated - starts immediately, water exchange done much more gradual - not as hard on the cardiac system; not dependent on facilities |
| Nursing care for PD | cath care,observe for infection (peritonitis),sterile technique,warm fluid w heating pad-prevents cramping,can add antibiotics/heparin,monitor I&O should ^ bc of pulling out fluid,if efulent (cloudy) report, alter diet-watch water,decreased K & phosphorus |
Created by:
breinard
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