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Unit 1

Advanced procedures

QuestionAnswer
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