Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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 |
Created by:
Beth Perry
Popular Nursing sets