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Ostomies

WOCN program

QuestionAnswer
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