Ostomy exam prep questions and answers graded A

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Ostomy exam prep questions and answers graded A IPAA Ileal pouch anal anastomosis. Entire colon is removed. Ileum used to create a J pouch, which is then connected to the anus. Done in stages. Sta... ge 1: loop ileostomy and pouch created. Stool diverted through ileostomy while pouch matures (7-10 weeks). Stage 2: reconnected IPAA is most commonly done to treat which condition? ulcerative colitis What is the best surgical procedure for Crohn's affecting the large intestine? total proctocolectomy and ileostomy continent ileostomy, kock pouch Reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is then constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube in inserted into the pouch several times a day to drain feces from the reservoir Kock pouch post-op care pouch connected to cath for 14 days, irrigated 3x/day after 2 weeks start progressive clamping of tube for gradual pouch expansion cath removed on day 24 post-op, continue to irrigate and intubate BCIR Barnett Continent Intestinal Reservoir improvement upon the Kock continent ileostomy Enteral feeding tube with continuous feedings: how often should it be flushed, and with how much water? every 4 hours with 30ml of water, also flush before and after med administration Signs of an impending EC fistula localized erythema, induration. local discomfort With a triple lumen GJ tube, which port should be used for feeding? The Jejunal port. Gastric port is used for decompression and meds. DC instructions for new nephrostomy tube change gauze dressing daily for first 2 weeks, then change twice weekly and PRN soiling How do you keep a hemovac drain patent? Milk or strip it to remove blood clots and tissue shreds ileal conduit stoma site marking right lower quadrant ileal conduit stoma site marking for an obese patient right upper quadrant APR (abdominoperineal resection) removal of rectum, anus and sphincter. Permanent end colostomy of sigmoid colon placed through LLQ. When does stomal necrosis occur? within first 24 hours of creation treatment of mucocutaneous separation fill defect with ostomy powder, fit appliance over the defect Which medications should be avoided with an ileostomy or transverse colostomy? enteric coated or ER After surgical closure of the ileostomy, what happens to the superficial skin? Left to close by secondary intention How can gas be managed by an ileostomate? eating small, frequent meals Pouches should be emptied when how full? 1/3 to 1/2 full normal ileostomy output after creation: 800-1700 levels off to: 500-1800 IPAA for high risk or acute colitis patients is better to be performed in how many stages? 3 stages: 1. subtotal colectomy with double ended ileostomy and sigmoidostomy. rectum remains. 2. IPAA, rectum removed, j pouch attached, diverting ileostomy. 3. ileostomy closed When collecting a sterile urine sample from an ileal conduit, how much urine do you need? 5-10 ml Definitive treatment for mucosal transplantation surgical excision Management of mucosal transplantation stoma powder to absorb mucus secreted by the tissue A peristomal bulge that is usually visualized in the standing or sitting position is actually a________________________ peristomal hernia Which kind of a pouching system should never be used with a peristomal hernia? Convexity, because it may cause: pressure ulcers, loosening of the system with change in body countours, stoma laceration. A sterile urine sample collected from an ileal conduit should be delivered to the lab within__________ 1 hour Gold standard surgery for ulcerative colitis proctocolectomy with IPAA Familial Adenomatous Polyposis (FAP) An autosomal dominant trait resulting in the development of polyps and benign growths in the colon. Polyps often develop into malignant growths and cause cancer of the colon and/or rectum. Treatment for FAP proctocolectomy with IPAA The main advantage of the coloanal J pouch reservoir anastomosis compared to a rectosigmoid anastomosis is that is has demonstrated a significant reduction in fecal urgency and frequency, because rectosigmoid approach means the loss of the rectum reservoir. What is an advantage of using a stapled anastomosis over a hand sewn anastomosis in an Ileal Pouch Anal Anastomosis (IPAA)? Stapled IPAA gives significantly better nocturnal continence compared with hand-sewn IPAA following proctocolectomy; other postoperative outcomes are similar between groups. After IPAA closure and recovery from postoperative phase, how many bowel movement should be expected per day? 5-6 bowel movements per day pseudoverrucous lesion etiology chronic irritation from moisture under the adhesive barrier of the pouching system Management of pseudoverrucous lesions ID and manage cause of extra moisture. Wear time should be shortened, if erosion of skin barrier is noted at removal. How did BCIR improve upon the Kock Continent Ileostomy? Encircling the intussuscepted bowel with a "living collar" to better support the continence mechanism What is the most successful version of the continent ileostomy to date? BCIR With BCIR, how often should the patient intubate the internal reservoir? 3-4 times per day What size catheter should be used to intubate the Kock pouch for drainage, how often? 28 Fr, 4-5 times per day Evacuation disorders are most commonly seen with what type of pouch? S pouch, created if there is excessive tension in the IPAA. High postoperative risk after IPAA surgery? Dehydration d/t frequent BMs Kock Pouch post op management connected to straight drainage for 14 days Irrigated 3x/day starting day 1 2 weeks postop, clamp cath to allow for expansion 24 days postop, cath removed, pt taught to intubate Kock pouch: how long does it stay connected to straight drainage postop 14 days How often should Kock pouch be irrigated? 3x/day, starting day 1 postop When should Kock pouch cath be clamped to allow for expansion of pouch? 2 weeks postop Kock pouch: how long after surgery is cath removed and pt taught to intubate and irrigate? 24 days postop What is a good way for a patient to decrease stooling frequency following IPAA surgery? encourage patient to delay defecation by tightening the pelvic floor. common postop problem for neobladder patients? nocturnal enuresis The goal to ensure catheter patency in the Indiana pouch in the early postop period is best achieved by: irrigation the catheter with 60mls of NS q 3-4 hours Neobladder urination schedule q2 hours during day, q3 at night increase by 1 hour until patient is able to urinate q6 around the clock (60mg NS & allow to drain) Indiana pouch: why is it important that the foley catheter that is in the stoma postop be positioned in the center, with no tension on the securement device? prevent stoma and valve injury, can lead to stomal stenosis and valve incontinence. Neobladder should be irrigated with _________ml of ________________every 2 hours and allowed to drain. This is done to prevent _______________accumulation. 60ml of NS every 2 hours mucus Failure to adequately empty the neobladder will result in: stone formation T or F loose stools are normal following neobladder surgery True. Decreased bowel length. Mitrofanoff appendicovesicostomy continent urinary diversion. Appendix is used to divert flow of urine away from bladder, brought out to stoma created at navel or RLQ of abd. Intubated and drained q3-4 hours. High output fistula vs low output >500ml/day, low output <200ml/day Fistula signs fever, localized erythema, induration, progressive discomfort, sepsis, malnutrition, dehydration, anemia Fistulas mostly happen as a result of __________ ______________,and are often due to the disruption of the _______________________. surgical procedures, anastomosis urethrocutaneous fistulae are the most common complication of which surgery? male bladder extrophy correction What should be done for the first 2 weeks following nephrostomy insertion? daily dressing changes With a GJ tube, which port is used for feeding? Jejunal port. Gastric port can be used for decompression, give meds, vent air, drain fluids. How often should a nephrostomy tube be exchanged? Every 3 months to prevent obstruction Which contrast should be administered anally to verify the patency of the ileal pouch (final stage of IPAA complete and prior to reanastomosis) Gastrograffin enema (water soluble) treatment for denuded peristomal skin triamcinolone (steroid) spray, ostomy powder Early (postop) use of rigid convexity should be avoided to prevent which complication? mucocutaneous separation d/t increased pressure on the suture line Ileus is normal for _____ hours after bowel surgery 72 hours Familial adenomatous polyposis polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated. Monitoring of individuals with FAP Yearly colonoscopy once polyps are found until a colectomy is planned. Typical jejunostomy output 2400cc/day What kind of appliance would a jejunostomy patient need? 2 piece high output system with spout Loop ileostomy Primarily a temporary stoma for fecal diversion. Also known as double barrel. Emergency treatment for toxic megacolon total colectomy with end ileostomy With high anterior resection, which part of the bowel is removed? sigmoid colon With low anterior resection, which part of the bowel is removed? rectum is removed. Descending colon attached to anus Most common surgery for rectal cancer LAR abdominoperineal resection the anus, rectum, and sigmoid colon are removed. This procedure is most often used to treat cancers located very low in the rectum or in the anus. subtotal colectomy rectum preserved, ileum connected to rectum hemicolectomy removal of right or left portion of the colon proctocolectomy surgical removal of the large intestine and rectum LAR treatment of choice for lesions located________________________ In upper and middle third of the rectum Dentate line divides the upper two thirds and lower third of the anal canal. First line constipation treatment for persons with a colostomy bulk-forming agents (psyllium or Metamucil) Bismuth subgallate reduces stool odor but also changes stool color, decreases peristalsis, can cause malaise if taken for a long time, tingling in extremities, fatigue Radiation skin effects manifest when? 2-3 weeks Radiation skin damage damage to apocrine and sebacious glands why should a fluid-filled blister from a frostbite injury be aspirated? fluid contains prostaglandin and thromboxane, which cause vasoconstriction, enhancing dermal ischemia How is BCIR different from Kock Pouch? Intestinal collar to help prevent slipping of valve, prevents fistula formation. T or F: Kock pouch can be both a continent urinary or continent fecal diversion True! BCIR is a urinary or a fecal diversion? Fecal Most common complications with IPAA pouchitis, anastomotic stricture Cecum first part of the large intestine ileocecal valve the valve between the small and large intestines superficial inflammation is typical of ulcerative colitis Friable, pinpoint ulcerations on mucosa ulcerative colitis T or F rectum is always involved in ulcerative colitis True How does the perianal area look in ullcerative colitis patients? normal Which disease is more likely to present with pain, ulcerative colitis or Crohn's? Crohn's Crohn's disease involves any part of GI tract, mouth to anus What makes diarrhea more likely with ulcerative colitis than with Crohn's disease? involvement of colon=diarrhea Why does obstruction occur with Crohn's disease? fibrosis and narrowing of the intestines Which patient is more likely to experience weight loss: ulcerative colitis or Crohn's? Crohn's patient Most commonly involved parts of the intestine in Crohn's patients cecum and terminal ileum Pyoderma gangrenosum is connected to which GI disorder? Crohn's disease UC patients are at risk for which neoplasia development? Adenocarcinoma patient with decreased manual dexterity need what kind of pouching system? 2 piece. discard bag instead of emptying it. Most succesful form of the continent ileostomy BCIR patients with high output colostomies should avoid which type of medication? extended release, because of the medications' slow dissolution properties When should the pouching system be connected to low suction? when volume of drainage overwhelms and loosens the seal Prolonged inflammation leads to Thicker epidermal layer Who is at most risk for pouchitis? Why? IBD patients. Abnormal mucosal immune response to bacterial flora Symptoms of urinary extravasation, which kind of operation puts PT at higher risk? Excessive drainage from surgical drains. Continent urinary diversions. Coloanal anastomosis A surgical procedure in which the colon is attached to the anus after the rectum has been removed, just above the levator anii muscles. Contraindications for continent urinary diversions Renal insufficiency, bowel disease, prior bowel resections, bowel malignancy or IBD. Which med to avoid in ostomate? Stimulant laxatives (phenolphthalein). Increases risk of diarrhea Amount of fluid to use for irrigation of colostomy 500ml ileal conduit UTI symptoms Fever, chills, flank pain When is Turnbull colostomy contraindicated? Perforation, hemorrhage or abscess What is the disadvantage of Turnbull colostomy? Source of infection is left in place (temporarily) When effluent sits on the skin Irritant contact dermatitis How long are ureteral stents left in place? 5-7 days Pyoderma gangrenosum Pustules that break open and form full thickness ulcers. The surrounding skin becomes red and purple. Toxic mega colon procedure of choice Subtotal colectomy and end ileostomy Most common complication of Neobladder Night time incontinence Anal rectal adenocarcinoma procedure of choice APR (rectum, anus, sphincter removed). End colostomy. Flush peg tube with_____ml of water q_______hours 30, 4 imperforate anus a congenital defect in which the rectal opening is missing, blocked or displaced (high type ends above rectal muscles, low type opening covered by skin). May be accompanied by fistula. Also accompanied by pulmonary complications. Who is a candidate for irrigation? End descending or sigmoid Who is a good candidate for stomal irrigation? end descending or sigmoid colostomy and has regular elimination pattern before surgery. Do not start while chemo in progress. pathergy is a hallmark sign of what condition? Pyoderma gangrenosum pathergy wound switches from healing mode to destructive/inflammatory mode pyoderma gangrenosum risk factors age 20-50, IBD, arthritis, blood disorder pyoderma gangrenosum treatment corticosteroids, immune modulators (Remicade, cyclosporine), pain meds. No debridement, any trauma triggers pathergy. Prune Belly Syndrome abscence of stomach muscles, undescended testes, urinary tract malformations. May cause pulmonary hypoplasia or renal failure d/t urine backing up into kidneys. The most crucial application of PLISSIT is proper referral to appropriate specialist PLISSIT model permission, limited info, specific suggestions, intensive therapy Hirschsprung disease hereditary defect causing absence of enteric nervous system (usually rectosigmoid area). Signs and symptoms of Hirschsprung's delay/fail to pass meconium Hirschsprung's treatment temporary ostomy then surgical correction Imperforate anus treatment simple: surgery to create anal opening complex: diverting colostomy as stage 1, then anoplasty and pull through procedure NEC (necrotizing enterocolitis) premature infants, day 3-10 vomiting, bld in stool, abd distension, sepsis dx: xray, labs tx: sx, bowel rest, NG, abx omphalocele a part of the intestine protrudes through the abdominal wall at birth, covered by membrane (at umbilicus). Huge risk of infection. gastroschisis congenital fissure of the abdominal wall to the right of umbilicus, organs not covered by membrane. Bowel atresia and ischemia occur, necessitating a stoma. Earliest sign of cystic fibrosis meconium ileus Meconium ileus thick secretions block bowel d/t CF. distension and vomiting first 24-48 hours of life. No meconium is passed per rectum. Tx: contrast enema, may relieve obstruction cloacal exstrophy bivalved bladder with 2 orifices, 2 appendiceal orifices, bifid penis, undescended testes, imperforate anus, inguinal hernia, omphalocele, shortened midgut with predisposition to malabsorption, spinal abnormalities, renal anomalies, NORMAL intelligence. cloacal exstrophy prognosis permanent intestinal stoma and continent urinary diversion/reconstruction bladder exstrophy exposed bladder, urethra and ureteral orifices through the suprapubic area, epispadias or vagina/uterus duplication. vesicoureteral reflux. hypospadias urethra opens on dorsal surface of penis epispadias urethra opens on anterior surface of penis (Female has bifid clitoris and separation of labia) [Show More]

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