Ostomy Care Questions and Answers Graded A

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Ostomy Care Questions and Answers Graded A What is an ostomy? ✔✔An opening or outlet through the abdominal wall that is created surgically for the purpose of eliminating waste What is the open... ing of an ostomy called? ✔✔Stoma How many Americans have an ostomy? ✔✔Over 700,000 Why would one need need an ileostomy? ✔✔Results from congenital disease like inflammatory bowel diseases like ulcerative colitis and/or Crohn's Why would one need a colostomy? ✔✔Results from colon and/or rectum cancer, diverticulitis, and/or trauma Why would one need a urostomy ✔✔A urinary diversion intended to correct bladder loss or bladder dysfunction What is the most common type of ostomy? ✔✔An ileostomy What are the three types of ostomies? ✔✔Ileostomy, colostomy, and urostomy Are ostomies permanent or temporary? ✔✔They may be either Why would one have a temporary ostomy? ✔✔To protect areas of the colon or rectum after surgical repair - the colon can be reconnected and bowel continuity is restored What is an ileostomy? ✔✔An ostomy in which a portion of the ileum is brought through the abdominal wall; an internal "pouch" is created from the ileum Intussusception ✔✔Inserting a portion of the intestine through an adjacent piece When is an intussusception used? ✔✔In an ileostomy to create a nipple that prevents stool and gas from coming out Discharge from an ileostomy ✔✔Liquid to semisoft and continous; contains intestinal enzymes Emptying from an ileostomy ✔✔A catheter is inserted into the "nipple" in order to remove contents How often is it required to empty an ileostomy? ✔✔Frequent at first, but eventually the pouch stretches so that it only needs to be drained three to five times daily Is an external pouch needed for an ileostomy? ✔✔No What is a colostomy? ✔✔A portion of the colon is brought through the abdominal wall What are the types of colostomies? ✔✔Ascending, transverse, and descending/sigmoid Output for ascending colostomy ✔✔Liquid to semi-liquid output Output for transverse colostomy ✔✔Liquid to semi-formed stool Output for descending colostomy ✔✔Semi-formed to formed stool Output for sigmoid colostomy ✔✔Semi-formed to formed stool Are ascending colostomies common? ✔✔No What are the characteristics of a ascending colostomy? ✔✔The ascending colon remains and the remainder of the colon is removed or bypassed T or F: Ascending colostomies ALWAYS need a pouch. ✔✔True What are the characteristics of transverse colostomies? ✔✔A piece of the transverse colon is lifted through an abdominal incision and a rod or bridge is placed under the loop to give it support while it heals What is the most common site for temporary colostomies? ✔✔Transverse colon What are the two types of transverse colostomies? ✔✔Loop and double-barrel What is the distinguishing characteristic of a loop transverse colostomy? ✔✔There are two holes that are so close together they combine into one opening What are the characteristics of a double-barrel colostomy? ✔✔Both ends of the colon are brought through the abdominal wall characterized by two stomas that are sutured to the abdominal wall What is the distal stoma called in a double-barrel transverse colostomy? ✔✔Mucous fistula What does each tract discharge in a loop transverse colostomy? ✔✔One tract discharges fecal material while the other tract discharges mucus - minimal amounts of stool and mucus seep through the rectum T or F: A descending and/or sigmoid colostomy must always use a pouch. ✔✔False, either a pouch or irrigation can be used. Are digestive enzymes typically present in the discharge from a descending or sigmoid colostomy? ✔✔No What is the purpose of a urinary diversion? ✔✔To divert urine through an opening in the abdominal wall What are the types of urinary diversions? ✔✔Ileal conduit, ureterostomy, cystostomy, and continent urinary diversion Ileal conduit ✔✔The bladder is removed, ureters are implanted in the bowel, and one end of the bowel is brought through the abdomen T or F: Ileal conduits always need a pouching system. ✔✔True Ureterostomy ✔✔Ureters (one or both) detached from bladder and brought through abdominal wall Cystostomy ✔✔Has to be done when a blockage of the urethra occurs, the urine is diverted directly from the bladder T or F: Cystostomies always require a pouch. ✔✔True What is a continent urinary diversion also known as? ✔✔Indiana Pouch Continent urinary diversion ✔✔Cecum and ileum are brought through the abdominal wall; a bladder is created from parts of the intestine! What are the ureters attached to in a continent urinary diversion? ✔✔To the cecum Where is the ileum attached in a continent urinary diversion? ✔✔Reattached to the colon What part of the intestine is responsible for the continent mechanism? ✔✔Ileocecal valve How is the pouch emptied in a continent urinary diversion? ✔✔Via a catheter Is an external pouch needed in a continent urinary diversion? ✔✔No What are the characteristics of an ideal ostomy pouching system? ✔✔Leak-proof, odor-proof, comfortable, easily manipulated, inconspicuous, safe, and inexpensive What is the purpose of an ostomy pouch? ✔✔To collect effluent What are the components of a pouching system? ✔✔Adhesive skin barrier, collection pouch, and/or accessories What is an alternative to a pouch for infants? ✔✔A diaper Pouches can be either... ✔✔A one-piece system or a two-piece system, reusable or disposable, opaque or clear, pre-cut or cut-to-fit, open-bottom or closed-bottom One-piece pouch system ✔✔Skin barrier and pouch are one piece Two-piece pouch system ✔✔Skin barrier is separate from pouch, adaptable to different abdominal folds How might skin barriers be shaped? ✔✔Flat or convex T or F: The stoma does not change in size over time. ✔✔False, the stoma may change in size over time, so the fit may also change What might happen to the stoma if the fit of the pouch is too small? ✔✔The stoma may swell How should a stoma be measured? ✔✔By measuring the base where the mucosa meets the skin What should be the clearance around the stoma regarding fit? ✔✔1/16th to 1/8th of a inch for a rigid barrier, 0-1 mm for a flexible barrier When should a pouch be emptied? ✔✔When it is 1/3 to 1/2 full Does the frequency for changing the pouch depend on the type of ostomy? ✔✔Yes How long can skin barriers be left in place? ✔✔3-7 days What might decrease the amount of time that a skin barrier can be worn? ✔✔Participating in physical activities Can water enter the stoma? ✔✔No Is it necessary to cover the stoma when swimming or bathing? ✔✔No How can a pouch be secured if a patient chooses to wear it while swimming or bathing? ✔✔Using waterproof tape What is a belt? ✔✔An pouch system accessory that provides elastic support and often contains latex What are alternatives to belts for women? ✔✔Pantyhose or panty girdles What might belts cause when worn too tightly? ✔✔Skin ulcers What are indications for belt use? ✔✔Deeply convex faceplate (skin barrier), short pouchwearing time, high activity level (especially in children), heavy perspiration, and/or personal preference What is the purpose of a skin barrier? ✔✔To protect the skin from the stoma discharge and allow the pouching system to fit more securely What is a useful accessory for weeping skin in an ostomy? ✔✔Powders What is a useful accessory for sealing the pouch? ✔✔Pastes (are not glue!) T or F: The skin barrier does not need to match the size of the stoma. ✔✔False, the skin barrier should match the size of the stoma Absorbent gel packets and/or flakes ✔✔Dissolve in effluent to make a gel and are useful to decrease noise, control odor, and prevent skin irritation and leaking What is best to cleanse skin around the stoma with? ✔✔Plain water Should skin be dried thoroughly after cleansing around the stoma? ✔✔Yes, skin should be allowed to dry thoroughly What types of special skin care products should be avoided in ostomy care? ✔✔Moisturizers, lanolin, petrolatum, and oils Adhesives ✔✔Come as cements or tapes What is available to assist in removal of adhesives? ✔✔Solvents Irrigating sets ✔✔1000 mL of lukewarm water is used to irrigate, the bowel expands, peristalsis occurs, and waste exits the stoma (similar to using an enema at the stoma) Deodorizers ✔✔Available as liquids or tablets (internal/external) that are placed directly into the pouch to neutralize odor What do some pouches contain to help control odor? ✔✔Charcoal filters What is a psychological complication of an ostomy? ✔✔Anxiety and/or fear When is fluid and electrolyte imbalance most problematic? ✔✔In patients with a liquid or semisoft discharge, which is least common in a descending or sigmoid colostomy How much fluid do patients typically lose through their stomas compared to a person with a normally functioning colon? ✔✔500-1000 mL compared to 100-200 mL Why is it important to maintain adequate fluid intake? ✔✔To prevent precipitation of crystals and kidney or gallstones. Why are ostomy patients vulnerable to fluid and electrolyte imbalance? ✔✔Due to vomiting and/or diarrhea What are the signs and symptoms of fluid and electrolyte imbalance in adults? ✔✔Increased thirst, dry mouth and mucous membrances, orthostatic hypotension, decreased urine volume, increased urine concentration, sunken eyes, extreme weakness, flaccid muscles, diminished reflexes, abdominal and leg muscle cramps, lethargy, tingling or cramping in feet or hands, confusion, N/V, SOB What are signs and symptoms of fluid and electrolyte imbalance in infants? ✔✔Depressed fontanel, lethargy, sunken eyes, weak cry, decreased frequency of wet diaper, increased urine concentration What types of vitamin deficiencies may occur in ostomy patients? ✔✔Hypophosphatemia, hypomagnesemia, and copper deficiency Where are many vitamins absorbed? ✔✔Via the GI tract What vitamins are absorbed in the small intestine? ✔✔Iron, vitamin D2, and vitamin D3 What vitamins are absorbed in the upper GI tract? ✔✔Vitamin B2 (riboflavin) What vitamins are absorbed in the terminal ileum? ✔✔Vitamin B12 and vitamin A What vitamins are absorbed in the proximal small intestine? ✔✔Vitamin K (phytonadione), folic acid (B9) What vitamins are absorbed in the distal small intestine? ✔✔Menadione What other vitamins are absorbed at various sites along the GI tract? ✔✔Calcium, pyridoxine (B6), pantothenic acid (B5), biotin (B7), choline, inositol, carnitine, vitamin C, vitamin E, and thiamine (B1) What are possible systemic complications in ostomy patients? ✔✔Constipation, diarrhea, and gas How can an ostomy patient attempt to prevent constipation? ✔✔Limit foods that can thicken stool such as bananas and bread Which ostomy patients is constipation problematic in? ✔✔Patients with descending or sigmoid colostomies How can an ostomy patient attempt to prevent diarrhea? ✔✔By using an anti-diarrheal agent such as loperamide, increasing fiber intake (Metamucil, Citrucel), and/or absorptive agents for the pouch (Ileosorb or Par-Sorb) How can an ostomy patient attempt to prevent gas? ✔✔Decrease foods that cause gas like beans, broccoli, and beer, and/or use of deodorizers When is the only time that odor should be present in an ostomy patient? ✔✔When changing the pouch What causes skin irritation in an ostomy patient? ✔✔Ostomy discharge and/or pouching systems and accessories How can an ostomy patient correct skin irritation? ✔✔Properly fit the ostomy system and/or try a skin barrier powder or ostomy cream What causes denuded peristomal skin? ✔✔Erosion of the skin due to digestive enzymes that occurs when an improper pouch is worn, the pouch opening is the wrong size, or the pouch is leaking How can denuded peristomal skin be corrected? ✔✔Change pouch to one that is appropriate, use a skin barrier powder, and change more frequently until the skin heals Contact dermatitis in an ostomy patient ✔✔Burning, stinging, itching, red skin that is typically an allergic reaction What causes alkaline dermatitis in an ostomy patient? ✔✔Mainly caused by urine In which type of ostomy patients is alkaline dermatitis common in? ✔✔Patients with urinary diversions What are the characteristics of alkaline dermatitis? ✔✔The skin around the pouch becomes gritty and the stoma often bleeds What is the treatment for alkaline dermatitis? ✔✔Solution of 1/3 white vinegar with 2/3 water (soak a cloth and put the cloth onto the stoma site for 10 minutes), acidify the urine, and/or use an antireflux urinary appliance What is hyperplasia? ✔✔An overgrowth of the skin When does hyperplasia occur in ostomy patients? ✔✔When the pouch opening is too large Is hyperplasia associated with pain? ✔✔Not at first, but progresses to severe pain What is the treatment for hyperplasia? ✔✔Make sure the pouch is the right size and that it is sealed (with paste, paste strips, a moldable seal, and/or skin barrier ring) What causes a mechanical injury in an ostomy patient? ✔✔Poor fit, difficult to access stoma, and/or tight-fitting clothing What causes skin stripping in an ostomy patient? ✔✔Often due to a strong adhesive or skin barrier removal (use adhesive removers [solvents] to help correct this problem) What is the cause of stenosis of the stoma? ✔✔Narrowing of the stoma is caused by scar tissue, the only cure is to re-do the stoma Excessive sweating can... ✔✔Lead to infection and decreases wear time of the pouch system; use of a skin sealant or cement and a belt may be needed to hold the system in place What is folliculitis? ✔✔Inflammation of the hair follicle that can be prevented by shaving the area around the stoma and by using antibacterial washes; if severe, an oral antibiotic may be needed What is a common infection affecting ostomy patients? ✔✔Candida infections sometimes occur under the pouch (ideal environment - dark and moist) What are the symptoms of infection? ✔✔Itching and rash What should be done if the skin becomes swollen due to an infection? ✔✔It may need to be drained Peristomal hernia ✔✔Protrusion of the colon or ileum through an area near the stoma; surgery may be required to correct Fistula ✔✔Formation of an opening between two internal organs or from inside the body to the skin Prolapse ✔✔Portion of the bowel comes out of the stoma and typically occurs during pregnancy, coughing, and/or crying What might a prolapse cause? ✔✔Decrease in blood supply to the rest of the bowel How can a prolapse be partially reversed? ✔✔Having the patient lie on his/her back and pushing on the distal end of the stoma Retraction ✔✔Stoma moves inside below the skin level; may occur due to weight gain or active Crohn's disease Impotence ✔✔Occurs due to nerve and vascular disruption caused by surgery; patient must be referred to urologist T of F: Ostomy patients do not need to chew food thoroughly. ✔✔False, they should chew their food thoroughly (they can still eat what they did before the procedure) What OTC medication can be used to control gas? ✔✔Beano (AI: alpha-d-galactosidase) How long is a low fiber diet suggested for an ostomy patient following surgery? ✔✔For the first 6 weeks after surgery What types of foods should patients with a urostomy avoid? ✔✔Foods that cause urine odor like asparagus, seafood, and some spices What are patients with ileostomies prone to? ✔✔More prone to intestinal obstruction, therefore patients should thoroughly chew food and eat high fiber foods in small amount and WITH other types of foods When patients are on medications, what should ostomy pouches be checked for? ✔✔Undissolved tablets What types of drugs may not be absorbed completely in ostomy patients? ✔✔Enteric-coated tablets and sustained-release drugs It is important to make sure ostomy patients are aware of which drugs... ✔✔Discolor feces and urine [Show More]

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