Ostomy Care Overview

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Questions and Answers

What should be noted about respiratory fluid during aspiration?

It may vary in color depending on the client.

It is typically clear with a pH greater than 6. (correct)

It is always alkaline regardless of pH.

It is usually cloudy with a pH less than 6.

Which client condition requires extra precautions to prevent improper tube placement?

Client who is restless or agitated. (correct)

Client with a strong gag reflex.

Client who is fully cooperative.

Client with a high level of consciousness.

What is the correct action to take to confirm tube placement?

Do a manual check of the tube length.

Inspect the tube for visible markings.

Use x-ray confirmation. (correct)

Palpate the tube for firmness.

What should be done if fluid cannot be obtained after the initial flush?

Reposition the client from side to side and try multiple flushes. Signup and view all the answers

How should the feeding tube be secured after insertion?

By marking with a permanent marker or tape at the point of insertion. Signup and view all the answers

What should ostomy clients be advised about during strenuous physical activity?

To maintain awareness of their hydration status Signup and view all the answers

What is a recommended strategy for ostomy clients to feel more secure about engaging in sexual activity?

To empty the pouch beforehand Signup and view all the answers

Which of the following should ostomy clients specifically avoid to prevent food blockage?

High-fiber foods and those that cause intestinal gas Signup and view all the answers

How should ostomy clients assess the character and color of their urine?

By comparing it to standard color charts provided by their nurses Signup and view all the answers

Which of the following is NOT a component of urostomy management education?

Learning advanced surgical procedures Signup and view all the answers

What should clients do when their ileostomy pouch is one-third to one-half full?

Empty the pouch immediately Signup and view all the answers

Which manifestation indicates a food blockage that should prompt contacting a healthcare provider?

Abdominal cramping Signup and view all the answers

What should ostomy clients use to protect their skin from irritation caused by effluent?

A skin barrier Signup and view all the answers

What position should clients assume to relieve intra-abdominal pressure during a blockage?

Knee-chest position Signup and view all the answers

How can clients manage concerns about body image after undergoing ostomy surgery?

By sharing their feelings with their partners Signup and view all the answers

What risk do clients with high-volume ileostomy output face?

Fluid and electrolyte imbalances Signup and view all the answers

Which pouching system might enhance confidence by providing odor control?

A commercially made pouch with a charcoal filter Signup and view all the answers

For clients with a colostomy, which dietary consideration is essential?

Being aware of foods that can cause gas and odors Signup and view all the answers

What is the primary goal of a restorative proctocolectomy with ileal pouch anal anastomosis (IPAA)?

To connect the ileum to a new rectum, preserving anal sphincter control Signup and view all the answers

Which of the following statements describes a double-barrel or loop colostomy?

It involves two stomas, one for fecal elimination and one for mucous. Signup and view all the answers

What should clients with a temporary diverting colostomy know regarding bowel sensations?

They may experience an urge to defecate through the rectum. Signup and view all the answers

Where is a colostomy typically placed for cancer of the rectum?

Sigmoid colon Signup and view all the answers

What type of output is expected from a colostomy in the ascending colon?

Liquid to semi-liquid Signup and view all the answers

What is the initial step in the insertion procedure of an enteral tube?

Dip the tip of the tube in a lubricant or water Signup and view all the answers

Which of the following indicates the output consistency from a transverse colon colostomy?

Pasty Signup and view all the answers

What pH range is typically observed in gastric fluid after fasting for at least 4 hours?

1 to 4 Signup and view all the answers

What should the client do while the tube is being inserted to aid in the process?

Tip their head backward and breathe through the mouth Signup and view all the answers

What is the characteristic appearance of intestinal fluid in terms of color and consistency?

Light to golden yellow with syrupy consistency Signup and view all the answers

What is the expected output consistency from a descending colon colostomy?

Formed Signup and view all the answers

What is constructed during the Kock's continent ileostomy procedure to allow for stool drainage?

A one-way nipple valve Signup and view all the answers

What is a common reason for creating a loop colostomy?

To address intestinal obstruction Signup and view all the answers

Which type of colostomy involves two separate stomas?

Double-barrel colostomy Signup and view all the answers

What might increase the risk of complications in clients undergoing a continent ileostomy compared to traditional ileostomy?

Higher complication rate Signup and view all the answers

What should clients with colostomies avoid to decrease malodorous flatus?

Foods that cause odors Signup and view all the answers

What type of medications should clients with colostomies use cautiously?

Enteric-coated and sustained-release medications Signup and view all the answers

Which of the following best describes a key feature of a transverse loop colostomy?

It has two openings through one stoma Signup and view all the answers

Why might some clients prefer Kock's continent ileostomy over a traditional ileostomy?

It allows them to avoid wearing an external pouch Signup and view all the answers

Study Notes

Ostomy Care

Ileal Conduit Care: Clients with ileal conduits might have drains still intact. Teach them to use a 4x4 inch dressing to absorb leakage around the drain.
Follow-up Care: Regular follow-up with surgeons and wound/ostomy/continence nurses is crucial. Discuss resuming activities after adequate stoma healing. Provide specific information about exercise and sexual activity guidelines from the provider.
Exercise: Ostomy clients should stay hydrated during strenuous activity and engage in regular cardiovascular and musculoskeletal exercises.
Sexuality: Address clients' concerns about body image changes. Encourage open communication with partners. Suggest emptying pouches, using smaller pouches, or pouch covers before sexual activity.
Urostomy Management: Teach clients and families about stoma/diversion care, odor management, skin care, hydration, pouch application, leakage prevention and signs of urinary infection or obstruction.
- Important: Evaluate urine color and character and skin alterations.
Urostomy Dietary Information: No dietary restrictions. However, some foods cause odor (e.g., alcohol, asparagus, beans, broccoli, cheese, eggs, fish, onions). Encourage adequate hydration (unless restricted) to maintain urinary function. Ileal conduits have a higher risk of electrolyte imbalances and metabolic acidosis.
Ostomy Management: Teach clients and families about stoma & diversion care including odor, skin care, hydration, pouch application & leakage prevention, self-catheterization (for continent reservoirs), and infection/obstruction signs.
Ileostomy: The stoma is typically located in the right lower quadrant. A restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) may be done.
- Initially, clients may follow a low-residue diet to prevent blockage and avoid high-fiber foods for 6-8 weeks.
- Use caution with enteric-coated pills/tablets. Monitor for undissolved meds in the pouch.
- Output is typically dark green, loose, and odorless. Empty pouch when 1/3 - 1/2 full.
- Use skin barriers and monitor for leakage.
- Recognize signs of food blockage (abdominal cramping, nausea, vomiting, stoma swelling, lack of output for 6 hours or more). Lie down in knee-chest position, massage abdomen to promote peristalsis, and consider changing to a pouch with a larger opening if stoma is swollen.
- High-volume ileostomy output puts clients at risk for fluid/electrolyte imbalances. Recognize the signs of dehydration/electrolyte imbalance.
Dietary Adjustments for Ileostomy and Colostomy: Clients may need to gradually resume a regular, balanced diet including fresh fruit, vegetables, proteins and whole grains.
- Avoid foods that cause gas/odor (e.g., alcohol, beans, broccoli, cabbage, chocolate, fried foods, fish, garlic, onions, highly spiced foods, raw fruits, stringy veggies).
- Avoid foods that cause blockage (strings veggies, coconuts).
- If client is experiencing large amounts of effluent, limit insoluble fiber to decrease digestion time.
- Some clients may require foods that thicken stools (e.g., applesauce, bananas, cheese, pasta, rice).
Colostomy: Depending on the area of the colon involved, stomas can be located in the ascending, transverse, descending, or sigmoid colon. Output varies based on location (liquid to semi-formed).
- Potential dietary adjustments for diarrhea, constipation, or medications such as antibiotics.
- Discuss usage of laxatives and enemas with provider/surgeon.
- Use caution with enteric-coated and sustained-release medications.
- Management options include drainable or closed-end pouches, irrigation and dietary management.
- Temporary diverting colostomy clients will have rectal urges/drainage.
- Clients with double-barrel/loop colostomies the distal section carries no feces.
Colostomy Location:
- Ascending colon (right abdomen): Liquid to semi-liquid output, very irritating to skin.
- Transverse colon (mid-abdomen): Temporary ostomy, output is pasty.
- Descending colon (left upper abdomen): Semi-formed output due to increased water absorption.
- Sigmoid colon (left lower abdomen): Formed output, commonly used for permanent colostomies.

Enteral Tube Feeding

Tube Insertion Preparation: Prepare the tube tip with water-based lubricant. Facility policies for numbing agents (lidocaine spray/gel) apply.
Client Positioning: Client tips head back, breathes through mouth, tube inserted through the naris to the posterior nasopharynx.
Tube Advancement: Have client flex head toward chest/swallow and advance tube on each swallow to predetermined length.
Tube Placement Verification: Use a penlight and tongue blade to visualize tube, assess for breathing/coughing/gagging, and client comfort. Verify placement by checking gastric aspirate pH or bilirubin/CO2 levels.
Fluid Analysis:
- Gastric fluid (fasted for 4+ hrs): pH 1-4, grassy green, off-white, or tan, consistency of water.
- Intestinal fluid: pH 7+, light to golden/brownish green, syrupy.
- Continuous tube feeding: pH 5+.
- Respiratory fluid: clear, pH > 6.
Client Risks: Decreased consciousness, poor cough/gag reflexes, recent intubation/extubation, inability to cooperate, restlessness/agitation increase risk for improper placement.
Tube Security: Secure tube at insertion point. Mark the tube.
Post-Insertion Client Care: Comfort, dispose of supplies, clean gloves, mouth care, documentation.
X-ray Confirmation: X-ray is needed.
Guidewire Removal: If using guidewire, remove it after placement confirmation to avoid tissue damage.
Assessment Prior to Insertion: Check client's nares and gag reflex, auscultate the abdomen. Determine the length of the tube necessary for insertion. Consult with appropriate clinical staff based on facility guidelines.

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Description

This quiz covers essential aspects of ostomy care, including ileal conduit management, follow-up procedures, exercise guidance, and addressing sexuality concerns for ostomy clients. It also provides insights into urostomy management and overall care strategies for maintaining health and quality of life.