Test 4 Objectives.docx

Objectives: Chapter 29, 30, 33, 39 Chapter 29 Complementary and Integrative Health CAM Terminology (Complimentary and Alternative Medicine) *CHA- complementary health approaches (CHAs) *IH (Integrative Health) Allopathic medicine- Allopathic medicine is a system in which medical doctors and other...

Objectives: Chapter 29, 30, 33, 39 Chapter 29 Complementary and Integrative Health CAM Terminology (Complimentary and Alternative Medicine) *CHA- complementary health approaches (CHAs) *IH (Integrative Health) Allopathic medicine- Allopathic medicine is a system in which medical doctors and other health care professionals, such as nurses, pharmacists, and therapists, treat symptoms and diseases using drugs, radiation, or surgery. Other terms for this type of approach are conventional medicine, biomedicine, mainstream medicine, orthodox medicine, and Western medicine. Allopathic medicine has been dominant for about 100 years in the United States and has spearheaded remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools. Allopathic medical care is particularly effective when aggressive treatment is needed in emergency or acute situations. Holism- Holism is a theory and philosophy that focuses on connections and interactions between parts of the whole; interrelationships of the physical, mental, emotional, sexual, cultural, social, spiritual, and energetic dimensions of the person. Holistic nursing- Holistic nursing is nursing practice built on a holistic philosophy. Healing the whole person is its goal. Since holism is a philosophy and not a specific nursing role, holistic nurses can be found in all varieties of health care settings as well as in independent practice settings. In addition, holistic nurses frequently add CHAs to their practice. Most holistic nurses use CHAs for self-care, an essential component of holistic practice (AHNA, n.d.). The American Holistic Nurse Association (AHNA) promotes the education of nurses, other health care professionals, and the public in all aspects of holistic caring and healing Integrative health care- A person who uses integrative care uses some combination of allopathic medicine and CHAs. There are several types of integrative care models used throughout the United States that can be housed in virtually all health care delivery structures. Optimally, these models include sensitive and knowledgeable health care providers who work with patients to design a plan of care that is responsive to the patient’s and family’s/caregiver’s preferences and needs and combines the best of allopathic medicine and CHAs while avoiding harmful interactions. Holism Complementary and Integrative Health Approaches That Work on Pain Mind-Body Practices Relaxation- Relaxation techniques promote parasympathetic nervous system activity, helping to reduce sympathetic activity and restore the balance of the two systems. The complex psychophysiologic processes that activate to deal with a real or perceived emergency, characterized by increased sympathetic nervous system activity, can contribute to symptoms such as increased blood pressure, cool hands and feet, tight muscles, increased heart rate, and increased anxiety. The ultimate goal is to increase the parasympathetic system influence in the mind–body and thus reduce the effect of stress and stress-related illness on the body. Relaxation can be useful whether a patient is experiencing a single stressful event, such as surgery or chronic stress. Patient benefits include reduced anxiety, reduced muscle tension and pain, improved functioning of the immune system, enhanced sleep and rest, and an improved overall sense of well-being. Relaxation techniques include progressive muscle relaxation, guided imagery, deep breathing exercises, autogenic training, biofeedback, and self-hypnosis. Because these modalities are quite different, the type of relaxation modality chosen needs to be individually suited to the patient, based on their health status, personal preferences, and available time. Meditation- Meditation has been part of many spiritual and healing traditions for hundreds of years. Meditation refers to a group of techniques, such as mantra meditation, relaxation response, mindfulness meditation, and Zen Buddhist meditation. In meditation, a person learns to focus attention. Some forms of meditation instruct the practitioner to become mindful of thoughts, feelings, and sensations and to observe them in a nonjudgmental way. This practice is believed to result in a state of greater calmness and physical relaxation, as well as psychological balance (NCCIH, 2021). Practicing meditation can change how a person relates to the flow of emotions and thoughts. Meditation normally has 4 elements in common: A quiet location, A specific comfortable posture, a focus of attention, an open attitude. Guided imagery-Guided imagery focuses on evoking pleasant images to replace negative or stressful feelings and to promote relaxation. Guided imagery involves using all five senses to imagine an event or body process unfolding according to a plan. When all senses are involved in the experience, the imaginary situation is more fully encoded in the body and more likely to take place. A relaxation technique is frequently used to prepare the mind and body before beginning an imagery session . Yoga-Yoga is a mind and body practice with historical origins in ancient Indian philosophy. In the United States, yoga is practiced independently or paired with other health-promoting activities that assist people to achieve unity and wholeness. In general, in the United States, yoga involves the combination of physical movements, breathing practices, and relaxation practices/meditation (NCCIH, 2019a). Yoga promotes strength and flexibility, increases endurance and relaxation, reduces a person’s response to stress, promotes healthy eating/activity habits, and promotes sleep (NCCIH, 2019a; Sivaramakrishnan et al., 2019). Yoga has been incorporated into comprehensive integrative pain management interventions (Pearson et al., 2020) and supportive interventions to address the negative side effects of cancer treatment (Johnson & Haag, 2019). Breathing exercises, posture awareness, spiritual practices, and mind–body centering can be added to the basic postures. Common styles or traditions of yoga include: *Iyengar, which focuses on proper alignment of the body and use of poses and breathing to address specific needs of the practitioner *Kripalu or “gentle yoga,” which focuses on relaxation and coming into balance *Ashtanga, which focuses on synchronizing breathing with a fast-paced series of postures *Bikram, which is done in a studio heated to 105°F and involves 26 set postures. Qi Gong and Tai Chi- Qi gong is a system of postures, exercises (both gentle and dynamic), breathing techniques, and visualization. The majority of qi gong exercises or meditations enhance systemic health. They are designed to restore the healing system, the body’s innate intelligence, so it knows how to correct and heal itself. Qi gong postures are illustrated in Figure 29-4. For techniques specific to particular diseases, a patient can consult a qi gong teacher. Tai chi, a martial arts, mind–body practice (Fig. 29-5) that likely developed from qi gong, has been shown to be better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being (Chan et al., 2018). Both tai chi and qi gong (also known as qigong) have origins in China and involve physical movement, mental focus, deep breathing, and relaxation (NCCIH, 2016b). As with yoga, qi gong and tai chi can be learned through the use of streamed or face-to-face classes. Various tai chi and qi gong organizations offer training and certification programs, with differing criteria and levels of certification for instructors (NCCIH, 2016b). Encourage those interested to ask potential instructors about their background and knowledge. Acupuncture- Acupuncture addresses a person’s qi. Traditionally, Qi (chi in Japanese) is believed to flow vertically in the body through an intricate structure of 12 primary meridians, energy circuits that nourish and support all cells and organs of the body (Fig. 29-6). Acupuncture consists of placing very thin, short, sterile needles at particular acupoints, believed to be centers of nerve and vascular tissue, along a meridian (Figs. 29-7 on page 896 and 29-8 on page 896). Acupuncture either increases or decreases the flow of qi along the meridian, restoring the balance of yin and yang. This change in the flow of energy contributes to healing. Conventional medicine suggests acupuncture stimulates improved biochemical actions involved in nerve transmission, direct effects on the central nervous and modulation of parasympathetic activity. Acupuncture is used for a variety of reasons, including reducing pain, promoting adherence to smoking cessation, addressing sleep disorders, and minimizing nausea and vomiting due to chemotherapy and pregnancy. Chiropractic health care-Chiropractic health care is a profession that focuses on the relationship between the body’s structure—mainly the spine—and its functioning (NCCIH, 2019c). Chiropractic practitioners primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body’s natural ability to heal itself (Fig. 29-9). The NCCIH reports that most research on chiropractic health care has focused on spinal manipulation (NCCIH, 2019c). Spinal manipulation appears to benefit some people with low-back pain and may also be helpful for headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. Aromatherapy-Aromatherapy is the use of essential oils of plants as a therapy to improve physical, emotional, and spiritual well-being (Fontaine, 2019). The fragrance of these oils is believed to ultimately affect the very sensitive amygdala of the limbic system in the brain, where emotional memories are stored and released (Johns Hopkins Medicine, n.d.). Laboratory and animal studies have shown that certain oils have antibacterial, antiviral, antifungal, calming, and energizing effects. Essential oils can be absorbed by the body through in halation and topical applications (Helming et al., 2022). Aromatherapy practices have been utilized in the management of pain, sleep disorders, anxiety, depression, nausea and vomiting, and increased general well-being (Dilek & Necmiye, 2020). Commonly used essential oils in a health care setting are ginger for nausea and lavender for insomnia (Fontaine, 2019). Essential oils vary in quality and potency depending on the manufacturing processes. If specific essential oils are approved for use in an inpatient setting, provide education on these oils. Some people are highly sensitive to strong fragrances, particularly concentrated essential oils. This might preclude their use in some patient settings. Certification in Aromatherapy for health professionals is available. Standards for professional aromatherapy education are set by the National Association for Holistic Aromatherapy. Benefits of Relaxation for Patients Theories of Homeopathy- Homeopathy is a medical system that was developed in Germany more than 200 years ago (NCCIH, 2018). The allopathic approach to dealing with illness is frequently to suppress symptoms; for example, acetaminophen can be given to reduce a fever. In contrast, homeopaths believe that when symptoms are suppressed in this manner, the condition “goes deeper” into the body, making it ultimately more difficult to cure. Supporters of homeopathy point to two unconventional theories: “Like cures like”: The notion that a disease can be cured by a substance that produces similar symptoms in healthy people. “Law of minimum dose”: The notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic remedies are so diluted that no molecules of the original substance remain. Homeopathic remedies are derived from substances that come from plants, minerals, or animals, and include things such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy, belladonna (deadly nightshade), and stinging nettle (NCCIH, 2018). Homeopathic remedies are often formulated as sugar pellets to be placed under the tongue; they may also be in other forms, such as ointments, gels, drops, creams, and tablets. Treatments are “individualized” or tailored to each person—it is not uncommon for different people with the same condition to receive different treatments (NCCIH, 2018). There is little evidence to support homeopathy as an effective treatment for any specific condition. Although people sometimes assume that all homeopathic remedies are highly diluted and therefore unlikely to cause harm, some products labeled as homeopathic can contain substantial amounts of active ingredients, thus could cause side effects and drug interactions. Principles Underlying Naturopathy Naturopathy has evolved from traditional practices and health care approaches popular in Europe during the 19th century. Naturopaths believe that health is a dynamic state of being that provides abundant energy for people to deal with life in our complex society. Naturopathic medicine holds that the body innately knows how to maintain health and heal itself. The naturopathic provider’s role is to support and restore the body using techniques and medicines that are geared to strengthen the body’s own healing ability. Naturopathic practitioners use many different treatment approaches, including dietary and lifestyle changes, stress reduction, herbs and other dietary supplements, manipulative therapies, practitioner-guided detoxification, psychotherapy, and counseling. In the United States, naturopathic medicine is practiced by naturopathic physicians, traditional naturopaths, and other health care providers who also offer naturopathic services. Chapter 30 Medications Pharmacokinetics (Effect of Body on Drug) The process by which a drug moves through the body and is eventually eliminated. It can be done via: Absorption Distribution Metabolism Excretion Adverse Drug Reactions Adverse Effects/Side Effects Allergic effects Drug tolerance Toxic effect Idiosyncratic effect - A`n adverse reaction that does not occur in most patients treated with a drug and does not involve the therapeutic effect of the drug.  Types of Medication Orders Standing order (routine order): carried out until cancelled by another order PRN order: as needed Single or one-time order Stat order: carried out immediately Rights of Medication Administration Right medication Right patient Right dosage Right route Right time Right reason Right assessment data Right documentation Right response Right to education Right to refuse Oral Medications Solid form: tablets, capsules, pills Liquid form: elixirs, spirits, suspensions, syrups Oral route: having patient swallow drug Enteral route: administering drug through an enteral tube Sublingual administration: placing drug under tongue Buccal administration: placing drug between tongue and cheek Administration of Parenteral Medications Subcutaneous injection: subcutaneous tissue Intramuscular injection: muscle tissue Intradermal injection: corium (under epidermis) Intravenous injection: vein Intra-arterial injection: artery Intracardial injection: heart tissue Intraperitoneal injection: peritoneal cavity Intraspinal injection: spinal canal Intraosseous injection: bone Angles of Insertion for Various Injections Sites for Intramuscular Injections Ventrogluteal site Vastus lateralis site Deltoid muscle site Preparing Medications for Injection : *Ampules-NEED FILTER NEEDLE; CLEAN NECK WITH ALCOHOL PAD and break with 4x4 wrapped around neck breaking away from your body to break open. Vials-if multi-dose vial, clean tops with alcohol pad and if its one time use then throw in sharps container. Prefilled cartridges or syringes-majority of prefilled medications is going to be like heparin. Mixing medication in one syringe- If you are going to be mixing medications in one syringe; that’s fine but you have to make sure there isn’t any contraindications with each other like if when you mix it together, they start changing colors or getting more viscous; changes consistency; gets cloudy; those are all signs of contraindications and that medications needs to be discarded and not given to your patient. When in doubt; contact pharmacy. Mixing insulins in one syringe- Mixing insulins- always remember cloudy, clear, clear, cloudy. Reconstituting powdered medications- Mixing a liquid diluent with a powdered medication to get your solution to administer to a patient. Topical Administration of Medications Skin applications: applying to the skin or mucous membranes allows it to enter the body; medication administered this way is known as topical. More than likely you would see it used for pain. Like Voltaren, which is used for pain relief in arthritis. Eye instillations and irrigations: hold 1-2 cm above the eye. Start with inner to outer. When applying ointment remember you want to apply a thin ribbon from the inner to the outer eye. Ear instillations and irrigations: always lay on the opposite side so if you are going to give me medication on my right ear; then my position would be on the left lateral side and vice versa. Nasal instillations: remember that we grab an alcohol pad and wipe the top of the applicator to make sure there is no nasal discharge or any crusting on the applicator and we close the nostril we are not using and inhale as we administer the medication. *FOR VAGINAL AND RECTAL APPLICATIONS, THESE ARE VERY SENSITIVE AREAS SO WE WANT TO PROVIDE THE PATIENT WITH PRIVACY AND EDUCATION AND MAKE THEM FEEL AS COMDORTABLE AS THEY POSSIBLY CAN. Vaginal applications: you can use vaginal applicators and you can put the pill or medical ointment; have the patient lay in a comfortable position, insert the applicator, and push the plunger to make sure all the medication is administered into the vaginal canal. Rectal instillations: left lateral with their right knee up or left sims. Always lubricate either enema or suppository. advise for patients to hold it in as long as they can and when they can no longer hold it; assist patient to the bed side commode or the restroom if they can make it. Patient Teaching: Review techniques of medication administration: if your patient is going home with insulin, make sure they can demonstrate and know how to administer it. Remind the patient to take the medication as prescribed for as long as prescribed: if the person must take medication for 10 days but they start to feel better at day 9 that they still continue to use it for the 10 days. Instruct the patient not to alter dosages without consulting a physician: make sure that if they are prescribed 10 mg to take 10mg and not any other amount. Caution the patient not to share medications : the medication was prescribed to them, not their husband or brother or cousin etc. Chapter 33 Skin Integrity and Wound Care Factors Affecting the Skin -Unbroken and healthy skin and mucous membranes defend against harmful agents -Resistance to injury is affected by age, amount of underlying tissues, and illness -Adequately nourished and hydrated body cells are resistant to injury -Adequate circulation is necessary to maintain cell life Types of wounds Intentional (surgical) or unintentional (traumatic) Neuropathic or vascular Pressure related Open or closed (CLOSED IS LIKE A BRUISE) Acute or chronic Partial thickness, full thickness, complex Wound Terminology (WORDS TO USE WHEN YOU ARE DOCUMENTING WOUNDS) -Incision -Contusion -Abrasion -Laceration -Puncture -Penetrating -Avulsion -Chemical -Thermal -Irradiation -Pressure ulcers -Venous ulcers -Arterial ulcers Diabetic ulcers Principles of Wound Healing #1 & #2 -Intact skin is the first line of defense against microorganisms -Careful hand hygiene is used in caring for a wound -The body responds systematically to trauma of any of its parts -An adequate blood supply is essential for normal body response to injury -Normal healing is promoted when the wound is free of foreign material -The extent of damage and the person’s state of health affect wound healing -Response to wound is more effective if proper nutrition is maintained.. REMEMBER WE NEED PROTEIN TO HELP A WOUND HEAL FASTER. Phases of Wound Healing Phase 1: Hemostasis Phase 2: Inflammatory Phase 3: Proliferation Phase 4: Maturation Phase 1: Hemostasis Occurs immediately after initial injury Involved blood vessels constrict and blood clotting begins Exudate is formed, causing swelling and pain (clear discharge; leukocytes help to heal) Increased perfusion results in heat and redness Platelets stimulate other cells to migrate to the injury to participate in other phases of healing Phase 2: Inflammatory Phase Follows hemostasis and lasts about 2 to 3 days White blood cells, predominantly leukocytes and macrophages, move to the wound Macrophages enter the wound area and remain for an extended period. They ingest debris and release growth factors that attract fibroblasts to fill in the wound Exudate is formed and accumulates, causing pain, redness, and swelling at the site of injury The patient has a generalized body response Phase 3: Proliferation Phase Lasts for several weeks New tissue is built to fill the wound space through the action of fibroblasts Capillaries grow across the wound A thin layer of epithelial cells forms across the wound Granulation tissue forms a foundation for scar tissue development Phase 4: Maturation Phase Final stage of healing; begins about 3 weeks after the injury, possibly continuing for months or years Collagen is remodeled New collagen tissue is deposited, which compresses the blood vessels in the wound, causing a scar Scar: flat, thin, white line; avascular collagen tissue that does not sweat, grow hair, or tan in sunlight Wound Complications Infection Hemorrhage Dehiscence and evisceration Fistula formation-A fistula is an abnormal passage from an internal organ or vessel to the outside of the body, or from one internal organ or vessel to another Risks for Pressure Injury Development Nutrition and hydration: Protein–calorie malnutrition predisposes a person to pressure injury formation because poorly nourished cells are damaged easily. Protein deficiency leading to a negative nitrogen balance, electrolyte imbalances, and insufficient caloric intake also predisposes the skin to injury. Other deficiencies can increase risk. For example, vitamin C deficiency causes capillaries to become fragile, with resultant poor circulation to the area. The condition of the teeth or fit of dentures may also exacerbate the problem of inadequate dietary intake. Dehydration as well as edema can interfere with circulation and subsequent cell nourishment Immobility: Patients who spend long periods of time in bed or seated without shifting their body weight properly are at great risk for developing a pressure injury. People who are ambulatory usually do not develop this type of injury because no part of the body experiences prolonged pressure. In addition, when asleep, healthy people tend to move about in bed freely. Patients who are unconscious and paralyzed, those with cognitive impairments, those experiencing depression, or those with other physical limitations such as a fracture, are subject to pressure injuries if they are allowed to remain in any one position for an extended period. Additional factors that cause immobility and may result in this serious problem include surgery and the use of tranquilizers or sedatives. Mental status: The more alert a person is, the more likely the person is to protect skin integrity by relieving pressure periodically and maintaining adequate skin hygiene. Apathy, confusion, or a comatose state can diminish these self-care abilities and increase the likelihood of skin breakdown. Age: Older adults are at a greater risk for pressure injury because the aging skin is more susceptible to injury. Chronic and debilitating diseases, more common in this age group, may adversely affect circulation and oxygenation of dermal structures. Other problems, such as malnutrition and immobility, compound the risk of pressure injury development in older adults. Stages of Pressure injuries- A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue. Stage 1: nonblanchable erythema of intact skin Stage 2: partial-thickness skin loss with exposed dermis Stage 3: full-thickness skin loss; not involving underlying fascia Stage 4: full-thickness skin and tissue loss Unstageable: obscured full-thickness skin and tissue loss Deep tissue pressure injury: persistent nonblanchable deep red, maroon, or purple discoloration Health History (the components you have to focus on for wounds) Recent changes in skin (any recent changes like rashes? bumps ? lumps?) Activity and mobility (if activity is decreased.. it can lead to a pressure ulcer) Nutrition (most recent diet) Pain (pain scale 0-10, location ? and description burning? Stabbing etc?) Elimination(what is the patients baseline?) Skin Assessment Inspection and palpation Systematically—head to toe Include bony prominences On admission and at regular intervals: Acute care—every shift Long-term settings—weekly for 4 weeks then quarterly Home health care—each visit Wound Assessment Appearance Size of wound Depth of wound Presence of undermining, tunneling, or sinus tract Drainage Serous Sanguineous Serosanguineous Purulent Preventing Pressure Injuries Assess at risk patients daily (every single shift) Cleanse the skin routinely (don’t let them sit in their feces or urine for prolonged periods) Maintain higher humidity; use moisturizers Protect skin from moisture Minimize skin injury from friction or shearing Proper positioning, turning, transferring (our goal is to turn patients every 2 hours) Appropriate support surfaces Nutritional supplements Improve mobility and activity Types of Wound Dressings Those that maintain moisture. Those that absorb moisture. Those that add moisture. Changing the Dressing Prepare the patient (always ask about pain beforehand) Use appropriate aseptic techniques Hand hygiene before and after Adhere to standard and transmission-based precautions Remove the old dressing Cleanse the wound Apply a new dressing Secure the dressing (always label when it was changed and by whom) Type of Drainage Systems Open systems Penrose drain Closed systems Jackson-Pratt drain Hemovac drain Effects of Applying Heat: (NORMALLY STARTED ABOUT 72 HOURS AFTER THE INJURY OCCURS) Dilates peripheral blood vessels Increases tissue metabolism Reduces blood viscosity and increases capillary permeability Reduces muscle tension Helps relieve pain Effects of Applying Cold (NORMALLY USED WITHIN THE FIRST 72 HOURS) Constructs peripheral blood vessels Reduces muscle spasms Promotes comfort ****For both cold and heat make sure temperature is appropriate for your patients. Factors Affecting the Response to Hot and Cold Treatments Method and duration of application Degree of heat and cold applied Patient’s age and physical condition Amount of body surface covered by the application Chapter 39 Bowel Elimination Variables Influencing Bowel Elimination Developmental considerations (sometimes when your young or old, you don’t have control of your bowels. Also when a child is very young and stressed- they will go from being potty trained to not being potty trained) Daily patterns (what we do throughout the day. Do we work early? do we work night shift? Are our bowel patterns now at night instead of during the day?) Food and fluid (if we are not hydrated, we will more likely have a touch of constipation. If we don’t have enough fiber, that might also be an issue) Activity and muscle tone (do we go out and be active and get everything moving?) Lifestyle Psychological variables Pathologic conditions Medications (opioids might make them constipated. Metformin can make them get diarrhea) Diagnostic studies (are they about to go into a diagnostic study where they have to go NPO 12 hours before which would affect their bowels) Surgery and anesthesia (surgery and anesthesia can slow down their bowel and elimination process) Effect of Medications on Stool Opioid-induced constipation Antacids decrease GI motility Antibiotics, magnesium, and metformin can cause diarrhea Nursing History (things we want to know from our patients) Usual patterns of bowel elimination (do they go everyday, every other day?) Aids to elimination (do they have coffee every morning? Did they increase their fiber?) Recent changes in bowel elimination (did they go from being frequent and now its been three days and they still haven’t gone?) Problems with bowel elimination (any problems with bowel elimination or have they in the past?) Presence of bowel diversion (does your patient have a colonoscopy? An ileostomy?) Physical Assessment of the Abdomen: The sequence for abdominal assessment proceeds from inspection, auscultation, and percussion to palpation Inspection: observe contour, any masses, scars, or distention Auscultation: listen for bowel sounds in all quadrants Note frequency and character, audible clicks, and flatus Describe bowel sounds as hypoactive, hyperactive, absent, or infrequent Percussion and palpations: performed by advanced practice professionals Individuals at High Risk for Constipation: Patients on bedrest or with decreased mobility Patients taking constipating medicines Patients with reduced fluids or bulk in their diet Patients who are depressed Patients with central nervous system disease or local lesions that cause pain while defecating Types of Enemas Cleansing Retention Oil Carminative Medicated Hypotonic large volume Hypertonic small volume Colostomy Diet Low-fiber foods during first 6–8 weeks Drink at least 2.5 quarts of fluids, preferably water Avoid foods that cause blockage: nuts, corn, popcorn, coconuts, mushrooms, stringy vegetables, and foods with skins and casings Avoid foods that may cause gas and/or produce odor Add foods that may help thicken stool: bananas, cheese, pasta, rice, yogurt, applesauce, potatoes Patient Teaching for Colostomies Explain the reason for bowel diversion and the rationale for treatment Demonstrate self-care behaviors that effectively manage the ostomy Describe follow-up care and existing support resources Report where supplies may be obtained in the community Verbalize related fears and concerns Demonstrate a positive body image Colostomy Care Keep the patient as free of odors as possible; empty the appliance frequently Inspect the patient’s stoma regularly Keep the skin around the stoma site clean and dry Measure the patient’s fluid intake and output Explain each aspect of care to the patient and self-care role Encourage patient to care for and look at ostomy Provide support for physical, psychological, and social activities Types of Ostomies Sigmoid colostomy Descending colostomy Transverse colostomy Ascending colostomy Ileostomy Desiccation is localized wound dehydration. Maceration is localized wound overhydration or excessive moisture. Necrosis is death of tissue in the wound. Evisceration is complete separation of the wound, with protrusion of viscera through the incisional area. With the yellow classification using the RYB wound classification system, wound irrigation should be implemented. Yellow wounds require wound cleaning and irrigation related to exudate and slough. Gentle cleansing and moist dressings are utilized in the Red classification. Debridement is required for the wounds in the Black classification because the wounds have necrotic tissue present. An albumin level of less than 3.2 mg/dL indicates that the client is nutritionally at risk for the development of a pressure injury. A hemoglobin A1C level greater than 8% puts the client at risk for the development of pressure injuries due to a prolonged high glucose level. Glucose levels greater than 120 mg/dL are a risk factor for the development of pressure injuries. Sodium of 135 mEq/L is normal and would not put the client at risk for the development of a pressure injuries. An albumin level of less than 3.2 mg/dL indicates that the client is nutritionally at risk for the development of a pressure injury. A hemoglobin A1C level greater than 8% puts the client at risk for the development of pressure injuries due to a prolonged high glucose level. Glucose levels greater than 120 mg/dL are a risk factor for the development of pressure injuries. Sodium of 135 mEq/L is normal and would not put the client at risk for the development of a pressure injuries. Undermining is the term for a hollow area between the outer wound and the wound bed. It resembles a cave. Eschar is a leathery covering that is dead tissue; it is usually removed by debridement. Tunneling is a cavity or channel formed from a wound. Dehiscence is the opening of a previously closed surgical wound. A T-tube is used to drain bile, such as after a cholecystectomy. A Penrose drain provides a sinus tract for drainage. Hemovac and Jackson-Pratt drains both decrease dead space by decreasing drainage. A ventriculoperitoneal shunt diverts drainage to the peritoneal cavity. Washing the stoma and surrounding skin with a mild cleanser and water and patting it dry can preserve skin integrity. When using a cleanser, it is important to rinse the area thoroughly. Any residue left on the skin can cause problems with the wafer adhering. Another way to protect the skin is to apply barrier substances such as karaya, a plant substance that becomes gelatinous when moistened, and commercial skin preparations around the stoma. Cleaning the stoma with just a dry, cotton bandage is not the correct way of preserving skin integrity. The left lateral or knee-to-chest position is the most common position for sigmoidoscopies or colonoscopies. If the client is not able to tolerate this position, Sims position may also be used. The nurse will teach that the 50-year-old client with a family history of polyps should consider a colonoscopy screening. Screenings should start at 50 years old and continue every 10 years thereafter. Other answers are incorrect. The most common types of solutions used for cleansing enemas are tap water, normal saline, soap solution, and hypertonic solution. Cleansing enemas are used to relieve constipation or fecal impaction, promote visualization of the intestinal tract by radiographic or instrument examination (colonoscopy), establish regular bowel function, and prevent the involuntary escape of fecal material during surgical procedures. Carminative enemas are classified as retention enemas and are used to expel flatus from the rectum and provide relief from gaseous distention. Return-flow enemas are also occasionally prescribed to expel flatus. If newborns are fed breast milk, the stools will be yellow to gold in color, soft, and unformed with an unobjectionable odor. Dark greenish stool characterizes the first stool after birth, the meconium. Beige and brown stools are characteristic of formula-feed infants. Very dark stools would be considered an anomaly. The abdominal assessment should be performed in the following sequence: inspection, auscultation, percussion, palpation. To prepare to introduce the enema solution for an adult client, the should generously lubricate the end of the rectal tube 2 to 3 in (5 to 7 cm) and slowly and gently insert the enema tube 4 to 5 in (10 to 12.5 cm). If the tube is inserted  at or less than 3 in (7.5 cm), then the enema solution will not make it into the rectum but will seep out during the administration of the enema.  A hypertonic enema solution lubricates the stool and intestinal mucosa, making stool passage more comfortable. Oil-retention enemas help to lubricate the stool and intestinal mucosa, making defecation easier. A hypertonic enema draws water into the colon, which stimulates the defecation reflex. Carminative enemas help to expel flatus from the rectum and relieve distention secondary to flatus. Anthelmintic enemas are administered to destroy intestinal parasites.  A vagal response, is an involuntary response which increases parasympathetic stimulation, causing a decrease in heart rate