What pre op teachings should be done for a stoma patient?
- Pt should be given inforation re: what a stoma is and how the different appliances work
- No heavy lifting for 8 weeks PO
- No heavy exercise until surgeon clears you (4-8weeks)
- Colostomy/ Urostomy can resume normal diet. Ileostomy should avoid certain foods to prevent flatus (cabbage, onions, spicy foods) or fibrous foods (celery, lettuce, nuts) to prevent blockages
Ideally, what muscle should the stoma be placed in? Why
Rectus abdominal - to help prevent hernia
What is a nurse assessing to judge if a stoma is healthy post op?
- Color - should be pink to bright red
- Output. May not have any output for the first few days. Flatus will return first
- If rod in place, should slide easily back and forth. Should be in center of stoma
- Surrounding skin should be intact - no redness, blisters, edema, skin loss, itchiness, pain or burning sensation
- Stoma spout should be >5mm to prevent complicatoins
- Sutures should be intack
- Stoma should be warm, not cool
What is an ostomy
Surgical intervention bringing a portion of the small or large bowel to the abdominal surface. May be temporary or permanent
What is effluent?
Drainage of an ostomy
What are continent urostomys? Incontinent?
Incontinent: ileal conduits, urostomy. Pouch required
COntinent: Kock or indiana pouch
What is a loop colostomy?
a temporary ostomy, usually performed in emergencies. Two openingsL one drains feces, distal drains mucous. Rod through the center.
POD 1 - the distal side may drain some stool
What is a double barrel colostomy?
The bowel is surgically severed and the two ends are brought onto the abdoment.
Two distinct stomas. Proximal = functioning, distal = non functioning (may excrete mucous)
Temporary colostomy to allow lower bowel to relax
What is an end colostomy?
One stoma is formed from the proximal end of the distal portion of the GI tract which is either removed or sewn shut.
Often a treatment for colorectal ca
Can be reconnected in the future (Hartmans procedure)
What are the different types of continent colostomies?
J, S, W pouch
Anal sphincter is used to create a pouch inside the body to allow for continence
How often should a colostomy bag be changed?
q 3-5d
What assessments should an RN do after a colostomy surgery?
1) auscultate for BS. Urinary output should happen immediately
2. Observe for skin leakage
3) observe stoma
4) monitor I&Os
What are potential stoma complications?
- Bleeding
- necrosis,
- prolapse,
- hernia,
- laceration,
- irritation,
- retraction
- stenosis
- deattachment
How much bigger should an ostomy bag be from the stoma?
1/16 - 1/8th of an inch
What are the principles of bladder irrigation?
- What goes in should come out - need to measure
- Sterile bodies are irrigated steriley
- Use a physiologic substance to rrigate (NS)
- Use gentle pressure, don’t force
- Assess pt continuous for discomfort
- Use gravity to return
- Irrigate until returns are clear
What is the difference between open and closed irrigation? Which is preferred?
Closed - preferred - catheter is still intact. Fluids (30cc) are inputted through a port on the catheter (catherter is occluded c elastic band).
Repeated until returns are clear
Open - catheter bag is discontinued from inserted cath. NS put in directed to the cath and therefore bladder. Increased risk of infection, but less chance of clots blocking tubing
What is CBI? When is it given? How fast should it run. What instructions should the patient be given?
How long until urine = clear?
Continuous bladder irrigation. Given after TUPR (pt at increased risk for blood clots). Speed dependent on the amount of blood in urine and what is required to prevent clots.
Pts should drink 1 glass H2O / hr
Urine should be clear after POD1
What do you do if the solution will not go through the catheter?
Change the catheter - may be occluded
When should you remove a drain?
Output <50/day
Why would a surgeon choose a JP over a hemovac?
JP - expected drainage 100-200ml/hr
hemovac - expected drainage 500cc/24hrs
When are sutures / staples gen removed Post op?
Why are they removed then?
POD 7-10
Removed ASAP to prevent infection, but removed late enough that the wound has healed enough to prevent dehiescience
When should steristrips be applied?
If there is a separation greater than two stitches or staples in width is between two sides
If the patient is receiving the medication for the first time, what actions should the nurse perform?
Nurse should stay with patient for the first 5 minutes
What is speed shock?
medication is given too quickly, causes toxic effects
