NR 226 Exam 3 Study Guide Fundamentals

NR 226 Exam 3 Study Guide Fundamentals – Patient Care Chamberlain College of Nursing

Latest 2023 / 2024

What is bowel diversion? A temporary or permanent artificial opening stoma in the abdominal wall  Surgical openings are created in the ileum (ileostomy) or colon (colostomy), with ends of intestine brought through the abdominal wall to create the stoma  Ascending colon frequent & liquid  Transverse colon  more solid/formed  Descending colon  formed  Sigmoid colon  near normal Differentiate colostomy vs. ileostomy  The location of any ostomy determines the consistency of stool. Colostomy- surgical opening created in the colon  large intestine (can irrigate)

• Injuries
• CA
• Perforated Diverticulitis
• Fistulas

 Ileostomy- surgical opening created in the ileum  small intestine (NEVER irrigate), stools are frequent and liquid.

o Injuries: gunshot, MVA

• Familial Polyposis
• CA
• Inflammatory disease- ulcerative colitis &chon’s disease

How to irrigate:

 Ostomy- After you insert the tube, you need to maintain its patency. Sometimes the tip of the tubing rests against the stomach wall, or the tube becomes blocked with thick secretions. Therefore regular irrigation is necessary. Flushing the tube with normal saline by way of a catheter-tipped syringe clears blockages in the 1 / 3

tube. Although this practice is not as common as it once was, some patients irrigate left-sided colostomies to regulate colon emptying  Other patients don’t want to spend additional 60-90 minutes in bathroom everyday  empty pouch as necessary  Only colostomies can be irrigated; never use an enema set to irrigate a colostomyuse special cone-tipped irrigator to prevent bowel penetration & backflow for irrigating solution  Before irrigating stoma  patient sits on toilet & places irrigating sleeve over stoma  extends into toilet bowl  Healthcare provider order amount & type of irrigation solution  Adults=ranges from 500-700mL of tap water; patient instills solution slowly through lubricated cone tip  Irrigation takes 5-10 minutes; patient removes cone tip & waits 30-45 minutes for solution & feces to drain out of irrigation sleeve  once drainage stops, patient applies a stoma cap or a pouch.

How to take care of stoma/colostomy:

 Patient needs to use meticulous skin care to prevent liquid stool from irritating the skin around the stoma. Changing and emptying- change with 1/3 to ½ full (33%-50% full), check it frequently if gases needs to be released Types of ostomies (Temporary or permanent and types of stools to expect) **There are three types of colostomy construction: loop, end, and double-barrel***  Loop Colostomy- TEMPORARY

• Performed in a medical emergency, removed in 7-10 days (the rod)
• A temporary large stoma constructed in transverse colon
• Surgeon pulls loop of bowel onto the abdomen
• External supporting device (plastic rod, bridge, and rubber catheter) is

temporarily placed under the bowel loop to keep it from slipping back

• Surgeon then opens the bowel and sutures it to the skin of the abdomen
• Loop ostomy has TWO openings through ONE stoma

 Proximal end drains stool 2 / 3

 Distal portion  drains mucus  Double-barrel Colostomy- TEMPORARY

• Surgeon divides intestine and brings both proximal & distal ends through

abdominal incision to abdominal surface when creating a double-barrel colostomy; two openings (one side is stool; other side is mucous)

• Small incision made in proximal stoma for fecal drainage, distal stoma

leads to inactive intestine is left intact

• When intestinal injury has healed  colostomy is reversed

 End Colostomy- PERMANENT or TEMPORARY

• One stoma formed from proximal end of bowel, with distal portion of GI

tract either removed or sewn closed

• Results of surgical treatment of colorectal cancer  return usually

removed

• Patients with diverticulitis who are treated surgically often have a

temporary end stoma with a Hartmann’s pouch

Normal Characteristics of ostomies:

 Deep reddish pink  Moist  No areas of impaired circulation or necrosis

Normal Characteristic of ileostomies:

 Red, moist

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