Nokea
A client is having a procedure that will remove the entire colon and rectum and will bring the end of the ileum through a separate area on the right lower quadrant of the abdomen. What type of procedure does the nurse understand this client will be having?
- A. Appendectomy
- B. Total colectomy
- C. Double-barrel colostomy
- D. Abdominoperineal resection
Correct Answer: B
Rationale: In the usual surgical procedure for a conventional ileostomy, the entire colon and rectum are removed (total colectomy). The terminal end of the ileum is brought out through a separate area on the right lower quadrant of the abdomen slightly below the umbilicus, near the outer border of the rectus muscle. The end is averted and sutured to the skin, a process referred to as a matured stoma. An appendectomy is removal of the appendix. A double-barrel colostomy may be a temporary colostomy for rest of the bowel. Abdominoperineal resection removes the anus, rectum, and part of the sigmoid colon.
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The nurse is preparing a client for surgery and observes on the operative permit that the client will be having a double-barrel colostomy. The nurse explains to the client's spouse that this is performed on what portion of the large intestine?
- A. Descending
- B. Ascending
- C. Transverse
- D. Sigmoid
Correct Answer: C
Rationale: A double-barrel colostomy, which is performed most often in the transverse section of the large intestine, contains both a proximal and distal stoma.
The nurse is caring for a client about to have the first stage of an ileoanal anastomosis. What should the nurse inform the client they will experience?
- A. Solid stool from the anus
- B. Very little discharge from the anus
- C. Control of the fecal material from the anus
- D. Continuous discharge of mucus from the anus
Correct Answer: D
Rationale: After the first stage of surgery, clients experience an almost continuous discharge of mucus from the anus and a frequent discharge of fecal material from the ileostomy. Initially, clients cannot control the frequent watery discharge.
The nurse is teaching the client post ileostomy surgery about attachment of the faceplate around the stoma. What measure will ensure secure attachment of the pouch to the peristomal skin?
- A. Apply a large quantity of adhesive around the stoma prior to attaching the faceplate.
- B. Press the adhesive faceplate around the stoma for about 30 seconds.
- C. Press the adhesive faceplate from the outward edge of the stoma inward.
- D. Wipe the faceplate with alcohol to remove debris.
Correct Answer: B
Rationale: Press the adhesive faceplate around the stoma for about 30 seconds. This measure ensures secure attachment of the pouch to the peristomal skin. A large amount of adhesive is not necessary to adhere the faceplate around the stoma. The adhesive faceplate should be pressed from the stomal edge outward. The faceplate should not be wiped with alcohol first.
A client will be having a total colectomy in 4 days. The client does not have an obstruction. What does the nurse anticipate instructing the client about doing prior to the surgery to prepare the bowel?
- A. Instructing the client about dietary restrictions and lavage agents
- B. Making sure the client drinks 2 L of fluids prior to the procedure
- C. Instructing the client to have no food except clear liquids for 4 days
- D. There will be no special preparation, and the client may eat until midnight the night prior to surgery.
Correct Answer: A
Rationale: Cleansing of the bowel before surgery is carried out using dietary restriction in combination with laxative or lavage agents, depending on the client's condition (i.e., presence or absence of obstruction) and according to the surgeon's preference. There are no benefits to the client drinking 2 L of fluids prior to the procedure or taking in only clear liquids for 4 days.
A client with an ileostomy tells the nurse that he is having a lot of problems with the formation of gas. What can the nurse tell the client to help her with this a common issue?
- A. Eat slowly and chew food well with mouth closed.
- B. Restrict fluids.
- C. Administer an enema to clear out the stool.
- D. Dilate the stoma.
Correct Answer: A
Rationale: The client should eat slowly and chew food well with the mouth closed to help lessen the development of gas. Restricting oral intake should only be done with medical supervision and will not help with gas reduction. Enemas should not be administered. The stoma is only dilated when the stool volume decreases.