Nokea
A client is preparing to have colorectal surgery and will have a colostomy created temporarily in hopes that he may be able to have it reversed in 6 months. The client is very concerned about the care of the colostomy. What preoperative interaction would the client benefit from?
- A. Discussing other options with the surgeon
- B. Meeting with an enterostomal therapist
- C. Going to a support group with other clients that have colostomies
- D. Watching a video about colostomies
Correct Answer: B
Rationale: Clients benefit from preoperative interactions with a specially certified nurse, referred to as an enterostomal therapy nurse, enterostomal therapist, or wound, ostomy, and continence nurse. This nurse assists with marking placement of the stoma and collaborates with the surgeon regarding placement and the client's educational needs. Other options may not be available for this client, especially if there is a tumor present. Going to a support group would be a good option in the postoperative management because the client should be given information from the professional prior to going to surgery. Watching the video with the therapist and having the option to answer questions would be a better choice than watching it alone.
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The nurse is caring for a client who is to undergo surgery for the creation of a continent ileostomy. Which statement by the client indicates the nurse's teaching has been successful?
- A. I'll need to empty the appliance more frequently.'
- B. I'll need to learn how to empty the reservoir several times a day.'
- C. My stool will be loose initially but then become formed in a week or so.'
- D. If I just push on the valve and the drainage will flow out easily.'
Correct Answer: B
Rationale: A continent ileostomy involves the creation of an internal reservoir for the storage of GI effluent. It stores the effluent for several hours until the client removes it with a catheter. Initially, the reservoir is emptied every 2 to 4 hours, and then three to four times per day as the capacity of the reservoir increases (usually in about 6 months). This reservoir eliminates the need to wear an external appliance. Stool will continue to be liquid at all times. A continent ileostomy does have a nipple valve through which a catheter is inserted to drain the reservoir.
The nurse is providing ostomy care to the client with an ileostomy. What can the nurse use to promote adhesion of the ostomy appliance?
- A. Adhesive glue
- B. Tincture of Benzoin
- C. Vaseline
- D. Karaya paste
Correct Answer: D
Rationale: Karaya paste, which becomes gelatinous when in contact with moisture, is commonly used in place of an adhesive. Karaya paste promotes adhesion of the ostomy appliance.
The nurse is instructing a client with an ileostomy on appliance and changing it. What statement made by the client demonstrates the client understands using a new appliance for the first time?
- A. I will patch test it first on nonirritated skin at the inner side of my forearm.'
- B. I can expect the new appliance to sting or itch for the first 24 hours.'
- C. When changing the appliance and faceplate, I should scrub vigorously to remove all debris.'
- D. I should change the faceplate every 8 hours.'
Correct Answer: A
Rationale: When using a new adhesive product, the client should patch test it first on nonirritated skin at the inner aspect of the forearm. The most common causes of discomfort are reactions to the adhesive or solvent used to remove it or irritation from leaking fecal drainage. In such cases, the client may experience stinging, tingling, or itching immediately after an appliance change. If a sensation is prolonged or intensified, the client should remove the appliance regardless of whether it has been on for 1 hour or several days. The client should avoid rubbing, which may further irritate skin. If the faceplate is changed too frequently, skin around the stoma may become raw and excoriated secondary to removal of protective layers of epithelium with the faceplate.
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.
The nurse is preparing to irrigate a client's single-barrel colostomy after surgery. The nurse would expect an order from the healthcare provider to irrigate the colostomy on what day after surgery?
- A. Fourth or fifth postoperative day
- B. The day after surgery
- C. The seventh postoperative day
- D. The colostomy should be irrigated immediately postop
Correct Answer: A
Rationale: Colostomy irrigation begins on the fourth or fifth postoperative day. Standard irrigation is a scheduled irrigation, using 500 to 1500 mL of tepid water.