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A client who is scheduled for an ileostomy surgery and been taking corticosteroids is instructed to taper the drug, eventually discontinuing it. The nurse would monitor this client for which of the following?
- A. Cerebral anoxia
- B. Cardiac dysrhythmias
- C. Hypothyroidism
- D. Adrenal insufficiency
Correct Answer: D
Rationale: Adrenal crisis is potentially life-threatening and may result from the abrupt withdrawal of corticosteroids. Therefore, the nurse should closely monitor a client who is scheduled for an ileostomy surgery for adrenal insufficiency, resulting from corticosteroid withdrawal. Withdrawal of corticosteroids does not cause cerebral anoxia, cardiac dysrhythmias, or hypothyroidism.
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The nurse is assessing the stool consistency of a client with an ascending colostomy. Which of the following would the nurse expect to find?
- A. Liquid
- B. Liquid to pasty
- C. Soft
- D. Formed
Correct Answer: B
Rationale: The consistency of fecal material ranges from semiliquid to formed depending on the area from which the colostomy is formed. With an ascending colostomy, stool would be liquid to pasty. An ileostomy would produce liquid stool, a transverse colostomy would produce soft stool; a sigmoid colostomy would produce formed stool.
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 has been discharged from the acute care facility with an ileostomy. The client comes to the clinic for a follow-up visit and informs the nurse that the wound has been draining and they are having abdominal pain and running a fever. What does the nurse suspect is occurring with the client?
- A. The client is having an allergic reaction to the appliance.
- B. The client has developed anemia from blood loss.
- C. The client has developed a wound infection.
- D. The client is not emptying the pouch correctly.
Correct Answer: C
Rationale: Signs of wound infection are wound drainage, abdominal pain, and elevated temperature. These symptoms do not indicate an allergic reaction, anemia, or not emptying the pouch correctly.
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.
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.