Nokea
The client is having a total colectomy with an ileostomy created. What does the nurse explain to the client that the stool consistency will be?
- A. Liquid or mushy
- B. Bloody, soft
- C. Small balls of feces
- D. Thin and firm
Correct Answer: A
Rationale: The fecal material discharged from an ileostomy is liquid or mushy and contains digestive enzymes. The stool does not have time to harden since there is not the large intestine available to process it.
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A client who had a total colectomy with an ileostomy has rectal packing in place to absorb drainage and promote healing. When the client asks how soon the packing will be removed, what is the nurse's best response?
- A. Within 24 hours
- B. 2 days
- C. Within 1 week
- D. In 2 weeks
Correct Answer: C
Rationale: The rectum is packed with gauze during surgery to absorb drainage and promote gradual healing. The rectal pack usually is removed in 5 to 7 days.
The nurse is caring for a client in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time?
- A. A reusable pouch appliance should be used.
- B. A disposable or temporary appliance should be used.
- C. A dry sterile dressing should be used over the stoma.
- D. A wet to dry dressing should be used over the stoma to keep it moist.
Correct Answer: B
Rationale: A disposable, or temporary, appliance is preferred in the immediate postoperative phase because the size of the stoma changes over time as a result of swelling from the procedure itself. The size of the stoma may change rapidly and differ from one appliance change to the next. After the stoma heals and reaches its final size and shape, a permanent appliance (reusable) may be used. A dry sterile dressing or wet to dry dressing should not be placed over the stoma due to the saturation of stool, which may cause maceration of the skin around the stoma.
A male client, age 32 years, was recently married, and he and his wife would like to have children. The client is scheduled to have a total colectomy and is concerned with being able to have children. What is the best answer given by the nurse related to the client's concern?
- A. There is no risk of you not being able to father children after this surgery.'
- B. Certainly understand your concern, but there are other options such as artificial insemination with a donor.'
- C. You may want to consider collection and storing of sperm for later use if you are planning to have children.'
- D. Infertility is a side effect of this surgery and should be considered carefully.'
Correct Answer: C
Rationale: Young male clients may wish to collect and store sperm for later use if they plan to have children. Sexual dysfunction in men after a total colectomy is unusual but sometimes occurs. If such dysfunction persists after a colectomy, operative and nonoperative options are available to facilitate erection.
The nurse is caring for a client who has undergone colostomy. Which of the following instructions should the nurse include in the teaching plan?
- A. Restrict traveling by air.
- B. Limit outdoor activities.
- C. Avoid light clothing.
- D. Chew food well.
Correct Answer: D
Rationale: The nurse should instruct a client who has undergone colostomy to chew food properly. This helps decrease gas that results chiefly from swallowing air rather than from digestion. The client need not limit or avoid travel or outdoor activities. If traveling by air, the nurse should instruct the client to take ostomy supplies in carry-on luggage to prevent their loss if luggage is misdirected or lost. If the client requires firm, light support, he or she should find a stoma shield to help prevent irritation or undue pressure on the stoma.
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.