Nokea
The nurse is discussing care of the client's ileostomy and is instructing the client to avoid certain medications that move through without being absorbed. What medications should the client avoid? Select all that apply.
- A. Enteric-coated products
- B. Liquid medication
- C. Slow-release beads
- D. Layered tablets
- E. Chewable tablets
Correct Answer: A,C,D
Rationale: Clients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. These products may pass through without being absorbed. The client may take liquid and chewable tablets because they will go through the breakdown process in the stomach.
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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.
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.
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 has had surgery to create an ileoanal reservoir. Which instruction would the nurse give to reduce the risk for bowel incontinence?
- A. Avoid high-protein food.
- B. Take frequent brisk walks.
- C. Perform perineal exercises.
- D. Perform warm water soaks.
Correct Answer: C
Rationale: To reduce the risk for bowel incontinence, the nurse should instruct a client who has undergone ileoanal reservoir surgery to perform perineal exercises. The client need not avoid high-protein food, take walks, or perform warm water soaks because these do not minimize the risk of bowel incontinence.
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.