nr226 exam 3 study guide latest 2021 nr 226 exam 3 study guide fundamentals – patient care chamberlain college of nursing
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Chamberlain College Of Nursing
NR226: Fundamentals – Patient Care
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, tube. Although this practice is not as common as it once was, some patients
irrigate left-sided colostomies to regulate colon emptying
Other patients don’t want to spend additional 60-90 minutes in bathroom
everyday empty pouch as necessary
Only colostomies can be irrigated; never use an enema set to irrigate a
colostomyuse special cone-tipped irrigator to prevent bowel penetration &
backflow for irrigating solution
Before irrigating stoma patient sits on toilet & places irrigating sleeve over
stoma extends into toilet bowl
Healthcare provider order amount & type of irrigation solution
Adults=ranges from 500-700mL of tap water; patient instills solution slowly
through lubricated cone tip
Irrigation takes 5-10 minutes; patient removes cone tip & waits 30-45 minutes for
solution & feces to drain out of irrigation sleeve once drainage stops, patient
applies a stoma cap or a pouch.
How to take care of stoma/colostomy:
Patient needs to use meticulous skin care to prevent liquid stool from irritating the
skin around the stoma.
Changing and emptying- change with 1/3 to ½ full (33%-50% full), check it
frequently if gases needs to be released
Types of ostomies (Temporary or permanent and types of stools to expect)
**There are three types of colostomy construction: loop, end, and double-barrel***
Loop Colostomy- TEMPORARY
o Performed in a medical emergency, removed in 7-10 days (the rod)
o A temporary large stoma constructed in transverse colon
o Surgeon pulls loop of bowel onto the abdomen
o External supporting device (plastic rod, bridge, and rubber catheter) is
temporarily placed under the bowel loop to keep it from slipping back
o Surgeon then opens the bowel and sutures it to the skin of the abdomen
o Loop ostomy has TWO openings through ONE stoma
Proximal end drains stool
, Distal portion drains mucus
Double-barrel Colostomy- TEMPORARY
o Surgeon divides intestine and brings both proximal & distal ends through
abdominal incision to abdominal surface when creating a double-barrel
colostomy; two openings (one side is stool; other side is mucous)
o Small incision made in proximal stoma for fecal drainage, distal stoma
leads to inactive intestine is left intact
o When intestinal injury has healed colostomy is reversed
End Colostomy- PERMANENT or TEMPORARY
o One stoma formed from proximal end of bowel, with distal portion of GI
tract either removed or sewn closed
o Results of surgical treatment of colorectal cancer return usually
removed
o Patients with diverticulitis who are treated surgically often have a
temporary end stoma with a Hartmann’s pouch
Normal Characteristics of ostomies:
Deep reddish pink
Moist
No areas of impaired circulation or necrosis
Normal Characteristic of ileostomies:
Red, moist
, What is a stoma?
Mouth-like opening, an incised opening that is kept open for drainage or other
purposes, such as the opening in the abdominal.
A surgically made artificial opening in the abdominal wall to eliminate wastes
What is a healthy stoma?
Deep reddish pink; beefy red (like a fresh piece of meat)
Moist
No areas of necrosis impaired circulation
No signs of infection
No skin breakdown
Notify healthcare provider if stoma is blue, brown, or black indicates
circulation problems to stoma
Pain is slowed peristalsis & stress; pain meds require stool softener
Pouching ostomies and ileostomies:
Ostomy requires pouch to collect fecal material
An effective pouching system protects skin, contains fecal material, and remains
odor-free, comfortable, & inconspicuous.
A person wearing a pouch needs to feel secure enough to participate in any
activity
To ensure that the pouch fits well/meets patient’s needs, consider location of
ostomy, type &size of stoma, type & amount of ostomy drainage, size & contour
of abdomen, condition of skin around stoma, physical activities of patient,
patient’s personal preference, age & dexterity, cost of equipment.
Some pouching systems are attached to patient’s skin from adhesive surface of
product; other pouching systems are non-adhesive
Pouches come in one & two piece systems that are disposable or reusable
Some pouches have opening precut by manufacturer, others require stoma
opening to be cute to patient’s specific stoma size.
One Piece Pouch System:
Wafer skin barriers are permanently attached to the ostomy pouch
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