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Ostomy Care: Questions/Answers
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Ostomy Care: Questions/Answers
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Ostomy Care: Questions/AnswersHere's your challenge. You are working on a medical-surgical unit. One of your
patients is a 30-year-old woman transferred from the post anesthesia care
unit after ileostomy surgery for Crohn's disease. You perform a postoperative
assessment and find the client alert, oriented, and responding appropriately.
However, when you pull down the sheet to observe her abdomen, you observe
a serious clinical manifestation. Her ileostomy pouch contains a significant
amount of bright, red blood.
What type of output is first expected from an ileostomy postoperatively?
Please select from the options below.
A.Loose, dark green liquid that may contain blood
B.Serous discharge
C.Formed to semi-formed stool
D.Pasty yellow-brown stool - ✔️ A.Loose, dark green liquid that may
contain blood
A - CORRECTYes. You have selected the correct response. This is the initial
output seen from an ileostomy. Over time, the output will become more pasty
and yellow-green or yellow-brown.
You have determined that you must assess the patient's abdomen first. You
observe, auscultate, and palpate it. You find the abdomen is slightly firm, but
not distended. The abdominal incision, closed with staples, is clean, dry, and
intact. Bowel sounds are hypoactive in all four quadrants.
Which of the following should you assess next?
please select from the options below.
A.Her urine output
B.The suture line
C.The stoma - ✔️ B The suture line
B - CORRECTYes. You have selected the correct response. After checking for
signs of abdominal bleeding, assess the suture line, also called the
mucocutaneous junction, for signs of frank bleeding due to injury of the
mesenteric artery. The presence of frank bleeding is a medical emergency
requiring the surgeon's immediate intervention.
, You assess the suture line carefully, but you do not see any bleeding, and it is
intact and dry all around the edges.
Which assessment should be your next step?
Please select from the options below.
A.Her urine output
B.The stoma - ✔️ B.The stoma
B - CORRECTYes. You have selected the correct response. Assess the stoma for
bleeding. Trauma to the stoma mucosa can also cause bleeding.
You find the stoma to be pink, moist, and edematous with no signs of bleeding
or trauma. You observe only watery greenish effluent coming from the stoma
and no additional blood. After looking for the source of bleeding, you reassess
the patient's status, including vital signs and urine output, for signs of
hemorrhage. Decreased urine output could be related to hemorrhagic shock.
Bloody urine may indicate damage to the kidneys or the urinary system
during surgery or may be due to systemic causes including underlying disease
or pharmacological therapy. The patient's urine output exceeds 30 mL per
hour and is clear yellow in color. You review her medications, looking for any
recent use of anti-inflammatory or antiplatelet medications, which could
increase the likelihood of bleeding. After ensuring that she is not taking any of
these medications, you conclude that the blood passed through the
gastrointestinal tract from the internal mucosa. You point it out to the surgeon
as she comes to the unit to assess the patient. You continue frequent checks of
the patient's vital signs, abdomen, stoma, and effluent to make sure that the
bleeding has ceased.
ASSESSMENT
Your patient's ostomy pouch is now one third full with watery green effluent.
You decide to talk with the patient about selecting a pouching system.
Which type of ostomy pouching system is appropriate for this patient at this
time?
Please select from the options below.
A.A pouching system without a skin barrier
B.A one-piece, closed-end pouching system
C.A two-piece pouching system with a pre-cut skin barrier
D.A one- or two-piece pouching system with a cut-to-fit skin barrier
- ✔️ D.A one- or two-piece pouching system with a cut-to-fit skin barrier
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