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Empty and Changing an Ostomy Practice Questions


What is an ostomy?


An ostomy is a surgical procedure that involves creating an opening (stoma) in the body to allow for the diversion of bodily waste or fluids. This procedure is typically performed when a person's natural bodily functions are impaired due to illness, injury, or a medical condition.


There are different types of ostomies, each serving a specific purpose:

  1. Colostomy: A colostomy involves creating an opening in the abdominal wall through which a portion of the colon (large intestine) is brought to the surface. This allows stool to be eliminated from the body through the stoma, often into a pouch that is worn over the stoma.

  2. Ileostomy: An ileostomy is similar to a colostomy, but it involves creating a stoma from the ileum (the final part of the small intestine). It is often performed when the lower part of the colon is not functioning properly.

  3. Urostomy: A urostomy is created to divert urine away from the bladder when the bladder is damaged, diseased, or removed. The ureters (tubes that carry urine from the kidneys to the bladder) are attached to the stoma, allowing urine to be collected in a pouch.


Ostomy


Ostomies may be temporary or permanent, depending on the underlying medical condition. People who undergo ostomy surgery often need to manage and care for their stomas and the collection pouches to maintain hygiene and ensure their comfort and quality of life.


It's important to note that ostomies can significantly improve the health and well-being of individuals with certain medical conditions, enabling them to lead active and fulfilling lives despite their challenges.


Practice Questions

Gently pat the area dry and apply the new appliance when the skin is completely dry.


If the nurse finds significant bleeding around the stoma, he or she would reassure the client, carefully pat the area dry trying to avoid further trauma to the area, and then apply the new appliance. Applying gauze with pressure to the area would cause further trauma as would washing it with soap and water. Allowing the bleeding to air-dry is not going to help the client, because it will leave a crust over the stoma and further irritate it.

  1. ​Fold the end of the pouch upward like a cuff.

  2. Empty the contents into a measuring device.

  3. 3)Wipe the lower 2 in (5 cm) of the pouch with toilet tissue.

  4. Uncuff the edge of the pouch.

  5. Apply the clamp. Creating a cuff before emptying prevents additional soiling and odor. Emptying comes next using a measuring device. Wiping the lower section removes any additional fecal material, thus decreasing odor problems. The edge of the appliance or pouch should remain clean. Then, the nurse uncuffs the edge of the pouch and, lastly, uses the clamp to secure closure.

​Washing around the ileostomy stoma

​Basin of warm water


The nurse would prepare a basin of warm water to wash around the stoma. Thorough cleansing of the skin removes excretions, old adhesive, and skin protectant, which can irritate and damage the skin. Sterile saline is not necessary, because clean technique is being used. Alcohol or hydrogen peroxide could irritate the skin; therefore, using warm water and mild soap is the recommended method for washing around the stoma.

​The curve of the clamp would follow the curve of the client's body.


After uncuffing the edge of the pouch, the client should apply the clip or clamp, ensuring that the curve of the clamp follows the curve of the body. Applying the clamp in this way ensures secure closure. If the curve of the clamp curves away from the client's body or is straight, it risks leaking because the clamp would not be secure.

Apply a commercially available skin barrier before applying the ostomy pouch., Thoroughly cleanse the skin surrounding the stoma and allow it to dry completely before applying the ostomy pouch.


In cases in which a client's colostomy bag continues to come loose or fall off, the nurse should either perform or recommend that the client do the following: thoroughly cleanse the skin and apply skin barrier. Allow the area to dry completely. Reapply the pouch. Monitor pouch adhesion and change the pouch as soon as there is an adhesion break. Wrapping an elastic bandage around the colostomy pouch would restrict the flow of feces into the pouch and so should not be done. The ostomy pouch should not be left off and replaced with an adult incontinence pad, as this would result in leakage. Having the client lie flat in the prone position for 10 to 15 minutes after applying the pouch to facilitate adhesion is not necessary; the nurse simply needs to apply gentle, even pressure to the appliance for about 30 seconds after applying it.

​When bag is one-third to one-half full


The ostomy appliance is emptied when it is one-third to one-half full. If it is allowed to fill up, it may leak or become detached from the skin. After each defecation is usually too frequent, depending on the client's elimination pattern. Daily or every 2 to 3 days is not an appropriate recommendation, because the client's elimination pattern may vary.

​Sitting


The nurse would place the client in a comfortable sitting or lying position if the client is in bed. If the client is in the bathroom, a standing or sitting position is used. Either position would allow the client to view the procedure in preparation to learn to perform it independently. Lying flat or sitting upright facilitates smooth application of the appliance. The prone or side-lying position does not allow the client to visualize the procedure.

​Notify the physician if

Stoma appears brown in color.


If the stoma appears brown or black in color, this means that there is compromised circulation and the nurse should contact the health care provider immediately. If the stoma protrudes into the bag, have the client rest for 30 minutes and if stoma is still protruding the nurse should contact the health care provider. A small amount of bleeding or fecal matter flowing from the stoma are common and do not require contacting the health care provider.

​Fold the end of the pouch upward, like a cuff.


After removing the closing clamp on the ostomy appliance, the nurse would fold the end of the pouch upward like a cuff. Creating a cuff before emptying the appliance prevents additional soiling and odor. It doesn't make a difference whether the nurse holds the bag open with the dominant or nondominant hand. Rolling the ends of the bag downward to the filled area is unnecessary and could lead to spilling. Folding the end of the pouch downward would create an obstacle to removing the fecal material and would soil the outside of the bag.

Continue the procedure, because this is a common finding during stoma care.


Minor bleeding coming from the stoma is a common finding during stoma care. A stoma is part of the intestinal tract brought through an opening in the abdominal wall and the gastrointestinal tract contains tiny vessels that can become traumatized during stoma care and cause minor bleeding. It is not necessary to notify the physician unless there are larger quantities of blood. If this is the case, the physician should be notified immediately. Alcohol would irritate the stoma and exposing it to air is not a recommended guideline. The stoma can be gently wiped with gauze prior to applying the new appliance.

"How will you know when a client begins to accept the altered body image?"

​"The client is willing to look at the stoma." "The client makes neutral or positive statements about the ostomy." "The client expresses interest in learning self-care."


Clients usually begin to accept their altered body image when they are willing to look at the stoma, make neutral or positive statements concerning the ostomy, and express interest in learning self-care. Agreeing to take prescribed antidepressants is not an indication that the client has begun to accept the altered body image. In fact, the client being depressed and needing to take an antidepressant is an indication that perhaps he or she has not begun to accept the ostomy. The client using spray deodorant several times an hour to mask odor also does not indicate acceptance.

​After performing the first appliance change, observe the client performing the next change.


A return demonstration of changing the ostomy appliance is the best way to ensure that client teaching has been effective. The nurse would observe the client changing the ostomy appliance during the second change, and offer guidance as needed.

​Ostomy appliance is leaking

​Change the appliance immediately.


If an ostomy appliance is leaking, the nurse should change the appliance immediately. The health care provider would be notified if the problem persists after changing the appliance. A leaking ostomy appliance can damage the skin around the stoma. The nurse would not attempt to repair it with tape or adhesives because the stool can get trapped between the device and the skin, causing skin breakdown and infection.

​Place a piece of gauze over the stoma to absorb the drainage.


When feces continue to flow from the stoma after removing the old appliance, the nurse would place a piece of gauze over the stoma to absorb the drainage while the skin is cleaned and dried. The nurse would then remove the gauze prior to applying the new appliance. Cleaning the stoma and applying suction would not stop the drainage from interfering with the process of applying a new appliance and may damage the stoma. Waiting for the drainage to stop would not allow for the timely application of the new appliance.

NCLEX: National Council Licensure Examination, OIIQ: Ordre des infirmières et infirmiers du Québec, OIIAQ: Ordre des infirmières et infirmiers auxiliaires du Québec

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