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73 Cards in this Set
- Front
- Back
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Patient has an ileal conduit. They had a loopogram and it indicated free reflux. How would you respond?
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In a normal GU system, free reflux would not be a normal finding. This is an ileal conduit, and because the ureters can not be tunneled far into the ileum free reflux IS normal.
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What is the purpose of ureteral stents in the conduit formation?
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The ureteral stents stabilize the anastamosis, prevent strictures and maintain patency.
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L-arginine is most likely to be helpful for which type of ulcer?
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arterial
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T/F Vasculitic ulcers occur with some sort of autoimmune process
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True (eg spina bifida)
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Where do neuropathic ulcers usually occur?
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Tips of the toes, bottom of the foot, side of the foot
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2 Classic presentations of an ischemic ulcers
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1. Necrosis involving the distal toes
2. Non-healing traumatic injury Pale ulcer bed, partially necrotic ulcer bed, non-healing |
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59 yo female presenting with bladder CA who is scheduled for an ileal conduit. Where would you mark the ideal stoma site?
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RLQ where the patient can see to manage it.
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Name the 4 levels of the PLISSIT model
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Permission (pt is given permission to express sexual concerns and anxieties. The nurse provides a comfort zone for the pt to facilitate open communication)
Limited Information (The nurse clarifies specific fears and misconceptions. The nurse provides factual information re surgical alterations and effects of surgery on sexuality) Specific Suggestions (The nurse provides helpful suggestions specific to the patients problem. Specific interventions are offered: empty pouch before sexual activity, use pouch covers or special underwear) Intensive Therapy (The nurse refers the pt to an appropriate source. Specific individualized therapy may be needed, such as reconstructive surgery and surgical implants. Psychosocial therapy may be required) |
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What type of stool output can be expected with a stoma in the proximal bowel?
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Since the proximal colon primarily mixes the ileal effluent to facilitate water and electrolyte absorption, the consistency of fecal matter passing through an ascending stoma is usually high-volume liquid with a high sodium concentration.
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What type of stool output can be expected with a medial or middle colon stoma?
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Less volume and is less liquid due to the action of the proximal colon.
Effluent may appear pasty to soft or of oatmeal consistency, with irregular evacuation. |
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What is Simethicone used for?
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A medication used for excess gas in the intestinal tract.
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What may be recommended when crystals appear in the peristomal skin area?
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Vitamin C which will acidify the urine
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Describe the Hartmann's Pouch procedure.
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Involved resection of the diseased bowel segment, closure of the distal stump (which was returned to the abdominal cavity) and construction of a proximal end stoma.
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What is the Mile's procedure?
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Miles= combined abdominal and perineal approach, with removal of the rectosigmoid, anal canal, and perirectal lymphatics, and construction of a permanent descending colostomy= APR
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Identify the 4 layers of the intestinal wall, from the inside out.
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mucosa
submucosa muscularis serosa or adventitia |
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What is the main goal for a continent urinary diversion?
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Goal is to keep it decompressed (keep in from becoming overfull)to allow it to heal.
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Patient presents with confusion and malaise. Has a continent urinary diversion. Is this normal?
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These may be signs of UTI.
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What are potential complications of a continent urinary diversion?
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Potential complications wound be renal and pouch calculi.
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What is a long term complication of a continent urinary diversion?
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Deterioration of renal function
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Main goal for any urinary diversion is...
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Maintain the health and function of the upper tracts.
Need to protect the kidneys. |
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Total pelvic exenteration
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Is not done in terminal disease. The pt needs to have a curable cancer.
Will have a urinary and colon diversion. |
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pH of saliva?
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6-7
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pH of gastic juice?
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1-3.5
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Bile pH?
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7.8
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Pancreatic juice pH?
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8-8.3
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Intestinal juice pH?
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7.5-8.9
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Patient has a soft abdomen. Which type of skin barrier would be the best choice?
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Convexity
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A patient has developed a rashlike appearance starting with small, red papules, and coalescing into a red, moist, patchy area around their gastrostomy tube. What treatment would be most likely?
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P.369 Colwell and Goldberg; fungal infection. Treat with antifungal powder or cream. If the rash does not resolve within 7 days or becomes more extensive, systemic treatment should be considered.
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Why does stomal necrosis occur?
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Ischemia
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A patient presents with papules, erythema, maceration, and complains of burning and itching around the stoma. What would be the cause?
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peristomal candidiasis
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What is the cause of pseudoverrucous lesions?
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Excessive moisture is the cause of pseudoverrucous lesions.
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What is peristomal irritant contact dermatitis?
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Peristomal Irritant contact dermatitis (PICD) is skin damage resulting from the contact of fecal or urinary drainage or chemical preparations.
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Name 2 uncommon stomal or peristomal complications
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Uncommon stomal or peristomal complications are malignancy, herpes, pemphigus, and psoriasis.
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In Hirshprungs disease there is an absence of....
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Myenteric parasympathetic, intramural ganglion cells.
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What is the most commonly affected area in HD?
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The rectosigmoid area
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What is the gold standard for diagnosis of HD?
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Rectal biopsy
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What is meconium ileus?
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Meconium ileus is the obstruction of the ileum with thick, sticky meconium that forms hard pellets in the narrowed distal bowel.
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Meconium ileus is the first sign of which disease?
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Cystic fibrosis
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Which exstrophy conditions is the most common?
a. cloacal exstrophy b. bladder exstrophy c. epispadias |
b. bladder exstrophy
(colwell & goldberg. p 304) |
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Toddlers can be helped to participate in ostomy care by being allowed to...
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gather supplies, holding tape rolls.
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Describe the pathophysiology of NEC.
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NEC is necrosis of the variable lengths of small or large intestine.
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Name the 3 factors that are implicated in the onset of NEC.
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3 Factors that are implicated in the onset of NEC are:
feeding mucosal injury bacterial invasion |
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What is meconium ileus?
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Meconium ileus is the obstruction of the ileum with thick, sticky meconium that forms hard pellets in the narrowed distal bowel lumen.
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List the 3 principles that guide the management of a person with a fecal or urinary diversion.
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1. Maintain the pouching seal for a consistent, predictable wear time.
2. maintain peristomal skin integrity 3. Support the person with a stoma. |
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Describe the normal output for a jujunostomy diversion.
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Output is watery, clear, and dark green
Can be in excess of 2400ml/24hrs |
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Describe the output for an ileostomy diversion.
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Immediately after creation output is liquid.
Amount varies between 800 and 1700ml/24 hours and levels of to gain consistency with amounts between 500 and 1800ml/24 hours. |
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Describe the output for a urostomy diversion.
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Normal output in 24 hours for the adult patient is approximately 1500 to 1600ml.
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Name and discuss the function of 3 materials found in solid skin barriers.
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Polymers: provide adhesiveness
Tackifers: adhesiveness Softeners & plasticizers: provide flow Hydrocolloids: absorb moisture Fillers: regulate absorption Pigment: provide color |
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The focus of the PLISSIT model is to....
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provide sexual rehabilitation to patients.
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Bladder cancer occurs more commonly in...(m/w)
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Men
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What is the current standard of care for invasive bladder cancer?
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radical cystectomy and urinary diversion.
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An example of a Ureteroenterocutaneous diversion would be:
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ileal, jejunal, or colon conduit. (incontinent)
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Kidneys area influenced by a hormone that affects the volume of water in urine and the thirst reflex. This hormone is....
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ADH
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The primary neurotransmitter of the detrusor that acts on specific receptors within the bladder wal to cause muscle contraction is....
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acetylcholine
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A common metabolic complication that can occur with urinary system reconstruction is....
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metabolic acidosis
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Across all age groups, the greatest risk factor for bowel obstruction is...
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abdominal adhesions
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What is the recommended daily intake of fiber? Water?
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Fiber 20-35 grams daily
Water: 2-3L daily |
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The surgical treatment of choice for a carcinoma in the upper and middle third of the rectum is...
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LAR
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What is the gold standard surgical procedure for treatment of low-lying rectal cancers?
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APR
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What is the most common primary cancer of the small bowel?
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adenocarcinoma
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In what section of the intestinal tract do the majority of colorectal cancers occur?
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Sigmoid and right colons.
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What is the gold standard adjuvant chemotherapy agent used in the treatment of colorectal cancer?
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5-FU
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Name the principle site of colorectal cancer metastisis
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Liver
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The primary treatment for rectal cancer is:
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surgical resection
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Name 2 skin reactions that are common with radiation therapy.
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tissue erythema
dry skin dry to moist desquamation |
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Explain what manifestations can be present when the gastrointestinal mucosa is involved in radiation.
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GI manifestations include:
denuded mucosa bleeding from the bowel tissue infection diarrhea malabsorption dehydration electrolyte imbalances proctitis |
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Name the 2 types of anal cancer
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adenocarcinoma and squamous cell carcinoma
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Name 2 side effects of 5-FU
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photosensitivity
hyperpigmentation in the area of administration hand and foot syndrome peripheral neuropathies |
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Most nutrients, vitamins, and minerals are absorbed in the...
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jejunum
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Chlorophyllin used as a deodorizing agent has what side effect?
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Can turn the stool green
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What is the recommended dosage of Vit C when used for urinary acidification in urostomy patients?
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1-2g four to six times per day around the clock.
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What would be the first radiographic study done when investigating the origin of the enterocutaneous fistula?
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fistulogram
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What is the recommended daily goal of fiber intake that may enhance GI absorption of water and improve stool consistency?
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25-30g per day
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