Cap Lesson Gi

Front 1

Begins at the base of the pharynx behind the trachea and ends at the opening to the stomach

Back 1

The esophagus. approximately 10 inches long. Layers of muscle tissue surround the esophagus. They consist of a striated muscle tissue in the proximal esophagus, striated and smooth muscle in the middle esophagus, and smooth muscle in the lower esophagus. Coordinated movement of these muscle layers propels food from the pharynx to the stomach. These wavelike contractions are known as peristalsis. and upper esophageal sphincter, or pharyngoesophageal sphincter, located at the upper end of the esophagus, prevent air from entering the esophagus and stomach during respiration. The lower esophageal sphincter or gastroesophageal sphincter is located where the esophagus joins the stomach. The lower sphincter remains contracted in order to prevent reflux of gastric contents into the esophagus. Passes through an opening in the diaphragm as it connects to the stomach.

Front 2

Approximately 4 to 5 feet long and 2 inches in diameter, receives waste from the small intestine and propels waist towards the anus, the opening from the body for elimination.

Back 2

The large intestine. *It absorbs water,* some electrolytes, vitamin K, and bile acids. The cecum, colon, rectum, and anal canal make up the structures of the large intestine through which fecal matter passes. The cecum is a pouch like structure at the beginning of the large intestine. The appendix, a narrow blind tube at the tip of the cecum, has no known function in humans. The colon is divided into the a sending, transverse, descending, and sigmoid colon.

Front 3

Primary function of small intestine

Back 3

Absorb nutrients from chyme

Front 4

A membrane that lines the inner abdomen, encloses the viscera and the serous fluid that it secretes. It allows the abdominal organs to move about without creating friction.

Back 4

The peritoneum. The walls of the digestive organs normally prevent the gastric and intestinal contents from escaping into the peritoneal cavity. Any perforation that allows material to sleep out of the digestive tract is serious because the microorganisms and enzymes can cause severe inflammation and infection in the surrounding tissue. This is known as peritonitis.

Front 5

History to identify client specific problems and it’s possible cause

Back 5

When they last had a bowel movement. Away. Labs. Palpate abdomen. Store or emesis you saw. Chief complaint, assessment of nutritional, metabolic, and elimination patterns, and a past history. The focus is on any abdominal pain, issues with digestion, nausea and or vomiting, constipation or diarrhea, incontinence, or other complaints. It is also important to seek information about the clients dental hygiene and condition of the mouth, teeth, and gums and if the client wears dentures. The clients use of alcohol and tobacco including smokeless chewing tobacco is also important to ascertain. All of these factors can have an impact on G.I. health.

Front 6

Physical exam, skin

Back 6

Using natural sunlight or bright artificial light the nurse inspects the skin for any abnormal color, such as a yellowish tint indicating jaundice. In clients with a very dark skin, the nurse inspects the hard palate, guns, conjunctiva, and surrounding tissues for discoloration. If the skin appears jaundice, the nurse inspects the sclera to see if it is yellow.

Front 7

Physical examination of the abdomen

Back 7

How did the client like supine, with the knees flexed slightly, for the abdominal exam. This position assist and relaxing the abdominal muscles. Note whether the clients admin is flat, round, concave, or distended as well as the effort associated with breathing. Distention may cause dyspnea as a result of upward pressure on the diaphragm. Abdominal auscultation is done before palpation because palpation disrupt normal bowel sounds. Using a stethoscope the nurse listens over each quadrant for bowel sounds, which sound like gurgles and normally occur every 5 to 20 seconds. The nurse describes the location, pitch quality, and frequency. Listening for 3 to 5 minutes over each quadrant is important to confirm the absence of bowel sounds. Generally, bowel sounds are described as absent, normal, hypo active which is one or two sounds into minutes, or hyper active which is 5 to 6 sounds in under 30 seconds. Measurement of abdominal girth is done at the widest point usually the umbilicus. Using a pen, the nurse marks the measurement location on the abdomen to ensure that additional examiners use the same reference point.

Front 8

Abdomen exam order of operations

Back 8

Inspect, auscultate, palpate, percuss

Front 9

Magnetic Resonance Elastography

Back 9

It’ll move screws in bones

Front 10

Assisting with a percutaneous liver biopsy

Back 10

Explain that the purpose of the procedure is to obtain a small sample of liver tissue for a differential diagnosis of liver disease or to evaluate the extent of liver disease. Check the results of coagulation studies (aPTT, PT, INR, and platelet count) *if these are low, don’t poke*

instruct the client to lie supine with the right arm behind the head.

Tell the client that the site will be cleansed and then draped with a sterile barrier. The doctor will instruct the client to take a deep breath and hold it while the needle is introduced, sample obtained, and needle withdrawn, this takes only a few seconds. Monitor vital signs throughout. *Place a pressure dressing over the biopsy site.* assist the client to lie on the right side after the procedure in place is small pillow under the costal margin. Instruct the client to remain in this position for at least two hours to prevent the release of blood, bile, or both. Instruct the client that they should remain in bed for 8 to 12 hours except to go to the bathroom. Avoid coughing or straining. Change in vital signs may indicate bleeding. *Monitor the biopsy site frequently for bleeding, swelling, or hematoma.* excess breath sounds regularly. Report diminished breath sounds immediately. Assess the abdomen for distention or rigidity. Instruct the client to avoid heavy lifting for 5 to 7 days after the procedure. Instruct the client to follow doctors orders for blood thinners.

*Instruct the client to call if they experience the following symptoms, severe pain at the biopsy site, SOB, chest pain, bleeding from the biopsy site, fever, abdominal pain, weakness for diaphoresis, heart palpitations*

Front 11

Gastrointestinal endoscopy

Back 11

G.I. endoscopy is the direct visual examination of the lumen of the G.I. tract. It facilitates evaluation of the appearance and integrity of the G.I. mucosa and detect lesions. It provides access for therapeutic procedures. G.I. endoscopy is performed using a flexible fiber optic endoscope. Diagnostic uses include obtaining biopsies of the mucosa, obtaining samples of fluids found in the G.I. tract, and injecting dye for radiographic purposes. Therapeutic uses include inserting tubes and drains, electrocautery, and injecting medication.

Before an endoscopic procedure, the client follows dietary and fluid restriction and bow preparation procedures if the examination involves the lower G.I. structures. For a client undergoing an esophagogastroduodenoscopy, it is necessary that they spray or gargle with a local anesthetic. For an EGD and a colonoscopy, the client receives an anxiolytic agent such as Midazolam before the procedure to provide sedation and relieve anxiety. Clients should not drive until the day after the procedure. During the procedure the nurse monitors respirations and vitals. After the test the nurse monitors vitals, respiratory status, level of consciousness, and abdominal symptoms. The nurse monitors for signs of perforation. This includes fever, abdominal distention, abdominal or chest pain, vomiting blood, or bright red rectal bleeding. The nurse offers the client like food and drinks unless the procedure was an EGD. *After an EGD, the client may not have food or fluids until the gag reflex returns.* once the gag reflex is present, the nurse may introduce clear fluids and advance the diet to regular foods and fluids according to the clients tolerance. If the clients gag reflex has returned, the nurse may offer Celine gargles, ice chips, or cold drinks.

Front 12

Laboratory test

Back 12

Laboratory test may include a complete blood count, urinalysis, serum Billy Rubin, cholesterol, serum ammonia level, prothrombin time, protein electrophoresis, and enzymes such as Emilie‘s, lipase, aspirate aminotransferase, and lactic acid dehydrogenase. Common tumor marker blood studies include carcinoembryonic antigen and alpha-fetoprotein. Test specific to the G.I. system are described in the following sections

Front 13

What type of bacteria is thought to be responsible for the majority of peptic ulcers

Back 13

Helicobacter pylori

Front 14

Stool analysis

Back 14

Stool specimens are collected to identify white blood cells indicating inflammation, red blood cells indicating G.I. blood loss, and fat indicating malabsorption. They are also collected to identify infection to examine for microorganism specimen should be in a covered container, fresh and warm. Placement of the specimen in a specific preservative to detect parasites and they’re over allows diagnosis of parasitic infection. A simple test that determines the presence of a cold blood in the stool is the Hemoccult test. A positive result indicates that the client is bleeding or has recently blood from somewhere and her G.I. tract. Substances that cause false positive results include red meat, iodine containing anti-septic preparation, aspirin greater than 325 mg a day, and other nonsteroidal anti-inflammatory agents. And excessive alcohol. Substances that may cause false negative results include ascorbic acid vitamin C greater than 250 mg a day and iron supplement.

Front 15

What may cause a false positive in a stool analysis

Back 15

Substances that may cause a false positive include red meat, iodine containing anti-septic preparation, aspirin greater than 325 mg a day, and other nonsteroidal anti-inflammatory agents, and excessive alcohol.

Front 16

What may cause a false negative result in a stool analysis

Back 16

Substances that may cause false negative results include ascorbic acid vitamin C greater than 250 mg a day, and iron supplements.

Front 17

Nausea and vomiting

Back 17

Common causes include drugs, infections and inflammatory conditions of the G.I. tract, intestinal obstruction, systemic infections, lesions of the central nervous system, food poisoning, emotional stress, early pregnancy, uremia, nausea generally perceive vomiting and usually results from distention of the duodenum.

Increased salivation and peripheral vasoconstriction, which causes cold, clammy skin, and tachycardia accompany nausea. The vomiting center, located in the medulla, is particularly sensitive to parasympathetic neurotransmitters released in response to gastric irritation. The Valsalva maneuver, which accompanies forceful explosion of stomach contents, causes dizziness, hypotension, and bradycardia.

Front 18

Diagnostic findings and medical and surgical management for nausea and vomiting

Back 18

Prolonged vomiting may lead to low levels of serum sodium and chloride. Bicarbonate levels may rise to compensate for the loss of chloride and accumulation of metabolic acid. The hematocrit value, if high is secondary to the hemoconconcentration that accompanies dehydration.

Nausea and vomiting may be short-lived and not require medical intervention. In some instances, IV fluids, electrolyte replacement, and drug therapy are necessary. Elimination of the cause necessitate various intervention, ranging from stopping a drug to a surgical intervention for the intestinal obstruction. Symptomatic relief may be achieved by administering an anti-emetic agent. Providing IV fluid and electrolyte replacement and temporarily restricting food intake until the cause of vomiting is eliminated.

Front 19

The early stage of oral cancer is characteristically

Back 19

Asymptomatic

Front 20

Ensuring correct feeding tube placement

Back 20

The most common practice related to initial feeding tube placement confirmation with radiographic confirmation with the entire length of the tube visualized. The most frequent method used to confirm placement before and during feedings was auscultation, followed by measurement of the external length of the tube, and assessment of the appearance of the aspirate. The researchers point out that current guidelines and standards of practice recommend against using auscultation because evidence from other studies have shown that auscultation is not a valid way to confirm tube placement. also, there is no consistent recommendation in the guidelines about using the appearance of the aspirate to confirm correct placement. Overall, it is recommended a higher reliance on measuring the external length of the tube, which is easy to do and considered reliable if the tube is accurately marked after correct initial placement is confirmed with the radiographic assessment. The current study makes the following recommendations related to tube placement confirmation, use various bedside methods to confirm placement, including capnography if available. Observing for Respiratory distress, and measuring the pH of feeding tube aspirate, auscultation should not be used to determine location, radiographic confirmation should always be done before the tube is used for feedings or medication administration, ultrasonography for select client population group, mark the tube exit site right after radiographic confirmation and then use the marker to ensure that the correct location is maintained during use, and monitor the aspirate for sudden change in amount.

Front 21

Prevention of complications related to percutaneous endoscopic gastrostomy tube

Back 21

Peg tubes are most often stabilized with internal and acts rental bumpers. The internal bumper prevents the tube from being dislodged from the stomach or intestine. The external bumper secures the tube to the abdominal wall and prevents the tube from migrating. Bumpers that are too tight may cause pressure ulcer on the admin, buried bumper syndrome, in which the internal bumper becomes buried in the abdominal wall. Possibly leading to gastrointestinal bleeding, perforation, or peritonitis. Bumpers that are too loose may cause free movement of the tube, leading to irritation, ulceration of the tract, or granulation tissue forming. Dislodgment. A new peg tube insertion site may have a slight amount of bleeding, mucus, or both, report any prolonged drainage or other problems. The tube insertion site should be inspected for signs of irritation, infection, drainage, or gastric leakage. Site should be cleaned with water and soft cloth, dressing, or gods only needed for any drainage or client comfort. New peg tubes are usually taped or sutured until the tracks heels. Once the tract heals, there is less risk for trauma to the abdominal wall. The peg tube is more easily replaced in a healed track. If you have to change the tube, do it within 10 minutes or you’re tract will close.

Front 22

GERD

Back 22

GERD results from an inability of the lower esophageal sphincter, also called the cardiac sphincter, to close fully, allowing the stomach contents to flow into the esophagus.

Front 23

Nursing management for gastroesophageal reflux

Back 23

The nurse educates the clients with Gerd about diet and lifestyle changes needed to reduce reflux symptoms. *dietary management consist of eating smaller meals and avoiding foods and beverages that increase gastric acidity.* Black and red pepper, regular and decaffeinated coffee, alcohol. And avoiding items that lower pressure in the LES, alcohol, chocolate, peppermint, licorice, citrus fruits, caffeine, high fat foods. Additional measures include losing weight, avoid tight fitting clothes, elevate the head of bed, stop smoking, and avoid food and drink for several hours before bedtime. instruct the client in controlling symptoms to prevent complications such as esophageal stricture, and esophageal cancer. They closely observed a client having fundoplication or postoperative abdominal distention and nausea because many clients cannot belch or vomit after undergoing this procedure.

Front 24

Esophageal diverticulum

Back 24

Foul breath, complains of difficulty swallowing. A diverticulum is a sack or pouch in one or more layers of the wall of an organ or structure. Esophageal diverticula are found at the junction of the pharynx and the esophagus or in the middle or lower portion of the esophagus.

Front 25

Signs and symptoms of constipation

Back 25

Bowel elimination is in frequent or irregular. Clients feel bloated. The abdomen may be Tim panic or distended, and bowel sounds may be hypoactive. The client experiences rectal fullness, pressure, and pain when attempting to eliminate store. What they pass usually is hard and dry. Rectal bleeding may result as the tissue stretches in tears while the person tries to pass the hard, dry stool. When a nurse inserts a gloved and lubricated finger in the rectum, the school may feel like a small rock, a condition referred to as scybala.

Sometimes, if the constipation has lasted for a long time, the client may begin passing liquid stool around an obstructive stool mass (encopresis), A phenomenon sometimes misinterpreted as diarrhea. The liquid stool results from dry stool stimulating nerve endings in the lower colon and rectum, which increases peristalsis. The increased peristalsis send watery feces from higher in the bowel than the retain stool. This symptom is most common in residence of nursing homes in school age children who have a long-standing history of constipation, store withholding behavior, or both.

Front 26

SS constipation

Back 26

Infrequent BM, distended abdomen, encopresis (liquid stool around an obstructive stool mass).

Front 27

Medical and surgical management of constipation

Back 27

Treating the cause provides the best relief. For quick symptomatic relief, the primary provider prescribes an enema or a laxative in oral or suppository form, followed by prophylactic administration of a stool softener. Fiber supplements, stimulants such as physical dial, or senna lubricant, ortho softeners may be ordered. Dietary management is also promoted

Front 28

Teaching for constipation

Back 28

Encourage client to slowly increase dietary fiber intake to 25 g a day. Brand cereals, fresh fruits and vegetables, and beans are excellent sources of insoluble fiber, which promotes normal bowel function. Remind the client to add these foods gradually. Fiber absorbs water in the colon and formed a gel, adding bulk and easing defecation. Adding fiber gradually helps to avoid bloating, gas, and diarrhea. Instruct the client to increase fluids to 6 to8 glasses per day. This intake prevents hard, dry sores. Encourage client to be out of bed, increase activity, or develop a regular exercise program. Activity increases peristalsis and promotes bowel elimination. Administer laxatives, suppositories, and enemas as ordered.

Front 29

Signs and symptoms of diarrhea

Back 29

Stores are watery and frequent. In severe cases, blood and mucus pass with the store. The client usually experiences urgency and abdominal discomfort. Bowel sounds are hyper active. Skin around the anus may become excoriated from contact with fecal matter and products of the digestive processes such as gastric acid and bile salts. Fever may be pregnant. Infectious diarrhea typically has a sudden onset, with a accompanying generalized malaise.

Front 30

Assessment for diarrhea

Back 30

Diarrhea can be acute or chronic. Acute episodes generally are short-lived, lasting at most 7 to 14 days. Chronic diarrhea occurs for more than two or three weeks. The most common cause is infection by bacterial, parasitic, or viral agents. Assessment, dehydration, electrolyte imbalances, vitamin deficiencies, skin breakdown.

Front 31

Signs and symptoms of IBS

Back 31

Many clients experience various degrees of abdominal pain that defecation relieves. Most clients with IBS describe having *chronic constipation with sporadic bouts of diarrhea.* Summerport the opposite pattern, although less commonly. Many clients suffer from belching and flatulence. In general, symptoms do not awaken people from sleep. Some clients with IBS report anxiety, insecurity, depression, or anger. *Weight usually remain stable,* indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. There often is white or yellow mucus in the store and clients may report that they do not feel like their balls completely empty with a bowel movement. They may also experience urgency. *Blood usually is not found in the stool because the bowel is not locally inflamed.

Front 32

Signs and symptoms of peritonitis

Back 32

Symptoms include severe abdominal pain, distention, tenderness, nausea and vomiting, anorexia, and diarrhea initially, followed by inability to pass for gas. Fever may be absent initially, but the temperature rises as infection becomes established. The client avoids moving the abdomen when breathing because movement increases pain. They may draw the knees up towards the admin to lessen the pain. Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and border like as it stands with gas and intestinal Contents. Bowel sounds typically are absent. The pulse rate is elevated, and respirations are rapid and shallow. If the peritonitis is unresolved, severe weakness, hypotension, and drop in body temperature occur as the client nears death.

Front 33

Intestinal obstruction

Back 33

Intestinal obstruction occurs when a blockage interferes with the normal progression of intestinal contact through the intestinal tract. Obstruction is more common in the small intestine than in other parts of the tract. Obstruction in the large intestine generally occurs in the sigmoid colon. The causes are classified as mechanical or functional. A dynamic or lacking peristalsis, also called paralytic ileus or pseudo-obstruction and as partial or incomplete. The severity depends on the region of the bowel affected, degree to which the woman is obstructed, and degree to which the blood circulation to the intestine is impeded. An intestinal obstruction is extremely dangerous and may be fatal if not treated promptly.

Front 34

Functional bowel obstruction

Back 34

In functional obstruction, the intestine can become a dynamic from an absence of normal nerve simulation to intestinal muscle fibers. Paralytic ileus is common 12 to 36 hours after abdominal surgery. It also can result from inflammatory condition such as peritonitis, electrolyte disturbances, or adverse drug affects. Even a vascular embolus or low blood flow during shock can interfere with the neuromuscular function of the bowel.

Front 35

Treating functional constipation

Back 35

First treat conservatively, give bowel time to kick back into gear before you cut them open

Front 36

Assessment findings in cancers of the colon and rectal

Back 36

The chief characteristic of colon cancer is a *change in bowel habits,* such as alternating constipation and diarrhea, and a narrowing of the stool. These changes last more than a few days. *Occult or Frank blood may be present in the stool.* There may be a sense of urgency to defecate, but a bowel movement does not remove the sensation. Sometimes a client Mayfield doll, vague abdominal discomfort. Pain is a late sign of cancer. On physical assessment, *the abdomen feels distended* and a mass may be palpated in the abdomen or rectum.

Cancers that start in the a sending: often grow to a large size before causing symptoms because this part of the colon has larger circumference and more flexibility. Eventually, client complains of vague abdominal pain. Stools will appear black or tarry (melena) because of blood loss from the surrounding tissue. As a result there can be iron deficiency anemia and fatigue. A number of diagnostic tests are performed for colorectal cancer including FOBT, sigmoidoscopy, a double contrast barium enema, colonoscopy, and digital rectal examination.

Genetic screening may detect chromosome all markers for particular types of colon cancer. An elevated carcinoembryonic antigen CEA test or carbohydrate antigen 19–9 (CA 19-9) tumor marker test results suggest a tumor. Unfortunately, these tests are not effective in identifying colorectal cancer and its earliest, most treatable stages. Unless malignant growths are elevated from the new postal wall, a barium enema may not provide a conclusive evidence either. A tissue sample taken during a proctosigmoidoscopy or colonoscopy may detect malignant cells in the area of the biopsy.

Front 37

Assessment findings for hemorrhoids

Back 37

External hemorrhoids more cars do symptoms, or they can produce pain, itching, and soreness of the anal area. They appear small, reddish blue clumps at the edge of the anus. Thrombosed external hemorrhoids are painful but seldom cause bleeding. Internal hemorrhoids cause bleeding but are less likely to cause pain unless they protrude through the anus. The amount of bleeding varies from an occasional drop or two of blood on the toilet tissue or underwear to chronic loss of blood. Leading to anemia. Internal hemorrhoids usually protrude each time the client defecate but retract after defecation. As the masses in large, they remain outside the sphincter. An anoscope, an instrument for examining the anal canal, or proctosigmoidoscopy allows visualization of internal hemorrhoids. A colonoscopy rules out colorectal cancer, which may have similar symptoms.

Front 38

Types of jaundice

Back 38

Hemolytic, hemolytic processes such as multiple blood transfusions, pernicious anemia, sickle cell anemia, cause an overproduction of bilirubin. Elevated unconjugated Bilirubin Levels.

Hepatocellular, liver cells damaged by viral infections, medication, or chemical toxicity cannot clear bilirubin from the blood. Elevated conjugated and unconjugated bilirubin cells.

Obstructive, gallstones, inflammation, or tumors obstruct the bile duct, causing reabsorption of bile into the blood. Elevated conjugated bilirubin levels.

Front 39

Diagnostic findings of cirrhosis

Back 39

A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. The biopsy is obtained percutaneously with mild sedation or through surgical incision. It can also be performed with ultrasound or CT to identify appropriate placement of the trochlear or biopsy needle. Certain blood test provide information about liver function. Prolonged prothrombin time PT and low platelet count place the client at high-risk for hemorrhage. The client receives intravenous IV administration of vitamin K or infusion of platelets before liver biopsy to reduce the risk of bleeding. Ultrasound scanning may be done to distinguish the density of scar tissue. Other test used to examine the liver include CT, MRI, radioisotope liver scan, all of which may demonstrate delivers in large size, nodular configuration, and disordered blood flow.

Front 40

Nursing management for cirrhosis

Back 40

If the client has active alcoholism and the nurse monitors vital signs closely. Arise in blood pressure pulse and temperature correlates with alcohol withdrawal, the nurse must recognize and treat these appropriately along with the other presenting symptoms. The nurse weighs the client daily and keeps an accurate record of intake and output. If the abdomen appears enlarged, the nurse measures it according to a set routine. Because of the anorexia that accompanies severe cirrhosis, the client may betree tolerate frequent, small, semi solid, or liquid meals rather than 3 full meals a day. Careful evaluation of the clients response to drug therapy is important because the liver cannot metabolize many substances. The nurse reports any change in mental status or signs of G.I. bleeding immediately because they indicate secondary complications. The nurse provides educational information specific to the liver disorder. The nurse emphasizes the need for abstinence from alcohol and all non-prescription drugs unless approved by the primary provider. Offer support groups and contact social services about referrals to alcohol or drugs cessation programs.

Front 41

A collection of fluid in the peritoneal cavity

Back 41

Ascites

Front 42

Client and family teaching care of the stoma and catheter after a continent ileostomy

Back 42

The nurse emphasizes the following points when teaching the client. Assemble a clean catheter, lubricant, basin, tissues, irrigating syringe and solution, and gauze dressing. Sit on or beside the toilet or on the side of the bed. Warm the catheter to body temperature and lubricate the tip. Insert it about 2 inches into the Stonewall opening. Expect resistance when the catheter reaches the nipple valve about 2 inches, which controls the retention of waste matter. Gently push the catheter a little further into the ileal pouch. At the same time, exhale, cough, or bear down as if to pass stool until fecal material begins to drain. Direct the external end of the catheter into a basin or the toilet about 12 inches below the stoma. If the catheter is obstructed, try the following measures. Bear down at that they have a bowel movement. Rotate the catheter tip inside the stoma. Milk the catheter. If these are not successful remove the catheter, rinse it, and try again. Notify the primary provider if efforts to unblock the catheter do not result in any drainage. Never wait longer than six hours without obtaining drainage. Allow 5 to 10 minutes for drainage to see, then remove the catheter, clean it with soapy water, and store it in a salable bag until needed again. Wash the area around the stoma and pat the skin dry. Place and absorbent pad or dressing over the stoma.

Front 43

Changing an ostomy appliance

Back 43

Clean gloves, scissors, ostomy belt, stoma gauge, face plate, pouch, adhesive or skin barrier protectant, and cleaning materials such as gods pads, water, or adhesive solvent. Wash hands and put on gloves. Empty pouch when it is 1/3 form. Change the face plate only when needed, that is, if if he comes loose or tight or if the client experiences discomfort. If the face plate is changed to frequently, skin around the stoma may become raw and excoriated secondary to removal of protective layers of epithelium with the face plate. If the Ostomy appliance is being replaced routinely, schedule the change when the gastrocolic reflex is less active. For many clients this time is early in the morning, before eating, for 2 to 3 hours after meal time. Gently is the face plate from the skin. If the face plate was applied with adhesive, roll the adhesive from the skin and appliance. If it does not roll off, use a small amount of solvent, which chemically loosens the adhesive bond. Because some solvent irritate the skin, apply solvent sparingly between the body and face plate using a sprayer, medicine dropper, or gods pad. Avoid rubbing, which may further irritate the skin. Clean the area with soap and water and pat dry after a solvent has been used. Inform the client that most common causes of discomfort or reactions to be adhesive or solvent used to remove it or irritation from leaking the cold drainage. In such cases the client may experience stinging or itching immediately after an appliance change. The sensations should quickly subside. If a sensation is prolonged, remove the appliance regardless of whether it has been on for one hour or several days. When using a new adhesive product, remember to patch tested first on non-irritated skin at the inner aspect of the clients forearm. After removing the face plate and pouch, protect the peristomal area from drainage by placing a tissue cup around the stoma Or using a receptacle such as a small paper cup to collect the drainage. Use a soapy washcloth to clean the skin around the stoma and wipe the soap from the skin. Pat the area or allow it to air dry. Inspect the stoma and skin carefully. If expiration is observed use a temporary appliance or hydrocolloid dressing. Such as DuoDERM or Tegaderm, to cover the excoriated scan to promote moist healing. If there is a yeast growth, nystatin powder may be ordered. Create an even surface for reapplying the pouch by filling irregular hollows in the peristomal skin with hydrocolloid paste such as karaya paste before replacing the face plate. Measure the circumference of the stoma and cut a comparable hole in the faceplate allowing an 18th of an inch margin to account for potential swelling in the new stoma. Secure the pouch to the face plate. Be sure to smooth out ridges or openings in the closure. Also, be sure to seal the pouch. Peel the backing from the faceplate. Fix the face plate to the skin

Front 44

Surgical management of a colostomy

Back 44

The term single barrel colostomy indicate that the awesome he has a single stoma there which the fecal matter passive. The colon is cut above the diseased area, and a healthy and is brought through the abdominal wall to form the matured so much. The diseased portion of bowel is removed, with the remaining distal end closed for later reconnection segmental resection. After performing an abdominal peroneal resection, the surgeon needs a drain or pack in the perineal area for about one week, after which it is removed, and irrigation of the peroneal wound may be ordered.

Front 45

Diet for colostomy and ileostomy clients

Back 45

Fiber is restricted after ostomy surgery to prevent irritation and slow transit time until healing is complete. Afterwards small amounts of foods contain fiber are added individually to the diet so that the clients tolerance can be evaluated. The primary nutrition concerns are fluids and electrolytes. 8 to 10 cups of fluid are recommended daily. Reassure the client that extra fluids do not contribute to watery stools but are excreted as urine. Fluid restriction should not be used to control liquid feces. Sodium and potassium requirements May increase because of increased losses. Eating small, frequent meals at regular time is recommended. Eating a large meal in the middle of the day instead of in the evening may help decrease the output at night. Chew food thoroughly especially for an ileostomy. Foods that may help decrease odor include butter milk, parsley, yogurt, kefir, and cranberry juice. Odor causing foods include dried peas and beans, fish, eggs, onion, garlic, vegetables from the cabbage family, asparagus, beer, and other alcoholic beverages.

Banana flakes, applesauce, pasta, potatoes, smooth peanut butter, and she may help thicken stores. Because they may cause obstruction, nuts, corn, cabbage, coconut, dried fruit, unpeeled apples, and grapes should be avoided. Eventually a high fiber diet may improve saw consistency and regularity and clients with a colostomy. Increase fiber gradually.

For clients with an ileostomy, lactose intolerance may occur. Limit liquids with meals if output is high. Oral rehydration formulas such as Gatorade may help maintain fluid and electrolyte balance. Depending on the replacement of the ileostomy, there is a potential for nutrient malabsorption. Recent research indicates that over a period of two years following reception, the remaining large intestine undergoes adaption to increase its absorptive capacity. However clients are prone to deficiency of vitamins and minerals and essential fatty acids. Zero levels should be monitored periodically and supplements provided as indicated.

Diet should include complex carbohydrates and simple sugars should be avoided.