MSN Exam for Colostomy

EXPLANATION

✔Correct answer:

Maintain the current care plan. On the first postoperative day after a colostomy, the absence of measurable fecal drainage is an expected finding. Following abdominal surgery, gastrointestinal (GI) motility is typically slowed or temporarily halted due to the effects of anesthesia, surgical manipulation of the bowel, and reduced activity (a condition known as postoperative ileus). It usually takes 2-4 days for bowel function to return and for the colostomy to begin producing measurable stool. Nurse Jenna should continue monitoring the patient’s condition while maintaining the current care plan, which typically includes assessing bowel sounds, monitoring the stoma, and encouraging early ambulation to promote GI motility.

Immediate interventions such as notifying the physician or irrigating the stoma are unnecessary at this stage unless other concerning signs are present, such as severe abdominal distention, pain, nausea, or vomiting, which could indicate complications like a bowel obstruction or stoma dysfunction.

Imagine a factory temporarily pausing production after maintenance work. It takes time for the machines to restart and begin functioning normally again. Similarly, the bowel needs time to recover and restart its normal peristalsis after surgery.

While maintaining the current care plan, Nurse Jenna should focus on the following interventions to support recovery and monitor for potential complications:

• Monitor for the return of bowel sounds, which typically indicates that peristalsis is resuming.
• Observe the stoma for signs of proper function, such as the passage of flatus or small amounts of liquid stool, which are early indicators of bowel activity.
• Encourage early ambulation to stimulate peristalsis and promote faster recovery of bowel function.
• Ensure the patient remains well-hydrated, as fluid intake supports bowel function and prevents dehydration.
• Assess for signs of complications, such as abdominal distention, severe pain, or nausea and vomiting, and notify the physician if these occur.

✘Incorrect answer options:

Notify the physician immediately. This is unnecessary in the absence of concerning symptoms, as it is normal for the colostomy to produce little to no output during the first 1-2 days after surgery. Notification would only be required if other signs of complications, such as severe pain, distention, or vomiting, were present.

Request an order to irrigate the colostomy stoma. Irrigation is not indicated at this stage. The absence of fecal drainage on the first postoperative day is due to the expected temporary lack of bowel motility, not a blockage. Irrigation could be harmful if the bowel has not yet regained function.

Place the patient on bed rest and contact the physician. Bed rest is not indicated and could hinder recovery. Early ambulation is encouraged after surgery to promote peristalsis and prevent complications such as deep vein thrombosis (DVT) or pneumonia.

EXPLANATION

✔Correct answer:

Temporary absence of gastrointestinal motility. The absence of colostomy output during the first 24 hours after surgery is typically due to temporary absence of gastrointestinal (GI) motility, also known as postoperative ileus. Postoperative ileus is a common and expected occurrence following abdominal surgery, as the manipulation of the bowel during surgery temporarily halts peristalsis. This condition usually resolves within 24 to 72 hours, depending on factors such as the type of surgery, anesthesia, and the patient's overall health.

It is important for Nurse Jenna to monitor for the return of bowel sounds and signs of colostomy function, such as gas or stool output, as indicators of recovering motility. During this period, the absence of colostomy output is not necessarily concerning unless it persists beyond the expected timeframe or is accompanied by other abnormal findings (e.g., severe pain, distention, nausea, or vomiting).

Imagine a conveyor belt in a factory stopping temporarily after maintenance. Similarly, the intestines "pause" after surgery due to the effects of handling and anesthesia, and it takes time for them to "restart" normal operations like producing stool.

Monitoring and supporting GI function after colostomy surgery are key nursing responsibilities. Nurse Jenna should consider the following interventions:

• Auscultate bowel sounds regularly to monitor the return of peristalsis, which indicates recovering GI motility.
• Encourage early ambulation if permitted, as movement helps stimulate bowel activity and can hasten the resolution of ileus.
• Ensure the patient remains well-hydrated, either through IV fluids or oral intake, to prevent dehydration and support bowel function.
• Monitor for signs of complications, such as severe abdominal distention, nausea, or vomiting, and report them promptly to the healthcare provider.
• Provide reassurance to the patient that a lack of colostomy output in the immediate postoperative period is a normal finding.

✘Incorrect answer options:

Proper operation of the nasogastric suction. While nasogastric (NG) suction is often used after abdominal surgery to decompress the stomach and prevent nausea and vomiting, it does not directly cause the lack of colostomy output. The primary cause remains the temporary absence of peristalsis.

Reduced fluid intake before surgery. Reduced fluid intake before surgery may contribute to dehydration, but it is not the primary cause of the absence of colostomy output. The lack of output is more directly linked to the temporary cessation of bowel motility caused by the surgery itself.

Post-surgical intestinal swelling. Post-surgical swelling of the intestines can occur, but it does not typically cause a complete lack of colostomy output. The primary cause is the temporary absence of peristalsis due to postoperative ileus, rather than swelling.

EXPLANATION

✔Correct answer:

The stool will be solid. A sigmoid colostomy is created in the last segment of the large intestine, where most water from the stool has already been absorbed. As a result, the stool output from a sigmoid colostomy closely resembles the consistency of normal feces, which is solid and well-formed. Patients with a sigmoid colostomy generally have predictable bowel movements and can often regulate them through colostomy irrigation.

Educating the patient about the consistency of stool they can expect is important in helping them prepare mentally and physically for life with a colostomy. Nurse Lisa should reassure the patient that a sigmoid colostomy allows for a degree of normalcy in stool appearance and elimination.

Think of the large intestine like a sponge that absorbs water from stool as it travels through. By the time stool reaches the sigmoid colon, most of the water has been removed, leaving it solid, just like squeezing most of the water out of a sponge leaves it dry and firm.

Proper preoperative education can help patients adjust to living with a sigmoid colostomy. Nurse Lisa should include the following key points in her teaching plan:

• Explain that the stool from a sigmoid colostomy will typically be solid and well-formed, resembling normal bowel movements.
• Discuss how diet, hydration, and physical activity can affect stool consistency and output.
• Educate the patient about colostomy irrigation as an option for regulating bowel movements and minimizing unexpected output.
• Reassure the patient that they will receive training on colostomy care, including managing stool output and maintaining peristomal skin health.
• Provide emotional support and resources to address any anxiety or concerns about living with a colostomy.

✘Incorrect answer options:

The stool will have a semi-mushy consistency. This is incorrect because semi-mushy stool is more typical of a colostomy in the descending colon, which is located higher than the sigmoid colon. A sigmoid colostomy produces more solid stool due to greater water absorption.

The stool will appear mushy. This is incorrect because mushy stool is more characteristic of a colostomy in the transverse colon, where less water has been absorbed compared to the descending or sigmoid colon.

The stool will be fluid-like. This is incorrect because fluid-like stool is typically associated with an ileostomy or an ascending colostomy, where minimal water absorption occurs. A sigmoid colostomy allows for maximum water reabsorption, resulting in solid stool.

EXPLANATION

✔Correct answer:

Having difficulty inserting the irrigation tube. Difficulty inserting the irrigation tube could indicate a serious issue, such as stoma stenosis (narrowing), obstruction, or improper healing of the stoma. These complications require prompt medical evaluation to determine the underlying cause and to prevent further issues, such as bowel injury or ineffective irrigation. Reporting this to the physician ensures that appropriate diagnostic and corrective measures can be taken.

Proper irrigation requires smooth tube insertion into the stoma to facilitate the inflow of irrigation fluid and the evacuation of fecal matter. If resistance, pain, or difficulty is encountered, it should never be forced, as this can cause trauma to the stoma or surrounding tissue. Instead, Mr. Reed should stop the procedure and contact his physician immediately.

Imagine trying to push a straw into a juice box, but the opening is blocked or too tight. Forcing it might damage the box or the straw. Similarly, difficulty inserting the irrigation tube signals a problem that needs to be addressed by a professional to avoid harm.

Ms. Carter should educate Mr. Reed about the steps of colostomy irrigation, potential complications, and when to seek medical attention. Key teaching points include:

• Emphasize the importance of stopping the procedure and contacting the physician if the irrigation tube cannot be inserted easily.
• Reassure the client that mild resistance can sometimes occur due to muscle tension, and relaxation techniques, such as deep breathing, may help.
• Advise against forcing the tube into the stoma, as this can cause trauma or damage.
• Teach the client to check for stoma changes, such as narrowing, discoloration, or swelling, and to report abnormalities immediately.
• Encourage Mr. Reed to maintain regular follow-up appointments to monitor stoma health and ensure proper healing and function.

✘Incorrect answer options:

Experiencing abdominal cramps during the fluid inflow. This is incorrect because mild abdominal cramping is a common and normal response during irrigation, often caused by the speed of fluid inflow or water temperature. Pausing the irrigation and adjusting the flow or temperature typically resolves this issue, and it does not usually require contacting the physician.

Noticing the passage of flatus during fecal expulsion. This is incorrect because the passage of flatus during or after irrigation is a normal and expected part of the process. It indicates that the bowel is functioning properly and is not a reason to contact the physician.

Being unable to finish the irrigation within 30 minutes. This is incorrect because the time needed for colostomy irrigation can vary depending on the individual and their bowel function. Taking longer than 30 minutes is not necessarily a problem unless accompanied by other issues, such as pain, obstruction, or lack of stool output.

EXPLANATION

✔Correct answer:

Eat beet greens and parsley regularly. Beet greens and parsley are known to help reduce colostomy odor due to their natural deodorizing properties. Parsley, in particular, contains chlorophyll, which can help neutralize odors in the digestive tract. Including these foods in the diet can improve the patient’s confidence and comfort when managing their colostomy.

Helping Mr. Harris identify odor-reducing foods can encourage him to feel more in control of his condition and minimize social concerns associated with colostomy odor. Alongside dietary advice, Nurse Dana can educate Mr. Harris on additional strategies, such as proper stoma care and the use of colostomy pouches with built-in filters to manage odors effectively.

Think of parsley and beet greens as "natural air fresheners" for the digestive system. Just as air fresheners neutralize unpleasant odors in a room, these foods help neutralize odors in the digestive tract, reducing colostomy odor.

To support Mr. Harris in managing colostomy odor, Nurse Dana should include the following in her teaching plan:

• Encourage the inclusion of odor-reducing foods such as parsley, beet greens, yogurt, and buttermilk in his diet.
• Advise Mr. Harris to avoid odor-producing foods such as eggs, fish, broccoli, garlic, and certain spices, which can increase gas and odor.
• Teach proper colostomy care, including emptying the pouch regularly and using pouches with built-in filters.
• Promote adequate hydration to prevent constipation, which can worsen odors.
• Discuss emotional support and provide resources, such as ostomy support groups, to address concerns about odor and social interactions.

✘Incorrect answer options:

Include eggs in your diet. Eggs are known to be odor-producing foods, as they contain sulfur compounds that can increase colostomy odors. This advice would not be helpful for reducing odor.

Add cucumbers to your meals. Cucumbers do not have any known properties to reduce colostomy odor. While they are a hydrating and nutritious food, they do not contribute to odor control.

Consume broccoli and spinach frequently. Broccoli is an odor-producing food due to its high sulfur content and may worsen colostomy odor. Spinach, while nutritious, is not specifically known for reducing odors.

EXPLANATION

✔Correct answer:

The pouch faceplate doesn’t properly fit the stoma. Red, weeping, and painful skin around the stoma is most commonly caused by improper fitting of the pouch faceplate (also called the wafer or flange). If the faceplate opening is too large, urine or stoma output can leak onto the peristomal skin, causing irritation and breakdown. This condition, known as contact dermatitis or skin excoriation, is a frequent complication of stoma care when the equipment does not fit securely.

Ensuring the pouch fits snugly around the stoma is essential to prevent leaks and protect the peristomal skin from exposure to urine, which is highly irritating due to its acidity and enzymes. Nurse Karen should take steps to address the fit of the pouch system and educate Mr. Harris on proper stoma care to prevent further complications.

Think of the stoma pouch like a lid on a jar. If the lid doesn’t fit snugly, liquids can leak out and create a mess. Similarly, if the pouch faceplate doesn’t fit securely, urine can leak and irritate the surrounding skin.

Nurse Karen should take the following steps to address and prevent peristomal skin irritation:

• Assess the current pouch system to determine if the faceplate opening is too large or if other factors are contributing to leakage.
• Measure the stoma accurately using a stoma measuring guide, as stomas can shrink in size during the first weeks after surgery.
• Select a new pouch with a faceplate that fits snugly around the stoma (approximately 1/8 inch larger than the stoma to avoid constriction).
• Apply a skin barrier (such as a barrier ring or seal) to protect the peristomal skin before attaching the pouch system.
• Teach Mr. Harris how to inspect and care for the skin around the stoma, and advise him to report persistent redness, weeping, or discomfort.
• Refer Mr. Harris to an enterostomal nurse therapist for additional support and education on pouch fitting and stoma care.

✘Incorrect answer options:

The skin wasn’t lubricated prior to applying the pouch. This is incorrect because lubricating the skin is not a standard step in stoma care. Skin protection relies on properly fitting equipment and the use of skin barriers, not lubrication.

A skin barrier was correctly applied. This is incorrect because if a skin barrier had been applied correctly, it would have protected the peristomal skin from irritation. The red, weeping, and painful skin indicates that a skin barrier was either not used or was insufficient.

Stoma dilation wasn’t performed. This is incorrect because stoma dilation is not part of routine care for an ileal conduit or colostomy. Stoma dilation is only performed in specific cases, such as with a stenotic or narrowed stoma, and is unrelated to the current issue of peristomal skin irritation.

EXPLANATION

✔Correct answer:

"Is the functioning end that expels stool." In a double-barrel colostomy, the proximal end of the colon is the functioning end that expels stool, as it is connected to the active portion of the bowel through which feces pass. The distal end, on the other hand, is the non-functioning end and typically produces only mucus, as it is not involved in the passage of stool. This setup allows for fecal diversion, often as a temporary solution to protect a healing bowel or surgical site.

Understanding the anatomy of a double-barrel colostomy is essential for managing care effectively. Nurse Diana should ensure the client knows which stoma is the functioning one and how to manage both stomas, as well as how to anticipate and handle mucus production from the distal stoma.

Imagine a highway split into two lanes: one lane (the proximal stoma) carries traffic (stool) to its destination, while the other lane (the distal stoma) is temporarily closed and only allows minimal activity, such as a maintenance vehicle (mucus) passing through occasionally.

Nurse Diana should educate the client on the function of each stoma and provide guidance on managing the double-barrel colostomy. Key teaching points include:

• Explain that the proximal stoma expels stool and will require the use of a colostomy pouch to collect output.
• Teach that the distal stoma produces mucus, which is normal and should be cleaned and managed appropriately to prevent skin irritation.
• Ensure the client understands how to differentiate between the two stomas and monitor for signs of complications, such as discoloration or unusual output.
• Provide emotional support and reassurance, as adapting to a double-barrel colostomy can be overwhelming, particularly if it is a new experience for the client.
• Discuss the possibility of reversal if the colostomy is temporary, helping the client understand the long-term plan for their treatment and recovery.

✘Incorrect answer options:

"Is the non-functioning end that only produces mucus." This is incorrect because the distal end, not the proximal end, is the non-functioning part that produces mucus. The distal stoma is often referred to as the "mucous fistula."

"Connects to the rectum to allow natural bowel movements." This is incorrect because the rectum is bypassed in a double-barrel colostomy. The proximal stoma diverts stool to the abdominal wall, preventing natural bowel movements through the rectum.

"Is not visible on the abdominal surface." This is incorrect because both the proximal and distal ends of the colon are brought to the surface of the abdomen and form separate stomas in a double-barrel colostomy.

EXPLANATION

✔Correct answer:

Broccoli. Broccoli is a well-known gas-producing food due to its high sulfur content and the way it ferments in the digestive system. For clients with a colostomy, consuming broccoli may lead to excessive gas and odor, which can be uncomfortable and distressing. While clients can eventually reintroduce some gas-producing foods into their diet in moderation, broccoli should be avoided initially or consumed cautiously to assess individual tolerance.

Educating clients about gas and odor management is essential for helping them regain confidence in their social and daily lives. Along with broccoli, other gas-producing foods like beans, cabbage, onions, and carbonated drinks should be avoided or limited during the early stages of adjustment to a colostomy.

Think of broccoli like a fizzy drink that produces bubbles when opened. Similarly, broccoli causes gas production in the digestive system, which can create discomfort and odor for someone with a colostomy.

When teaching dietary management to a client with a new colostomy, the nurse should include the following key points:

• Encourage the client to avoid or limit gas-producing foods such as broccoli, beans, cabbage, onions, and carbonated beverages, especially during the early stages of recovery.
• Recommend odor-reducing foods such as yogurt, parsley, and buttermilk, which can help neutralize digestive odors.
• Teach the client to eat smaller, frequent meals and chew food thoroughly to aid digestion and reduce gas production.
• Emphasize the importance of staying hydrated, as adequate fluid intake supports overall digestion and bowel health.
• Encourage the client to reintroduce foods gradually to determine their individual tolerance and response to specific items.

✘Incorrect answer options:

Yogurt. This is incorrect because yogurt is actually beneficial for clients with a colostomy. It contains probiotics, which can help reduce gas and odor by supporting healthy gut bacteria.

White rice. This is incorrect because white rice is a low-fiber, easily digestible food that can help manage stool consistency and does not typically produce gas or odor.

Chicken breast. This is incorrect because chicken breast is a lean protein that is well-tolerated and unlikely to produce gas or odor. It is a safe dietary choice for colostomy clients.

EXPLANATION

✔Correct answer:

"Are you feeling the need for privacy when changing your colostomy?" This response acknowledges the client’s potential feelings of discomfort or loss of autonomy and invites him to express his concerns openly. It demonstrates Nurse Lisa's understanding of the psychosocial aspects of colostomy care, including the importance of independence, privacy, and self-efficacy. Many clients with colostomies struggle to regain a sense of control over their lives, and having the ability to independently manage their colostomy is an important step in building confidence and restoring normalcy.

This response is client-centered, as it encourages discussion of the emotional impact of the situation while focusing on the client’s perspective rather than making assumptions about his wife's intentions. Nurse Lisa can use this opening to explore further and provide education or counseling on strategies to balance support from the spouse with the client’s need for independence.

Imagine learning to drive and someone insists on always taking the wheel for you. It might feel helpful at first, but eventually, it prevents you from gaining the confidence to drive on your own. Similarly, this client may feel his wife’s involvement, while well-intentioned, is limiting his ability to take control of his own care.

Nurse Lisa should take a supportive approach to help the client and his wife balance shared responsibility and the client’s independence. Key interventions include:

• Encourage the client to express his feelings about his wife managing the colostomy and explore what level of involvement he is comfortable with.
• Provide education for both the client and his wife, emphasizing the importance of the client’s independence in colostomy care while acknowledging the spouse’s supportive role.
• Discuss strategies for the client to regain control, such as gradually taking over certain tasks during colostomy care with his wife’s support.
• Refer the couple to a support group for individuals and families adjusting to life with a colostomy, where they can learn from others’ experiences.
• Address any underlying emotional or relational concerns, such as anxiety or guilt, that may be affecting the client’s wife’s behavior.

✘Incorrect answer options:

"Your wife's desire to help is something you may need to adjust to." This response is dismissive and does not address the client’s concern. While his wife’s intentions may be supportive, this approach ignores the client’s feelings and his need for autonomy in managing his colostomy.

"Do you think your wife might find counseling helpful for this?" While counseling might benefit the wife, this response shifts the focus away from the client’s immediate concerns. The client’s feelings of discomfort and need for privacy should be prioritized before suggesting interventions for his wife.

"Have you brought this issue up with your physician yet?" This response deflects responsibility and does not validate the client’s concerns. Nurse Lisa, as part of the care team, should take the lead in addressing the psychosocial aspects of colostomy care rather than delegating the issue to another healthcare provider.

EXPLANATION

✔Correct answer:

Struggling with acceptance and showing signs of denial. Denial is a common psychological response in patients adjusting to a major life change, such as the creation of a colostomy. Mr. Lee's avoidance of showing his stoma to his wife and his disregard for dietary instructions indicate difficulty accepting his new reality. Denial serves as a defense mechanism to protect the individual from overwhelming emotions such as fear, embarrassment, or loss of control. However, prolonged denial can interfere with recovery and the patient’s ability to adapt to their new body and lifestyle.

Nurse Rachel should recognize this as an opportunity to provide emotional support, education, and counseling to help Mr. Lee progress toward acceptance. Gradual desensitization, open communication, and involving his wife in the care process can ease his transition and promote adjustment.

Think of denial like putting on sunglasses in a bright room. It temporarily shields you from discomfort (overwhelming emotions) but makes it hard to see the details (accept reality). Gradually removing the sunglasses (addressing denial) helps the person adjust to the light (their new situation).

Helping Mr. Lee move through denial and begin to accept his colostomy is critical for his psychological and physical recovery. Key interventions include:

• Provide a safe, nonjudgmental environment where Mr. Lee feels comfortable expressing his fears and concerns.
• Offer gradual exposure to the stoma, starting with observing stoma care performed by the nurse and eventually encouraging Mr. Lee to participate.
• Involve his wife in the education process to foster her understanding and ability to support Mr. Lee emotionally and practically.
• Emphasize the normalcy of initial emotional challenges after colostomy surgery, reassuring Mr. Lee that many patients successfully adapt over time.
• Provide referrals to a support group or counselor experienced in helping patients with body image changes and ostomy care.

✘Incorrect answer options:

Displaying reaction formation related to his changed body image. Reaction formation involves exhibiting behaviors or attitudes that are the opposite of one’s true feelings, such as pretending to be indifferent to or overly proud of the stoma while actually feeling embarrassed. Mr. Lee’s avoidance behaviors align more closely with denial than reaction formation.

Experiencing impotence and requiring sexual counseling. While body image changes can affect sexual confidence, there is no indication in the scenario that Mr. Lee is experiencing impotence or requiring sexual counseling. The primary issue here is psychological denial and adjustment to his colostomy.

Having suicidal ideation and requiring psychiatric intervention. There is no evidence in the scenario to suggest suicidal ideation. While psychological distress is possible, Mr. Lee’s behaviors are indicative of denial rather than an immediate need for psychiatric intervention.

EXPLANATION

✔Correct answer:

Pause the irrigation for a short time. Abdominal cramps during colostomy irrigation are commonly caused by the flow of irrigant being too fast or the water being too cold. By pausing the irrigation, Nurse Carla can give Mr. Johnson's bowel time to relax and adapt, alleviating the cramping. Once the cramping subsides, she can resume the procedure at a slower rate to prevent recurrence. It is also important to ensure the irrigant is at body temperature to avoid triggering intestinal spasms.

Abdominal cramps during this procedure are not unusual, but they should always be addressed promptly to ensure patient comfort and safety. This action aligns with the principle of "do no harm" by adjusting the procedure based on the patient's tolerance.

Imagine filling a balloon with water too quickly. The balloon will stretch and might even feel strained. If you pause and let it settle before continuing to fill it more slowly, it can accommodate the water without "cramping." Similarly, the bowel needs time to adjust to the irrigation fluid.

When performing colostomy irrigation, nurses must be vigilant about the patient's responses and adjust the procedure as needed. Below are key steps to enhance comfort and prevent complications:

• Pause the irrigation if the patient experiences cramping, and resume at a slower rate once the cramps subside.
• Ensure the irrigant is warmed to body temperature (about 37°C or 98.6°F) to reduce the risk of intestinal spasms.
• Position the irrigation bag at the correct height, typically 18–20 inches above the stoma, to maintain a controlled flow rate.
• Encourage the patient to take slow, deep breaths to relax the abdominal muscles and reduce discomfort.
• Monitor for other adverse signs, such as excessive pain, nausea, or dizziness, and stop the procedure if they occur.

✘Incorrect answer options:

Notify the physician immediately. While cramps may cause discomfort, they are a common response during irrigation and do not usually require immediate notification of the physician. Appropriate nursing interventions (e.g., pausing the procedure) are sufficient in most cases.

Raise the irrigation bag to a higher position. Raising the irrigation bag will increase the flow rate of the irrigant, which is likely to worsen the cramps by overstimulating the bowel. This action would exacerbate the problem instead of resolving it.

Administer pain medication and continue the procedure. Pain medication is not indicated for abdominal cramps caused by irrigation. Cramping is typically resolved by pausing the irrigation and adjusting the flow rate or temperature. Continuing the procedure without addressing the cause of the cramps may harm the patient.

EXPLANATION

✔Correct answer:

An enterostomal nurse therapist. An enterostomal nurse therapist (also referred to as a wound, ostomy, and continence nurse or WOC nurse) is a specialist trained in providing education, counseling, and support for patients undergoing ostomy surgery. This professional is uniquely qualified to address Mr. Alvarez’s concerns about stoma care, lifestyle adjustments, and overall adaptation to a colostomy. They can provide hands-on training, answer questions about postoperative care, help him choose appropriate supplies, and discuss strategies for maintaining quality of life.

Referring Mr. Alvarez to an enterostomal nurse therapist ensures that his specific needs related to the colostomy are addressed comprehensively and with expert guidance. This referral can also help alleviate anxiety by empowering him with knowledge and skills for self-care.

Imagine preparing for a big trip to an unfamiliar destination. While general travel advice can be helpful, consulting a local guide with firsthand expertise in that area gives you the specific knowledge and confidence you need. Similarly, the enterostomal nurse therapist acts as a "local guide" for managing life with a colostomy.

While referring Mr. Alvarez to an enterostomal nurse therapist, the nurse should also provide immediate support and education to help address his concerns. Key interventions include:

• Reassure Mr. Alvarez that it’s normal to feel anxious and that the healthcare team is there to provide support.
• Provide basic information about the descending colostomy, such as its function, expected stool consistency (solid or formed), and how it differs from other types of colostomies.
• Emphasize that ostomy care is a skill that can be learned and that resources, including specialized nurses, are available to help him adapt.
• Discuss potential lifestyle adjustments, such as diet modifications and managing social situations, and provide practical tips for reducing odors and leaks.
• Encourage Mr. Alvarez to write down questions for the enterostomal nurse therapist to ensure all his concerns are addressed during the consultation.

✘Incorrect answer options:

A social worker. While a social worker can provide emotional support and assist with resources for coping with anxiety, they are not specifically trained in stoma care or lifestyle adjustments for ostomy patients. An enterostomal nurse therapist is more appropriate in this context.

A registered dietician. A dietician is important for providing dietary recommendations, particularly for managing colostomy output, but they cannot address Mr. Alvarez’s broader concerns about stoma care and lifestyle changes. Dietary advice is part of the overall care plan but does not address all of his needs.

An occupational therapist. Occupational therapists are primarily focused on helping patients regain independence in performing daily activities, particularly if physical limitations exist. However, they do not specialize in ostomy care or the specific concerns related to colostomies.

EXPLANATION

✔Correct answer:

Increase daily fluid intake. Increasing daily fluid intake helps to soften stool, promoting easier and more effective fecal returns during colostomy irrigation. Proper hydration ensures that the stool in the colon remains manageable and can be expelled more efficiently, reducing the likelihood of incomplete evacuation or difficulty with irrigation. Dehydration, on the other hand, can lead to hard, dry stool, making irrigation more challenging and less effective.

A well-hydrated colon also minimizes the risk of complications such as cramping, constipation, or blockages. Therefore, Nurse Julia should emphasize the importance of drinking plenty of fluids as part of the client’s overall colostomy care routine.

Think of the colon as a plumbing system. If there’s not enough water in the system, the waste becomes too thick and gets "stuck," making it harder to flush. Drinking more fluids is like adding water to help the system flow smoothly during irrigation.

Nurses should provide comprehensive education on colostomy irrigation and lifestyle adjustments to maximize its effectiveness. Key considerations include:

• Encourage the client to drink at least 2–3 liters of fluid per day, unless contraindicated by conditions such as heart failure or kidney disease.
• Explain the importance of a balanced diet with adequate fiber to support stool consistency and regularity.
• Teach proper irrigation techniques, including using the recommended amount of lukewarm water (approximately 500–1000 mL) during the procedure.
• Advise the client to irrigate at the same time each day to establish a predictable bowel routine.
• Monitor for signs of dehydration, such as dark urine, dry skin, or fatigue, and address these promptly.

✘Incorrect answer options:

Apply heat to the abdomen. While heat may sometimes help relax abdominal muscles or relieve cramping, it is not a primary strategy to improve fecal returns during colostomy irrigation. Increased fluid intake has a more direct and significant impact on stool consistency and the effectiveness of irrigation.

Schedule the irrigation for the evening. This is incorrect because colostomy irrigation is generally more effective when done in the morning, after breakfast. Morning irrigation takes advantage of the body’s natural gastrocolic reflex, which promotes bowel activity after eating. Evening irrigation may disrupt the client’s routine and be less effective.

Use less irrigation solution during the procedure. Using less irrigation solution would likely result in incomplete evacuation, as an inadequate volume of water might not sufficiently stimulate the bowel. The recommended amount (500–1000 mL of lukewarm water) should be used to ensure effective returns.

EXPLANATION

✔Correct answer:

"Using cold water will help reduce odor during irrigation." This statement indicates a misunderstanding of proper colostomy irrigation techniques. Cold water is not recommended for irrigation as it can cause cramping, discomfort, and even spasms in the intestines. Instead, lukewarm water is the appropriate temperature for irrigation because it is closer to body temperature and minimizes irritation or cramping. Additionally, odor management during colostomy irrigation is not affected by water temperature but is better addressed by diet, proper hygiene, and the use of deodorizing products designed for ostomy care.

Think of the intestines like a garden hose—if you flush it with water that’s too cold, it might shrink or "kink" due to the temperature difference, causing discomfort and reduced flow. Lukewarm water, on the other hand, helps everything flow smoothly and comfortably.

Nurses must ensure that clients understand proper colostomy care techniques, including irrigation, to prevent complications such as intestinal cramping or inefficient evacuation. The following steps are critical for effective education:

• Instruct the client to always use lukewarm water during irrigation to prevent intestinal cramping.
• Educate the client about the importance of establishing a consistent routine to regulate bowel movements.
• Advise that tap water is typically acceptable for irrigation unless contraindicated by the healthcare provider.
• Provide guidance on managing colostomy odor, emphasizing proper cleaning techniques and dietary choices.
• Encourage the client to ask questions or report any discomfort during the irrigation process to their healthcare provider.

✘Incorrect answer options:

"I should use lukewarm water for the irrigation to prevent cramping." This is a correct statement. Lukewarm water helps prevent cramping and irritation during colostomy irrigation by maintaining a temperature close to that of the body.

"I will perform irrigation at the same time each day to establish a routine." This is a correct statement. Performing irrigation at the same time daily helps the client establish a predictable routine for bowel movements, which can improve colostomy management.

"I can use tap water as the irrigation solution unless otherwise instructed by my provider." This is a correct statement. Tap water is typically safe and appropriate for use as an irrigation solution unless contraindicated due to specific health concerns or provider recommendations.

EXPLANATION

✔Correct answer:

A healthy brick-red hue.  A stoma should normally appear moist and have a healthy brick-red or deep pink hue. This coloration indicates an adequate blood supply to the stoma, which is essential for its viability and proper functioning. Since the stoma is formed by bringing a portion of the intestinal mucosa to the surface of the skin, its vascularity gives it this characteristic color.

A stoma that deviates from this normal appearance may signal complications. For example, a pale, bluish, or black discoloration may indicate ischemia or necrosis due to compromised blood flow. Nurses must regularly assess stoma color and immediately report abnormalities to prevent further complications.

Think of the stoma as a flower that needs good soil and water to remain vibrant. The brick-red hue represents a healthy "bloom," indicating the flower is receiving enough nutrients (in this case, blood supply). If the flower looks pale, gray, or wilted, it means something is wrong with its environment.

A thorough stoma assessment and proper care are crucial to ensure the stoma remains viable and free from complications. Key considerations include the following:

• Inspect the stoma daily for color, moisture, and surrounding skin integrity.
• Ensure that the stoma remains brick-red; any deviation (e.g., pale, gray, or black) should be promptly reported to the healthcare provider.
• Clean the stoma gently with warm water and avoid using alcohol-based or harsh cleansers that can damage mucosa.
• Monitor for signs of complications, such as stoma prolapse, retraction, or irritation of the peristomal skin.
• Provide patient education on stoma care, including signs of infection or poor circulation to watch for at home.

✘Incorrect answer options:

A grayish discoloration. A grayish discoloration of the stoma suggests ischemia or necrosis. This occurs when the blood supply to the stoma is compromised. Immediate intervention is necessary to restore perfusion or prevent further tissue death.

A bluish appearance. A bluish stoma indicates cyanosis due to poor oxygenation or inadequate blood flow. This is an urgent finding requiring rapid assessment and intervention by the healthcare team.

A pale pink tone. While a pale pink tone may seem acceptable, it can indicate reduced blood flow or early signs of ischemia. A healthy stoma should exhibit a more robust brick-red or deep pink hue.

EXPLANATION

✔Correct answer:

"I’ll eat what I did before surgery but avoid foods that cause gas." This statement indicates that the client understands that, for most people, dietary patterns after a colostomy can remain largely the same as before surgery, with some individualized adjustments based on tolerance. Avoiding foods that cause gas (e.g., beans, broccoli, cabbage) or excessive odor (e.g., garlic, onions, fish) is a common and recommended approach for colostomy management. Clients are encouraged to reintroduce foods gradually, monitoring their body's response to identify any specific intolerances, and to maintain a balanced diet that promotes regular bowel function.

Colostomy clients should not feel unnecessarily restricted in their food choices. Instead, they should focus on a varied and nutritious diet while managing factors such as gas, stool consistency, and odor. This approach empowers the client to maintain quality of life and enjoy meals without undue anxiety about their colostomy.

Think of your digestive system after a colostomy like adjusting to driving a car on a new road. You can still drive (eat your regular diet), but you might need to avoid certain potholes (foods that cause gas or odor) or slow down in certain areas (introduce high-fiber foods gradually). Over time, you’ll learn which paths are smooth (foods your body tolerates well) and which ones to steer clear of, allowing for a comfortable and enjoyable journey.

Nurse Carla should reinforce the following dietary guidelines to help the client manage their colostomy effectively:

• Encourage a balanced diet with adequate fiber, protein, and hydration to promote overall health and regular bowel function.
• Teach the client to introduce high-fiber foods and new items gradually to avoid overwhelming the digestive system and to monitor for tolerance.
• Educate on foods that can cause gas or odor, such as broccoli, cabbage, beans, onions, garlic, and carbonated drinks, and how to manage their intake if they cause discomfort.
• Promote adequate fluid intake (at least 2-3 liters daily) to prevent constipation and ensure proper colostomy function.
• Reassure the client that occasional food-related changes in stool output, odor, or gas are normal and can be managed with dietary adjustments.

✘Incorrect answer options:

"I’ll stick to low-fiber foods to reduce stool production." This is incorrect because fiber is essential for overall bowel health and stool consistency. While the client may need to limit high-fiber foods initially after surgery, reintroducing fiber gradually is important for maintaining regular bowel movements and preventing constipation.

"I’ll choose bland foods to avoid irritating my intestines." This is incorrect because bland foods are not necessary unless the client is experiencing specific digestive issues, such as diarrhea. Most clients can tolerate a variety of foods, and overly restricting the diet may lead to inadequate nutrition.

"I’ll eat soft foods that are easier for my large intestine to process." This is incorrect because the consistency of foods does not typically impact the large intestine's ability to process them. A regular, balanced diet is recommended unless the client has specific digestive problems.

EXPLANATION

✔Correct answer:

"Chewing food thoroughly can help prevent digestive issues." Chewing food thoroughly is an essential recommendation for patients with colostomies. Proper chewing helps to break down food more effectively, reducing the risk of blockages in the stoma or bowel. Colostomy patients are particularly susceptible to blockages from poorly digested or fibrous foods, so careful chewing is a simple but critical strategy to prevent complications.

This advice applies to patients with colostomies because the digestive process is altered, and some foods may be harder to pass through the stoma. Educating Mrs. Watson to chew her food thoroughly promotes safe digestion and optimal colostomy function.

Think of the digestive system like a garbage disposal. If you put large chunks of food into the disposal without breaking them up first, it’s more likely to clog. Similarly, chewing food thoroughly helps prevent blockages in the digestive tract or stoma.

Nurse Carla should provide Mrs. Watson with comprehensive dietary education tailored to living with a colostomy. Key considerations include:

• Encourage the patient to chew food thoroughly to aid digestion and reduce the risk of stoma blockages.
• Teach the patient to introduce high-fiber foods gradually to avoid overwhelming the digestive system and causing discomfort.
• Promote hydration, as sufficient fluid intake helps to soften stool and prevent blockages or dehydration.
• Educate the patient on foods that may produce gas, odor, or stool consistency changes, such as beans, onions, or fatty foods, and how to manage them.
• Advise the patient to maintain a balanced diet with small, frequent meals if large meals are not well-tolerated, but ensure these suggestions are individualized based on tolerance and nutritional needs.

✘Incorrect answer options:

"Foods high in fiber should be avoided to prevent blockage." This is incorrect because high-fiber foods are not strictly prohibited. However, they should be introduced gradually and with proper monitoring. Over time, many colostomy patients can tolerate a variety of high-fiber foods when chewed thoroughly and consumed with adequate hydration.

"Frequent snacking is better than eating large meals." While some colostomy patients may find smaller meals easier to tolerate, this is not a universal recommendation. The patient’s dietary routine should be individualized based on tolerance and nutritional needs.

"Colostomy feeding requires using a feeding tube directly into the stoma." This is incorrect. Colostomies are part of the large intestine and do not require feeding tubes. A colostomy allows stool to exit the body but does not involve direct feeding through the stoma. This statement confuses colostomies with gastrostomies or jejunostomies, which are used for feeding via the GI tract.

EXPLANATION

✔Correct answer:

"I’ll call if I have trouble inserting the irrigation tube into the stoma." Difficulty inserting the irrigation tube into the stoma could indicate a serious issue, such as stenosis (narrowing of the stoma), obstruction, or improper stoma healing. These complications require immediate medical evaluation to determine the cause and prevent further issues, such as bowel obstruction or trauma to the stoma. Prompt communication with the healthcare provider ensures that any underlying problem is addressed appropriately and in a timely manner.

Proper insertion of the irrigation tube is essential for the success of colostomy irrigation, which promotes predictable bowel movements and improves the patient’s quality of life. Any challenges with this process should not be ignored, as they may signal underlying complications.

Imagine trying to water a garden but finding the hose nozzle blocked or difficult to insert into the connector. You wouldn’t force it; instead, you’d investigate the blockage. Similarly, difficulty with the irrigation tube might indicate a "blockage" or issue that requires attention.

It is critical to educate patients about when to seek medical attention after colostomy surgery. Key considerations include the following:

• Teach patients to contact their healthcare provider if they encounter difficulty inserting the irrigation tube, as this may indicate complications such as stenosis or obstruction.
• Encourage patients to report other signs of complications, such as unusual pain, bleeding, excessive gas, or no stool output.
• Reinforce the importance of performing colostomy irrigation gently and following all steps carefully to avoid trauma or injury.
• Provide resources, such as stoma care nurses or support groups, to assist with troubleshooting irrigation issues.
• Educate patients to monitor the stoma for changes in color, size, or function, which may also require prompt medical attention.

✘Incorrect answer options:

"I’ll call if I feel abdominal cramping during irrigation." Mild abdominal cramping is a common and normal response during irrigation, often caused by the flow of the irrigation solution or the temperature of the water. This can usually be resolved by pausing the procedure, adjusting the flow rate, or ensuring the water is at body temperature. It does not require contacting a healthcare provider unless the cramping is severe or persistent.

"I’ll call if I pass gas while the return is flowing out." Passing gas during the return is a normal occurrence during irrigation and indicates that the bowel is functioning properly. This does not warrant contacting the healthcare provider.

"I’ll call if I can’t finish the irrigation in under an hour." The duration of irrigation can vary between individuals. Taking longer than an hour may simply indicate the need for adjustments, such as slowing the flow rate or improving technique. However, it does not necessarily signal a complication requiring medical attention unless accompanied by other abnormal findings (e.g., no return flow, severe pain).

EXPLANATION

✔Correct answer:

Hanging the irrigation bag on a hook on the bathroom door during the procedure. The irrigation bag should be positioned no more than 18–24 inches above the stoma to ensure proper flow of the irrigation fluid into the bowel. Hanging the bag too high, such as on a bathroom door, can cause the fluid to flow too quickly, increasing the risk of cramping and discomfort for the patient. Proper bag height allows for a controlled and comfortable instillation, promoting effective colostomy irrigation. Nurse Ellen should provide additional teaching to ensure Mr. Garcia understands the importance of proper irrigation bag positioning during the procedure.

Think of the irrigation bag as a water tank feeding a gentle stream into a garden hose. If the tank is placed too high, the water will flow too forcefully, potentially damaging the garden bed. Similarly, if the irrigation bag is too high, the fluid flows too quickly, causing discomfort and cramping.

Proper colostomy irrigation techniques are essential for patient comfort and effectiveness. Nurse Ellen should provide Mr. Garcia with the following guidance:

• Ensure the irrigation bag is hung 18–24 inches above the stoma for controlled fluid flow.
• Demonstrate how to adjust the height of the irrigation bag and explain why proper positioning minimizes cramping and promotes effectiveness.
• Encourage Mr. Garcia to take slow, deep breaths during the procedure to help relax the abdominal muscles and reduce discomfort.
• Advise him to stop or slow the fluid flow if cramping occurs and resume when the discomfort subsides.
• Reassess his technique after additional teaching to ensure proper execution of the irrigation process.

✘Incorrect answer options:

Pausing the fluid flow when he feels discomfort. This is a correct action. Pausing the fluid flow when discomfort or cramping occurs allows the bowel to relax and helps prevent injury or further discomfort.

Applying lubrication to the catheter tip before inserting it into the stoma. This is a correct action. Lubricating the catheter reduces friction, making insertion more comfortable and minimizing the risk of trauma to the stoma.

Stopping the fluid instillation after administering only 500 mL. This is a correct action depending on the patient’s individual tolerance and prescribed irrigation volume. Some patients may only require 500 mL of irrigation fluid, as the appropriate amount varies between individuals. If discomfort occurs before reaching the full volume, stopping is appropriate.

EXPLANATION

✔Correct answer:

No more than 3 inches. When performing colostomy irrigation, the catheter should be inserted no more than 3 inches into the stoma. This depth ensures that the catheter reaches the bowel without causing trauma to the stoma or bowel wall. Inserting the catheter too deeply could lead to irritation, bleeding, or perforation of the intestinal tissue, while insufficient insertion may result in ineffective irrigation.

Lubricating the catheter before insertion is critical for reducing friction and ensuring the procedure is as comfortable as possible for the patient. Proper technique not only enhances the effectiveness of the irrigation but also prevents complications such as injury to the stoma or surrounding tissues.

Think of inserting a key into a lock—if you insert it too far, it can get stuck or damage the lock. Similarly, inserting the catheter more than 3 inches into the stoma could cause harm to the bowel, so it’s important to stop at the right depth.

Teaching proper colostomy irrigation techniques is essential for patient safety and effectiveness. Nurse Carla should emphasize the following points:

• Instruct the patient to lubricate the catheter tip with a water-soluble lubricant before insertion to reduce discomfort and prevent injury.
• Advise the patient to gently insert the catheter no more than 3 inches into the stoma. Explain that resistance should not be forced, as this could damage the bowel.
• Encourage the patient to relax their abdominal muscles during insertion to make the process easier and less uncomfortable.
• Teach the patient to monitor for signs of complications, such as pain, bleeding, or resistance during catheter insertion, and to stop the procedure and contact their healthcare provider if these occur.
• Reinforce the importance of cleaning and storing the irrigation equipment properly to prevent infection.

✘Incorrect answer options:

No more than 2 inches. This is incorrect because inserting the catheter only 2 inches may not allow it to reach the bowel adequately for effective irrigation. Proper irrigation requires reaching slightly deeper into the bowel.

No more than 4 inches. This is incorrect because inserting the catheter 4 inches may be too deep, increasing the risk of bowel wall irritation or injury.

No more than 5 inches. This is incorrect because inserting the catheter 5 inches is excessive and could cause significant trauma to the bowel or stoma.

EXPLANATION

✔Correct answer:

Semi-formed and pasty. At four days postoperatively, the stool from a sigmoid colostomy is expected to be semi-formed and pasty. This consistency reflects the natural function of the sigmoid colon, where much of the water has been reabsorbed from stool. However, in the immediate postoperative period, the stool may still be slightly softer than usual as the bowel adjusts to the surgical changes and the patient's diet gradually returns to normal.

A sigmoid colostomy, located in the final segment of the large intestine, mimics normal bowel elimination, but complete formation of stool may not occur until later in the recovery period as healing continues.

Think of the stool consistency in the sigmoid colon as being like soft cookie dough. It is no longer liquid (like batter) because water has been absorbed, but it is not fully solidified either. The bowel is still adjusting to the changes after surgery.

Nurses play a critical role in monitoring colostomy output to ensure the bowel is functioning correctly and to identify potential complications early. Key points include:

• Document the stool consistency, color, and frequency to assess recovery and detect complications.
• Educate the patient about the expected stool consistency (semi-formed and pasty) during the early recovery phase.
• Advise the patient on the importance of hydration and a balanced diet to support normal stool consistency and bowel function.
• Monitor for abnormal findings, such as watery, bloody, or absent stool, and report these immediately to the healthcare provider.
• Reassure the patient that stool consistency will likely continue to normalize as they heal and adjust to their colostomy.

✘Incorrect answer options:

Watery and continuous. This is incorrect because watery and continuous stool output is typically seen with ileostomies or colostomies in the ascending colon, where minimal water absorption occurs. In a sigmoid colostomy, the stool has passed through most of the colon, where significant water reabsorption takes place.

Formed and solid. This is incorrect at this early postoperative stage because the bowel is still healing, and the patient's diet may not yet support fully solid stool. Solid, formed stool is more typical after complete recovery.

Loose and liquid. This is incorrect because loose and liquid stool output is not expected from a sigmoid colostomy. Such a finding may indicate diarrhea, infection, or another complication requiring medical evaluation.

EXPLANATION

✔Correct answer:

The stoma is protruding with a swollen appearance. A prolapsed stoma occurs when the bowel telescopes out through the stoma opening, causing it to protrude abnormally beyond its usual level. It often appears swollen, elongated, and protruding, which are the hallmark characteristics of a prolapsed stoma. This condition may result from increased abdominal pressure, improper placement of the stoma, or weakened abdominal muscles, especially in the early postoperative period.

While a prolapsed stoma may still function (passing stool and gas), it can be uncomfortable for the patient and may increase the risk of complications such as impaired circulation, trauma, or infection. Nurse Anna should notify the healthcare provider immediately and take measures to prevent further injury or swelling, such as keeping the stoma moist and protected.

Imagine a rolled-up sock being pushed through a small hole in a piece of fabric. If you push the sock too far, it bunches up and protrudes outward awkwardly. Similarly, in a prolapsed stoma, the bowel pushes outward through the stoma opening, protruding beyond its normal level and becoming swollen and elongated.

When a prolapsed stoma is identified, Nurse Anna should focus on preventing complications and ensuring patient comfort. Key interventions include:

• Keep the stoma moist by covering it with a clean, damp dressing to prevent drying and tissue damage.
• Position the patient in a supine position with their knees slightly bent to reduce abdominal pressure and swelling.
• Notify the healthcare provider immediately, as manual reduction or surgical correction may be required if the prolapse does not resolve spontaneously.
• Monitor for signs of impaired circulation, such as changes in color (dusky, bluish, or black), indicating ischemia, which requires urgent intervention.
• Educate the patient about measures to prevent stoma prolapse, such as avoiding heavy lifting and managing abdominal pressure effectively.

✘Incorrect answer options:

The stoma appears sunken and not visible. This describes a retracted stoma, not a prolapsed stoma. A retracted stoma is when the stoma pulls inward below the skin level, increasing the risk of stool leaking onto the surrounding skin and causing irritation.

The stoma looks dusky and bluish in color. This describes a stoma with compromised blood flow, potentially indicating ischemia or necrosis. While this is a medical emergency, it is not the defining characteristic of a prolapsed stoma.

The stoma is narrow and flattened. A narrow and flattened stoma may indicate constriction or stenosis, a condition where the stoma becomes abnormally tight. This could cause difficulty in stool passage but is not related to a prolapse.

EXPLANATION

✔Correct answer:

At the time the client would typically have a bowel movement. The best time to teach colostomy irrigation is when the client would naturally have a bowel movement. This timing aligns with the body's natural gastrocolic reflex, which occurs after meals and encourages bowel activity. Demonstrating the procedure during this period ensures the highest likelihood of effective fecal evacuation, helping the client establish a predictable routine.

By teaching the client to perform irrigation at this time, Nurse Rachel also reinforces the importance of consistency in maintaining bowel regularity, which is a key goal of colostomy irrigation. This timing promotes success and reduces frustration, allowing the client to gain confidence in managing their colostomy.

Think of bowel movements like a train schedule. Trains (bowel movements) run more smoothly if they follow a predictable schedule. Performing irrigation at the usual "departure time" ensures everything stays on track and runs efficiently.

Teaching colostomy irrigation requires careful planning and consideration of the client's unique schedule, preferences, and emotional readiness. Key teaching points include:

• Encourage the client to perform irrigation at the same time each day, preferably when their bowel movements typically occur.
• Explain the role of the gastrocolic reflex and why timing the procedure after a meal (e.g., breakfast) can enhance effectiveness.
• Demonstrate the correct steps of irrigation and allow the client to practice under supervision to build confidence and skill.
• Ensure the client has appropriate supplies and understands how to clean and store equipment.
• Provide emotional support to address any concerns or anxieties the client may have about managing their colostomy independently.

✘Incorrect answer options:

After the client has mentally adjusted to their colostomy. While emotional adjustment is important, delaying education until the client is fully adjusted could hinder their ability to manage their colostomy effectively. Teaching should begin as soon as the client is physically and emotionally ready to learn.

Early in the morning, before breakfast and morning care. Performing irrigation before breakfast may not be as effective because the gastrocolic reflex, which is stimulated by eating, is not yet active. Scheduling the procedure after a meal maximizes the natural bowel activity and improves fecal evacuation.

At least 2 hours prior to any scheduled visitors. While privacy is important for the client’s comfort, timing the procedure based solely on visitor schedules does not optimize the success of irrigation. The focus should remain on aligning irrigation with the client’s bowel patterns.

EXPLANATION

✔Correct answer:

Plain Normal Saline Solution (NSS). Tap water, not normal saline solution (NSS), is typically used for colostomy irrigation. Tap water is safe, readily available, and effective for this procedure. Using normal saline for irrigation is unnecessary, as the colon is already accustomed to handling water. Preparing NSS for irrigation would indicate that Nurse Anne requires additional guidance regarding the appropriate fluid for this procedure.

Colostomy irrigation is a simple process designed to promote regular bowel movements and does not require sterile or isotonic fluids. Tap water at body temperature is sufficient to prevent bowel spasms and ensure comfort during the procedure.

Think of irrigating the colon like watering plants in a garden. Just as regular tap water is enough to nourish the plants, tap water is sufficient for colostomy irrigation—there's no need for a special or enhanced solution like saline.

To ensure proper colostomy irrigation, Nurse Anne should focus on the following points during preparation and teaching:

• Use lukewarm tap water (about body temperature) for irrigation to prevent cramping or irritation during the procedure.
• Explain that sterile or isotonic solutions, such as normal saline, are unnecessary because the colon does not require sterility for irrigation.
• Demonstrate how to use an irrigation sleeve and ensure the patient understands how to manage stool return during the procedure.
• Teach the importance of using a water-soluble lubricant, like K-Y Jelly, to ease catheter insertion and minimize trauma to the stoma.
• Reinforce proper technique and troubleshooting tips, such as slowing the flow of water if the patient experiences discomfort or cramping.

✘Incorrect answer options:

K-Y Jelly for lubrication. This is correct and necessary for colostomy irrigation. A water-soluble lubricant like K-Y Jelly ensures smooth catheter insertion without damaging the stoma or surrounding tissue.

Tap water for irrigation. This is correct. Tap water is the recommended fluid for colostomy irrigation because it is effective, safe, and does not require additional preparation.

An irrigation sleeve for managing the procedure. This is correct. The irrigation sleeve is essential for collecting stool and water during the procedure and preventing mess or contamination.

EXPLANATION

✔Correct answer:

It compromises the odor-proof barrier of the bag. Punching small holes in the colostomy bag is not an appropriate practice because it compromises the bag's odor-proof barrier. Colostomy bags are designed with materials that contain odor and prevent leakage of gas and stool. Creating holes in the bag allows gas to escape in an uncontrolled manner, leading to offensive odors and potential contamination, which can be distressing and socially embarrassing for the patient.

Instead, patients should be educated to use colostomy bags with built-in filters designed to allow gas to escape without releasing odors. Filters are safe, effective, and maintain the integrity of the colostomy system while addressing the problem of gas buildup.

Think of a colostomy bag like a sealed soda bottle. If you punch a hole in the bottle to let out gas, not only will the gas escape, but the liquid and odor might spill out too. The bottle’s design is meant to contain everything inside, just like the colostomy bag is built to contain gas and stool without odor escaping.

Nurses play a vital role in educating patients about appropriate colostomy care practices to avoid complications and maintain quality of life. Key considerations include:

• Explain the purpose of the colostomy bag's odor-proof barrier and why it should not be compromised.
• Recommend using colostomy bags with integrated filters to manage gas buildup effectively and hygienically.
• Teach patients to "burp" the colostomy bag by carefully releasing gas from the top of the bag, if necessary, without damaging its structure.
• Emphasize proper stoma care and ensure the patient knows how to securely seal the bag to prevent leaks.
• Address the psychological and social concerns of living with a colostomy and provide support resources, such as ostomy support groups.

✘Incorrect answer options:

It has no significant impact on the colostomy system. This is incorrect because creating holes in the colostomy bag significantly impacts its function, particularly the odor-proof barrier, and increases the risk of leaks.

It is an acceptable method to manage gas in the bag. Punching holes in the colostomy bag is not acceptable because it leads to uncontrolled odor release and compromises the functionality of the bag. Proper techniques, such as using bags with filters or manually releasing gas appropriately, should be utilized.

It damages the bag's moisture barrier seal. While punching holes in the bag may damage its overall structure, the primary concern is the compromise of the odor-proof barrier, not necessarily the moisture barrier seal.

EXPLANATION

✔Correct answer:

He takes part in daily ostomy care with the nurse. Taking part in daily ostomy care is one of the clearest signs of positive adaptation because it demonstrates that Mr. Thompson is actively engaging with his new reality and is willing to take responsibility for managing his colostomy. Participation in care requires a combination of practical skill development, emotional adjustment, and acceptance of his condition. It also indicates that he is progressing toward independence, which is a critical goal in colostomy rehabilitation.

By actively participating in his care, Mr. Thompson is showing readiness to learn and take ownership of his health. This behavior can boost his confidence, reduce feelings of helplessness, and foster long-term adaptation to life with a colostomy.

Think of learning to care for a colostomy like learning to cook a new recipe. Watching someone else cook (e.g., the nurse doing all the care) helps you understand the basics, but participating yourself builds the confidence and skills you need to prepare the dish independently. Similarly, by participating in daily ostomy care, Mr. Thompson is preparing to manage his colostomy on his own.

Nurse Megan should continue to support and guide Mr. Thompson as he transitions toward full independence in managing his colostomy. Important steps include:

• Provide step-by-step guidance during ostomy care to build Mr. Thompson’s confidence and competence.
• Offer positive reinforcement and encouragement to validate his progress and foster a sense of accomplishment.
• Allow Mr. Thompson to gradually take over tasks, such as cleaning the stoma, changing the appliance, and managing supplies, to promote independence.
• Involve his family or caregivers, as needed, to ensure they are prepared to assist if necessary.
• Continue to monitor for emotional and social adjustment, offering additional resources or counseling as needed.

✘Incorrect answer options:

He looks at the ostomy site. While this is an early sign of acceptance, it does not reflect active engagement or the development of skills needed for long-term adaptation. It is a passive behavior compared to participating in daily care.

He requests pamphlets and contact information for ostomy support groups. Seeking information and support is a good sign, but it indicates a desire to adapt rather than actual engagement in self-care. Participating in daily ostomy care is a more concrete demonstration of adaptation.

He openly discusses his ostomy with the nurse and friends. While openness is an excellent indicator of emotional acceptance, it does not necessarily reflect active involvement in self-care. Participation in daily care demonstrates both physical and emotional adaptation.

EXPLANATION

✔Correct answer:

Projection. Projection occurs when an individual attributes their own unacceptable thoughts, feelings, or fears to someone else. In this scenario, Mr. Carter likely feels uncomfortable or self-conscious about his wound and projects these feelings onto Nurse Jamie by accusing her of being uncomfortable. This defense mechanism allows Mr. Carter to deflect his own emotional distress and avoid addressing his negative feelings directly.

Projection is common among patients coping with body image changes after major surgeries, such as a colostomy. Recognizing this defense mechanism allows Nurse Jamie to respond with empathy, reassurance, and support to help Mr. Carter process his emotions in a healthier way.

Imagine feeling nervous about giving a speech and saying, "Everyone in the audience looks so tense!" when, in reality, the nervousness is coming from within. Similarly, Mr. Carter accuses Nurse Jamie of being uncomfortable, but this reflects his own feelings about the wound.

Understanding that Mr. Carter is using projection as a defense mechanism, Nurse Jamie can help him work through his feelings by using these strategies:

• Acknowledge Mr. Carter’s feelings without judgment, saying something like, "It sounds like you're feeling concerned about how the wound looks."
• Provide reassurance that the wound is healing as expected and offer factual information about the healing process to alleviate his concerns.
• Encourage Mr. Carter to express his emotions openly and discuss any fears or anxieties about his body image or recovery.
• Offer resources, such as counseling or support groups, to help him cope with the psychological impact of his surgery.
• Maintain a calm and confident demeanor during wound care to demonstrate professionalism and reassure Mr. Carter that the wound does not cause discomfort or distress for the nurse.

✘Incorrect answer options:

Reaction formation. Reaction formation involves behaving in a way that is opposite to one's true feelings, such as overly praising the wound despite actually feeling negative about it. This is not evident in Mr. Carter's behavior, as he directly accuses the nurse of being uncomfortable.

Sublimation. Sublimation is a mature defense mechanism where negative emotions are redirected into socially acceptable actions or activities, such as channeling anger into art or exercise. Mr. Carter’s accusation does not demonstrate sublimation, as it does not involve redirecting his emotions in a positive or constructive way.

Intellectualization. Intellectualization involves using logic, reasoning, or excessive thinking to distance oneself from emotional distress. For example, Mr. Carter might focus on discussing the medical aspects of the wound in great detail to avoid addressing his emotions. This is not present in the scenario.

EXPLANATION

✔Correct answer:

"Agreeing to observe and look at the colostomy." Agreeing to observe and look at the colostomy is the best initial step in the learning process because it indicates the client is beginning to acknowledge and accept the colostomy. This is a critical starting point for successful self-care education. Many clients experience emotional distress or denial about their colostomy initially, and observing it shows a willingness to engage with the reality of the new condition. From this step, the nurse can build the client’s confidence and gradually introduce hands-on skills for colostomy care.

Learning to manage a colostomy involves several stages, starting with observation, followed by assisting with care, and finally performing care independently. By taking this first step, the client demonstrates readiness to move forward in the learning process.

Imagine learning to ride a bicycle. The first step is watching someone else ride, which helps build familiarity and reduces fear. Similarly, observing the colostomy is a critical first step in becoming comfortable with its care.

Nurse Mia should encourage and support the client’s progress in the learning process, focusing on small, manageable steps. Key strategies include:

• Reassure the client that it’s normal to feel hesitant at first and that observation is an important step toward learning self-care.
• Encourage the client to ask questions and express any concerns while observing colostomy care, fostering a supportive and open learning environment.
• Gradually introduce hands-on participation by having the client assist with small tasks, such as cleaning around the stoma or applying a new pouch.
• Provide positive reinforcement for each step the client takes, building confidence and motivation to learn.
• Offer educational materials, such as step-by-step guides or videos, to supplement the client’s learning and reinforce key concepts.

✘Incorrect answer options:

"Asking to delegate colostomy care to someone else." This is incorrect because delegating care suggests the client is not ready to engage in the learning process. While some clients may need assistance from caregivers, independence is the ultimate goal, and the nurse should encourage the client to take steps toward self-care.

"Promising to start paying attention to care instructions tomorrow." This is incorrect because delaying engagement indicates avoidance, not readiness to learn. The nurse should work with the client to address any fears or concerns that may be causing the delay.

"Stating that colostomy care is the nurse’s responsibility during hospitalization." This is incorrect because it reflects denial or dependence rather than readiness to participate in learning. While the nurse initially performs colostomy care, the client must eventually take responsibility for managing the colostomy at home.

EXPLANATION

✔Correct answer:

"Irrigate the colostomy at the same time each day to establish a routine." Regular irrigation at the same time each day helps establish a predictable bowel elimination pattern for patients with a colostomy. This practice trains the bowel to evacuate at a specific time, minimizing the occurrence of unexpected bowel movements. It is particularly beneficial for patients with a descending or sigmoid colostomy, as these areas of the colon are more receptive to irrigation and can achieve better bowel control.

Consistency is critical to successful irrigation. The process mimics the body’s natural bowel rhythm and promotes effective waste elimination, helping patients maintain a sense of control and improving their quality of life.

Think of irrigation as setting an alarm clock for your bowel. By irrigating at the same time daily, the bowel "learns" to expect elimination, much like training your body to wake up at the same time every morning.

Educating the patient about proper colostomy irrigation techniques ensures the procedure is performed safely and effectively. Below are key points to include:

• Emphasize the importance of performing irrigation at the same time each day to establish a routine.
• Instruct the patient to use lukewarm water (not cold or hot) to prevent bowel spasms or mucosal injury.
• Teach the patient to assume a comfortable seated position on the toilet or a commode during irrigation for ease of evacuation.
• Advise the patient to allow the water to flow slowly into the stoma and pause if cramping occurs.
• Reassure the patient that colostomy irrigation is a clean technique, not sterile, and demonstrate proper equipment care and disposal.

✘Incorrect answer options:

"Perform irrigation with the colostomy bag in place to avoid leakage." This is incorrect because irrigation involves removing the colostomy bag and attaching an irrigation sleeve to allow controlled elimination of waste. The colostomy bag is reattached after the procedure.

"Use cold water to stimulate bowel movements during irrigation." Cold water can cause intestinal spasms and discomfort. Lukewarm water (about body temperature) should always be used for colostomy irrigation to ensure patient comfort and effective bowel stimulation.

"Lie flat on your back while irrigating the colostomy for the best results." This is incorrect because lying flat does not facilitate effective waste elimination. Patients are typically instructed to sit upright on the toilet or commode during irrigation, which utilizes gravity to aid evacuation.

EXPLANATION

✔Correct answer:

With guidance, a near-normal life, including full sexual function, is achievable. Nurse Sarah should emphasize that, with proper education, support, and adaptation, Mr. Reynolds can resume a near-normal lifestyle after his colostomy. This includes returning to work, engaging in hobbies, participating in physical activities (including swimming), and enjoying an active sexual life. Providing reassurance that life can continue with minimal limitations helps to reduce anxiety, promote acceptance, and empower the patient to confidently manage their condition.

Sexual health is often a significant concern for clients with a new colostomy, and Nurse Sarah should address this topic openly. While there may be physical and emotional challenges initially, full sexual function is achievable for most patients with proper guidance and communication. Encouraging Mr. Reynolds to seek support, such as counseling or ostomy groups, can also improve his quality of life.

Think of adjusting to a colostomy like learning to use a new tool. At first, it may feel unfamiliar and awkward, but with practice, guidance, and support, you can master it and continue with most activities as before.

Nurse Sarah should include the following points in Mr. Reynolds's discharge education to help him adapt and thrive:

• Reassure the patient that most activities, including sports, swimming, and sexual activity, can be resumed once the surgical site has healed.
• Teach proper colostomy care to boost confidence and independence, including how to prevent leaks and manage odor during daily activities.
• Provide information on special equipment, such as waterproof colostomy pouches, to facilitate participation in swimming and other water activities.
• Encourage open communication with partners and provide resources for addressing concerns related to intimacy and body image.
• Refer the patient to support groups or ostomy organizations to connect with others who have adjusted to similar changes.

✘Incorrect answer options:

Lifestyle changes may be needed to adjust to the physical changes caused by the surgery. While this statement is true, focusing solely on lifestyle changes may sound discouraging to the patient. The priority is to emphasize that most daily activities can be resumed with minimal adjustments, promoting a positive outlook.

Most sports can be resumed, except swimming, depending on the client’s general health. This is incorrect because swimming is an activity that colostomy patients can resume safely with proper equipment, such as waterproof pouches. There is no inherent restriction on swimming after the surgical site has healed.

Returning to daily routines quickly is essential to prevent depression and dependence. While returning to routines is important, the emphasis should be on pacing the recovery process based on the patient’s readiness and ensuring adequate education and support. Pushing for rapid adjustment may create unnecessary stress and hinder emotional healing.

EXPLANATION

✔Correct answer:

You can resume normal sexual relationships after recovery. Nurse Elena should reassure Mr. Taylor that sexual activity can usually resume after the healing process is complete. While having a colostomy might initially create concerns about body image, confidence, or functionality, it does not prevent most individuals from maintaining a healthy and fulfilling sexual life. Providing reassurance and education about managing the colostomy during intimate moments is critical to addressing his concerns and promoting confidence.

It is essential to emphasize that intimacy is a normal part of life and that adjustments can be made to accommodate the colostomy. These may include using accessories such as smaller or more discreet colostomy bags, emptying the pouch beforehand, and open communication with the partner to ensure comfort and understanding.

Imagine getting a small adjustment to your daily routine, like wearing a fitness tracker on your wrist for the first time. Initially, you may feel self-conscious about how it looks or worry about it getting in the way during certain activities. But over time, as you become more familiar with it and see how it fits into your life, it becomes just another part of your routine, and you barely notice it. Similarly, adjusting to intimacy with a colostomy takes some time and confidence, but with reassurance and practical steps, it can become a seamless part of life again.

To support Mr. Taylor's adjustment to intimacy with a colostomy, Nurse Elena should address both physical and emotional concerns. Key points include:

• Encourage open communication with his partner about his feelings and the changes after surgery to foster understanding and support.
• Provide practical tips, such as emptying the pouch before sexual activity and using smaller, low-profile colostomy bags for discretion.
• Reassure Mr. Taylor that many individuals with colostomies maintain healthy and satisfying intimate relationships.
• Discuss the potential for temporary emotional challenges, such as concerns about body image, and offer resources such as counseling or support groups if needed.
• Educate him about the importance of waiting until the surgical site has fully healed and consulting his surgeon or healthcare provider if he has specific concerns.

✘Incorrect answer options:

The surgery may temporarily reduce sexual desire. While emotional and physical recovery after surgery may temporarily affect libido, this response does not address Mr. Taylor’s primary concern about resuming sexual relationships. It also risks discouraging him rather than promoting adaptation.

Sexual activity should be avoided for a few weeks. This is only partially correct but incomplete. While sexual activity should be delayed until the surgical site has healed (usually a few weeks), this response does not provide the reassurance that Mr. Taylor can resume normal sexual activity after recovery.

It is important to inform your partner about the surgery before engaging in intimacy. While open communication with a partner is important, this response places the focus solely on his partner's reaction rather than providing reassurance and addressing Mr. Taylor’s concerns about his own ability to engage in sexual activity.

EXPLANATION

✔Correct answer:

Stop the irrigation by clamping the tubing. If the client reports severe cramping during colostomy irrigation, the first action Nurse Jenna should take is to stop the irrigation by clamping the tubing. Severe cramping indicates that the irrigation fluid is likely flowing too quickly, causing the bowel to spasm. Stopping the flow allows the bowel to relax and helps alleviate the discomfort. Once the cramping subsides, the nurse can resume the irrigation at a slower flow rate to prevent recurrence.

This intervention prioritizes the client’s comfort and safety by addressing the immediate source of the problem. Restarting the procedure without adjusting the flow or monitoring for further discomfort could exacerbate the issue.

Imagine filling a balloon with water. If the water flows in too quickly, the balloon becomes overstretched, causing discomfort. Stopping the flow gives the balloon time to adjust, just as clamping the tubing allows the bowel to relax and adjust to the irrigation process.

After stopping the irrigation and alleviating the client’s discomfort, Nurse Jenna should take additional steps to ensure the procedure is completed safely:

• Assess the water temperature, as cold water can also cause cramping. Use lukewarm water to minimize bowel spasms.
• Check the height of the irrigation bag; it should be no more than 18-20 inches above the stoma to prevent excessive flow pressure.
• Resume the irrigation at a slower flow rate once the client’s cramping has resolved.
• Encourage the client to take slow, deep breaths to help relax the abdominal muscles and reduce discomfort during the procedure.
• Educate the client that mild cramping can occasionally occur and that stopping or slowing the irrigation can help resolve the issue.

✘Incorrect answer options:

Slow the irrigation to a reduced flow. This is incorrect because severe cramping requires the immediate cessation of irrigation. Slowing the flow may be appropriate after the cramping subsides, but it is not the first action to take.

Reassure the client that cramping is normal and will pass. This is incorrect because while mild cramping may occur during irrigation, severe cramping should not be ignored. Simply reassuring the client without addressing the cause of the cramping could delay appropriate intervention and worsen the discomfort.

Contact the physician for further guidance. This is incorrect because severe cramping during colostomy irrigation is typically resolved through nursing interventions, such as stopping or slowing the irrigation. Contacting the physician is unnecessary unless the cramping persists or is accompanied by other signs of complications, such as bleeding or obstruction.

EXPLANATION

✔Correct answer:

Disturbed body image. A colostomy can significantly impact a client's perception of their body, leading to feelings of embarrassment, loss, or self-consciousness. "Disturbed body image" is a priority nursing diagnosis for postoperative care because it addresses the psychological and emotional challenges the client may face as they adapt to life with a colostomy. This diagnosis focuses on helping the client come to terms with their altered body structure, regain confidence, and develop coping strategies for their new reality.

A colostomy is visible and can affect how a client feels about themselves, especially in social or intimate settings. Providing education, emotional support, and practical strategies for managing the colostomy can help the client improve their body image and overall quality of life.

Imagine getting a scar on your face that you feel others will notice right away. You might feel self-conscious or even avoid social interactions until you learn how to feel comfortable again. Similarly, a client with a new colostomy may initially struggle with how their body looks and functions, but with support, they can regain confidence.

Addressing disturbed body image involves both education and emotional support. Nurse Carla should include the following in the care plan:

• Provide reassurance that many clients successfully adapt to life with a colostomy, and highlight examples of others who lead fulfilling lives.
• Encourage the client to express their feelings and concerns about their body image, and listen without judgment.
• Teach the client how to care for their colostomy, including managing odors and preventing leaks, to boost their confidence in social situations.
• Offer resources such as support groups or counseling to connect the client with others who have experienced similar challenges.
• Involve the client’s partner or family in education to foster understanding and provide emotional support at home.

✘Incorrect answer options:

Sexual dysfunction. While sexual dysfunction may occur for some clients with a colostomy due to altered body image or physical changes, it is not typically the priority immediately after surgery. Sexuality concerns can be addressed as part of long-term adaptation once the client has adjusted to their new body and colostomy care routine.

Fear related to an unfavorable prognosis. This diagnosis may apply to clients with terminal or life-threatening conditions, but it is not a primary concern for most clients undergoing colostomy creation unless the surgery is directly linked to a poor prognosis, such as advanced cancer.

Imbalanced nutrition: more than body requirements. This is not relevant in the immediate postoperative period for a client with a colostomy. Nutritional concerns for colostomy patients are usually focused on ensuring adequate hydration, preventing malnutrition, or identifying food intolerances rather than addressing excessive intake.

EXPLANATION

✔Correct answer:

Approximately 3-4 inches. During colostomy irrigation, the colostomy tube or catheter should be inserted approximately 3-4 inches into the stoma. This depth ensures that the irrigation solution reaches the bowel effectively without causing trauma to the stoma or intestinal wall. Inserting the tube too shallowly may lead to ineffective irrigation, while inserting it too deeply increases the risk of bowel injury or discomfort for the patient. Using lubrication on the catheter tip and inserting it gently are essential to ensure patient safety and comfort.

Proper insertion depth is a key component of effective irrigation, as it helps promote predictable bowel movements and reduces complications such as incomplete evacuation or bowel irritation.

Think of the colostomy tube like a straw inserted into a juice box. If you push the straw too far, it could damage the box, and if you don't push it far enough, you won’t reach the juice. The correct depth ensures the tube functions effectively and safely.

To ensure safe and effective colostomy irrigation, Nurse Laura should follow these key practices:

• Lubricate the catheter tip with a water-soluble lubricant to minimize friction and prevent trauma during insertion.
• Insert the colostomy tube gently to a depth of 3-4 inches, stopping immediately if the patient experiences resistance or pain.
• Ensure the irrigation solution is at body temperature to avoid cramping or bowel spasms.
• Monitor the patient for any signs of discomfort, bleeding, or unusual resistance during the procedure, and stop if complications arise.
• Provide patient education on proper technique, including the importance of correct insertion depth, for independent irrigation at home.

✘Incorrect answer options:

About 1-2 inches. This is incorrect because inserting the tube only 1-2 inches would be too shallow. It would not reach the bowel adequately, leading to ineffective irrigation and incomplete evacuation.

Between 6-8 inches. This is incorrect because inserting the tube 6-8 inches is too deep and could cause trauma or irritation to the bowel, increasing the risk of complications.

Around 12-18 inches. This is incorrect because inserting the tube this deeply would be dangerous and could lead to severe bowel injury. Such depth is far beyond what is needed for colostomy irrigation.

EXPLANATION

✔Correct answer:

Administering neomycin sulfate on the evening prior to surgery. Administering neomycin sulfate or another bowel preparation antibiotic prior to surgery is a standard measure to reduce the bacterial load in the bowel and lower the risk of postoperative infection. Neomycin is often combined with a mechanical bowel preparation, such as a clear liquid diet and laxatives, to clean the bowel and minimize contamination during the surgical procedure. This step is particularly important for surgeries involving the colon, such as an abdominal perineal resection with a permanent colostomy.

Neomycin works by killing gut bacteria that could otherwise enter the bloodstream or surgical site during the operation, helping to prevent complications like peritonitis or sepsis. Nurse Carla should also explain the purpose of this medication to ensure Mr. Johnson understands its role in his preoperative care.

Think of the bowel as a road with debris (bacteria) that could cause problems during construction (surgery). Neomycin acts like a street sweeper, clearing away the debris to make the area safer for the construction team.

Preoperative care for Mr. Johnson should focus on reducing infection risk and preparing him physically and emotionally for surgery. Key interventions include:

• Administer preoperative antibiotics like neomycin sulfate as prescribed to reduce bacterial load in the bowel.
• Ensure the patient follows the bowel preparation plan, which may include laxatives, enemas, and a clear liquid diet 24–48 hours before surgery.
• Keep the patient NPO (nothing by mouth) after midnight the night before surgery to reduce the risk of aspiration during anesthesia.
• Provide preoperative education about the procedure, expected outcomes, and colostomy care to reduce anxiety and promote understanding.
• Assess the patient’s physical and emotional readiness for surgery and address any concerns or questions.

✘Incorrect answer options:

Keeping the patient NPO for 24 hours before surgery. This is incorrect because patients are typically kept NPO starting after midnight or 8–12 hours before surgery, not 24 hours. Prolonged NPO status can lead to dehydration and electrolyte imbalances.

Explaining that total parenteral nutrition will likely be needed post-surgery. Total parenteral nutrition (TPN) is generally not required after an abdominal perineal resection unless the patient experiences complications such as poor wound healing, prolonged ileus, or severe malnutrition. Most patients will resume oral intake gradually as bowel function returns.

Advising the patient to significantly reduce physical activity. This is incorrect because maintaining physical activity within the patient’s tolerance is encouraged to support overall health, reduce the risk of complications like deep vein thrombosis, and promote faster recovery postoperatively. Physical activity should not be reduced unless contraindicated.