Urostomy
What is a Urostomy Bag and what are the reasons someone has one?
Urostomy pouches are special bags that are used to collect urine after some types of bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen.
Stomas are surgically created for conditions that include bladder cancer, damage to the nerves that control the bladder, birth defects, and chronic inflammation of the bladder.
How many types enemas are there?
Name the types?
Tap water
Physiologic
Hypertonic
Harris Flush
Soap suds
Oil retention
Carminative
Newborn (birth -2 days)
pulse rates (Bpm) and Respiration rate (RR)
Pulse: 110/160 min
RR: 30-60 per min
What is the Fundus ?
And location?
Part of an organ that’s the farthest away from the organs opening
The upper portion of the uterus between the fallopian tubes.
What are some considerations with Peds Urostomy bags and care?
Select the correct the peds pouched designed for neonates, infants, children. (smaller)
Include children in ostomy care, as appropriate, encourage independence and acceptance (body image)
What prevents or makes it difficult for a good seal around the Stoma?
A stoma with redness, irritation, soreness or leakage of urine
What is peristalsis?
The involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wave-like movements that push the contents of the canal forward.
Infant ( 2 days to 1 year)
Pulse rate and RR - What are they?
Pulse : 90-160 per min
RR : 25-30 per min
Why is it important to check the Fundus?
To make sure that the uterus is going back to pre-pregnancy.
(Fundal height tells your healthcare provider important things about your baby's size, growth and position in your uterus. It helps confirm that your baby is growing as they should. It can also tell them how much amniotic fluid is in your uterus.)
Which Enema does a pediatric pt usually does not receive?
A pre-packaged hypertonic enema.
Hypertonic solutions cause a rapid shift in fluid. Fleets enema is one of most common brands. This can be used for tests also and for constipation. The enema solutions may contain either Bisacodyl or sodium phosphate, which are both rectal stimulants. The solution is hypertonic and thus, draws fluid into the bowel, softening and loosening the fecal mass.
What are the 2 basic types of pouches?
1- One piece pouch
2- Two piece pouch
Which position do you ask the pt or place the pt in for an enema?
Left side-lying or Sims with the right knee flexed
Toddler (1-3 years old)
Pulse rate and RR - What are they?
Pulse rate : 80-140 min
RR : 25-30 per min
What is Gravida and Para mean?
Gravida- The number of times a woman has been pregnant
Para- A woman who has born offspring who reached the age of viability. (# of times a pt has given birth)
What is Intussusception?
A form of bowel obstruction seen in children.
Small intestine fold “into” itself.
How often do we change the pouch and or Empty the bag?
Pouches are recommended for change daily, every 2-3 days or every week depending on Manufacturer
Empty pouch if it is more than one-third to one-half full
After administering a cleansing enema, the nurse should instruct the patient to retain the solution for this recommended amount of time before expelling it — and if the patient reports cramping during administration, this is the first nursing action.
What is 5 to 10 minutes, and lower the enema bag (or clamp the tubing temporarily)?
Preschooler (3-5 years)
Pulse rate and RR - What are they?
PR : 70-120/min
RR : 20-25/min
What does the term TPAL stand for and its meaning?
Give an example for extra points!
Term- # of full term; births 37 weeks or more
Preterm- # of PT births; less than 37 weeks.
Abortions- includes ectopic, miscarriages, spontaneous abortions, elective abortions, etc.
Living- number of living children.
What is Pyloric Stenosis?
What is a main symptom/sign?
A congenital narrowing of the stomach outlet which obstructs the emptying of the chyme into duodenum.
Vomiting!
This specific segment of bowel, typically 15–20 cm in length, is the preferred conduit in an ileal conduit urinary diversion, and it is isolated approximately 15–20 cm proximal to the ileocecal valve to preserve bile salt and vitamin B12 absorption."
What is Distal Ileum?
The maximum recommended volume for a cleansing enema in an adult is this amount — but when a physician orders 'enemas until clear,' the nurse should not exceed this many administrations without notifying the provider, primarily due to the risk of this fluid and electrolyte complication."
What is 750–1000 mL, no more than 3 enemas, and the risk of fluid and electrolyte imbalance (specifically water intoxication or hyponatremia)?
School aged (6-12 years old)
Pulse rate and RR - What are they?
60-110/min
20-25/ min
A Bishop Score of this number or higher indicates a 'favorable' cervix and predicts a successful induction of labor."
What is 8? (≥8 is considered favorable)
What is the 24h fluid requirement needed for a pediatric client who weight 25kg?
For 24H CALCULATION: 25kg (10+10+5)
1st 10kg = 100mg/kg= 1000
2nd 10kg= 50mg/kg= 500
10kg for balance= 5x 10= 50
Total: 1,550