Hi guys, it's me Professor D and welcome back to my YouTube channel. On this video, we're going to be covering care of the patient with an ileostomy. Before we get started, as always, I'm going to ask you to please support me and support this channel by liking the video. You're going to love it, so go ahead and give it a thumbs up now.
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All right, guys, let's get started. So the first question, it says the nurse in the outpatient GI clinic is teaching a patient how to care for his new ileostomy. The patient asked the nurse how long he should wear the patch before changing it. What instructions should the nurse provide?
A, the pouch should be only changed when it leaks. B, you can wear it for about four to seven days. C, it should be changed every morning.
Or D, it should be changed every night. What do you guys think the answer is? And guys, the correct answer is B. You can wear it for about four to seven days before it needs to be changed. Now, obviously, guys, that's if there's no leaking.
If it's leaking, you're going to have to change it earlier. But outside of that... just generally speaking, it should be changed about every four to seven days.
Now let's look at the wrong answer choices. A, the PAU should only be changed when it leaks. What is the one word in this question to make you know most likely this is not the correct answer?
Only. Remember what I taught you about staying away from all-inclusives. If you don't know what the answer is but you see the answer includes the words like only, always, never, stay away from them, that most likely is not your answer.
Now C and D, it should be changed every morning and it should be changing every night. Both of those are wrong because again unless there's something like a leakage or something's wrong it's going to be changed every four to seven days. Now let's say you had no idea what the answer was.
And when I say no idea, not even a clue. In that case, you would try to look for two options that are either the opposite or almost the same, but one thing is different, right? So if you had no idea what the clue was, you take a chance.
You have to guess anyway. You'd be guessing between C and D. In this case, C and D are both wrong.
But very often when it comes to testing, if you have no idea what the answer is and you and you see something like that are like two opposites, and you're going to take your chance to choose the answer anyway, because you have no idea what the answer should be, a good rule of thumb is just choose something that are two opposites just to try to increase your chances, but it doesn't always work. All right, next question. It says a 32-year-old patient scheduled for an ileostomy.
Which is the best action in preparing the patient psychologically for the surgery or the procedure? A, involve family members in the pre-op teaching sessions. B, urge the patient to talk about questions or concerns. C, provide Provide a short but thorough explanation of all pre-op and post-op procedures.
Deinstruct the patient that having an ileostomy is a predisposition to infertility. And guys, the correct answer is going to be... What is the correct answer? Let me look at the choices. The correct answer is C, provide a short but thorough explanation of all pre-op and post-op procedures.
Why? The question is asking us, how do we help the patient? What?
Psychologically. So the patient's going to have fears. They're going to have anxiety.
What is the best way to relieve those fears and anxiety? By educating the patient. So you're going to educate them about everything that's going to be done pre-op before and post-op after.
Why aren't you going to educate them about what's going to be done during the surgery? because you'd be stepping outside of your scope of practice, right? That's informed consent. And when you're getting informed consent, it's a surgeon that has to explain everything that's going to happen during surgery.
What could possibly go wrong? Complications that can happen. That's the job of the surgeon. Your job is to just witness and make sure the patient has informed consent.
So you're not going to be telling them in depth what's going to happen during the surgery, but you absolutely can tell them in depth what to expect before surgery and after surgery. So that's why that... that's the correct answer choice.
Now let's look at the wrong choices. We have A, involve family members in pre-op teaching sessions. This is a beautiful thing to do. This is absolutely correct as far as nursing intervention, but it doesn't answer our question. It doesn't answer the question about how to help prepare the patient psychologically before the procedure.
The reason you want to teach family members and get them involved is because that increases the likelihood likelihood of, what's the word I'm looking for? Compliance. So you want to get family members involved as long as that's okay with the patient.
You want to teach them because it increases the likelihood of compliance. But it really doesn't answer the question that we have, which is how do we help prepare them psychologically? The second option, urge a patient to talk about questions or concerns.
That is beautiful. That is absolutely a nursing intervention we're going to do where we want to have a therapeutic. therapeutic communication.
We want to know what the patient's thinking. We want them to ask questions. But again, this is not the answer.
This is not the best answer for preparing the patient psychologically. And last... I literally can't even with you.
Look at what it says. It says instruct the patient that having an ileostomy is a predisposition to infertility and that's just absolutely false. It doesn't cause you to be infertile.
That's false. So the correct answer, guys, again, is you want to provide a short, because listen, the reason is short. If you go long and in depth, the more that you're talking, the more you're making that patient nervous.
So short, but thorough. Where was it? Short, but thorough explanation of what's going to happen before and after, because you want to decrease that patient's fear, educate them. Educating the patient is going to decrease the fear and anxiety that they may have. Next question.
Which instructions should the nurse provide to the patient who's scheduled for an ileostomy in two weeks? A. Cease use of all drugs that interfere with clotting.
B. Follow a low-residue diet. C. Avoid sexual relations.
D. Notify the healthcare provider for any temperature above 98 degrees Fahrenheit. And the correct answer is A, cease use of all drugs that interfere with clotting. Now, normally, under normal circumstances, we hate all-inclusives.
We stay away from them. We don't like answers that say only, always, never, all. We stay away from them, generally speaking.
But guys, if you've learned anything in the nursing programs, they're... is always an exception to the rule. That's why in nursing, you have to use critical thinking. You can't just stick yourself into a box, right?
And this is one of the exceptions to the rule because this answer has the word all in it and it's still the answer. Yeah. And here's why. I want you to think about it. It says that, let me go back to the question.
It says that the patient's about to have surgery in two weeks. What do we know about surgery? Any invasive procedure that patient has?
We're going to be concerned. about these three things. Always, we're going to be concerned about infection because there's a chance of us introducing pathogens into that patient's body.
We're going to be concerned about hemorrhage, right? Because they may bleed out. This is an invasive procedure and we're going to be concerned about the patient developing a DVT or pulmonary embolism. With that being said, they're about to have surgery. Do you think it's a good idea for them to take anything that can cause them to bleed when they're already going to be at risk for hemorrhage?
that's we're going to be concerned about that of course we don't want them to take those kind of things so we're going to tell them to stay away from alcohol we're going to tell them about those um drugs that can cause a hemorrhage you know the anticoagulants um ibuprofen, aspirin, hep, all those things a patient's going to be taking, they're going to stop taking before the procedure. Now, the exact timeframe they're going to stop taking it before the procedure, the healthcare provider will specify that, but you have to let the patient know that it's very important that they do stay away from those drugs that can cause bleeding because they're already going to be at risk for bleeding from the procedure. Now let's look at the wrong answer choices.
B, follow a low residue diet. No, they're going to need a high residue diet and increased fluids. We don't want them constipated.
They're going to have increased fluids and high fiber. C, avoid sexual relations. That's not necessary. And D, notify healthcare provider for any temperature above 98 degrees, really anything above 99.9, because that's where we're becoming, that's where we're getting into the infection territory, right?
So above... 98, that's still normal, but above 99.9, that's when we're concerned. We're going to be like, yeah, you need to notify the healthcare provider, let us know, because there may be an infection or infectious process that's happening.
Which goal has the highest priority immediately after surgery for the creation of an ileostomy? A, prevention of constipation. B, assistance of ADLs. That's your ADLs.
What does ADLs stand for? Activities of daily living. C, maintenance of fluid electrolyte balance.
Or D, minimization of odors. Which one's going to be a priority? And the correct answer is C, maintaining fluid and electrolytes. Whenever you're asked about a priority, you always have to think about what will kill my patient the fastest or keep them alive the longest.
So when it comes to priority, you're thinking about anything that affects the patient's physiological status, abnormal vital signs, abnormal ABCs, abnormal fluid electrolytes, um, abnormal... Symptoms such as symptoms that could cause dehydration, right? What else? Hypoglycemia, signs and symptoms of MI, seizures, anything that physiologically affects that patient's physiological status, that's going to be your priority. And when we look at the choices here, it's fluid and electrolytes.
Guys, let me be specific. Not only fluids and electrolytes, when it comes to, let's say you had a test question and they gave you different fluids and electrolytes, which one? would you be most concerned about? Always, it's going to be abnormal potassium first and then sodium, right?
So your potassium level is 3.5. I'm going off on a tangent. Don't worry about that.
Your potassium normal is 3.5 to 5. Anything outside of that, either higher or lower, patient's going to be at risk for cardiac dysrhythmias. And sodium is 135 to 145. Anything outside of that, patient can have seizures, all types of issues. So when you're thinking of priority, those are the things you should be thinking about. Of course, maintenance of fluid and electrolyte balance. That's going to be important because think about it.
The patient has an ileostomy. They are constantly draining liquid to semi-liquid stool, right? They're losing that liquid. It needs to be replaced. They're losing fluids and electrolytes through that stool.
It needs to be replaced. Now, let's look at the wrong answer choices. A, prevention of constipation. The patient with an ileostomy, again, they're going to have continuous stool or at very frequent intervals at the least of liquid or semi-liquid stools. We're not really going to be too concerned about constipation.
B, assistance of ADLs. We want the patient to be as independent as possible. We encourage independence.
D, minimization of odors. Well, minimization of odors, that's good, but that's going to be done through the diet to help minimize the odor. So the correct answer and what's going to be the priority, because that's what could kill you the fastest out of the list that we've been given that we're looking at is going to be the fluid and electrolytes.
The nurse is providing education to a 23-year-old female patient with a new ileostomy. During the teaching session, the patient begins to cry and states, now that I have this on my stomach, I won't be able to have kids anymore. Which response by the nurse would be most appropriate?
A. Don't worry. Many women with ileostomies decide to adopt or have a surrogate.
Would you like to discuss your options? B. The presence of an ileostomy does not necessarily mean that you cannot get pregnant or bear children.
Let's discuss your concerns. C. You seem Excuse me, C, I see you're upset. I would like to hear more about your concerns. D, you seem quite upset.
The situation requires some adjustment. I'll ask the healthcare provider for a referral for outpatient counseling. Which answer would you choose?
And the correct answer is B. The presence of an ileostomy does not necessarily mean you cannot get pregnant or bear children. Let's discuss. your concerns.
So not only are you clarifying this misconception that that patient has, you're also providing them an opportunity to discuss their fears, their anxiety, and just to talk further. Let's look at the wrong answer choices. A, don't worry.
Stop right there. Do we ever say don't worry or why did you to a patient? Absolutely not, right?
That is a barrier to therapeutic communication. Um, C, I see you're upset. That's beautiful. You're making an observation. Let's keep going.
This situ, um, I would like to hear more about your concerns. That is beautiful. Matter of fact, if the correct answer choice of B was not here, that would have been your answer. But the reason we went with B instead of C is because B also, um, gives information because this patient has.
an untrue understanding or a thought that's not correct. So B not only acknowledges the patient's concern, but it also addresses it with the truth. But if B was not here, we would have went with C.
C is the second best answer. It's just not the best answer. And then D, you seem quite upset. That's beautiful. That's an observation.
That's therapeutic communication. Let's keep going. The situation requires some adjustment. The adjustment would be you clarifying the thoughts that they have that's not true.
Let's keep going. I'll ask the healthcare provider for a referral. Why are we passing the buck? When it comes to these test questions, you don't ever pass the buck on something you can do yourself.
You can give the patient correct information. What are you passing the buck on to the healthcare provider for? Absolutely not.
So that's why B is the correct answer choice. Which nursing intervention would be most appropriate for a patient who has questions about leading a normal life after an ileostomy? A, invite the facility chaplain to discuss concerns with the patient. B, encourage the patient to avoid the troublesome thoughts regarding the ileostomy. C, invite a person with an ileostomy or ostomy to visit the patient before surgery.
Or D, notify the healthcare provider of the patient's concerns. And the correct answer is C, have someone who's already had that procedure visit with the patient. Who would be better to ask questions about how they adjusted their life after the surgery and setbacks or things that they thought they couldn't do or that they could do?
Who better than somebody who else who's experienced it? So that's the correct answer. Look at A, invite the facility chaplain. The facility chaplain is not going to be able to give the information that the patient's asking about.
Choice B, you never encourage a patient to just avoid thinking about certain things. You want open communication. That's not therapeutic, so we're not choosing that. And then D, again, why are you passing the buck?
Why are you passing the buck on something that you can absolutely address? So D is not the correct answer. We're going with C. It's been several weeks since the patient had surgery for the creation of an ileostomy.
Which finding would cause the nurse to conclude that the skin barrier has been applied correctly? A. The stoma is void of odor. B.
The patient exhibits no signs or symptoms of dehydration. C. There's no skin irritation around the stoma. D.
The patient changes the ostomy pouch daily. And guys, the correct answer is C, no irritation around the stoma. Again, the question is asking us, how do we know that the skin barrier has been applied correctly?
What does the skin barrier do? It protects the skin around the stoma. So duh, the answer is C. Look at A, the stoma is void of odor.
That would be wonderful, but again, that odor is controlled by what? Diet. Choice B, the patient exhibits no signs of symptoms of dehydration.
That's wonderful, but that has nothing to do. with that skin being protected. We want them to avoid dehydration.
That's why we tell them to increase fluids, but it has nothing to do with that skin around the stoma being protected. And then choice D, the patient changes the ostomy pouch daily. They're not supposed to change that ostomy pouch daily.
It gets changed every four to seven days, unless there's a leak, then you change it earlier. So that's why C is the correct answer choice. The nurse has just received a report on four patients with ileostomies. All of them have ileostomies. Which patient should the nurse assess first?
A, liquid stool seeping from the stoma. B, presence of undigested food in the pouch. C, no drainage from the pouch in the last five hours.
Or D, a temperature of 99.7. And the correct answer is C. No stool draining from that pouch in five hours? That's a problem. What are we suspecting?
Obstruction. You're going to notify the healthcare provider immediately. This patient might have to go back into surgery.
Now look at the wrong answer choices. A, liquid stool seeping from the stoma. That's what we expect because it's an ileostomy, the location. That patient's going to have either liquid or semi-liquid stools at very frequent intervals, if not continuously.
Choice B, presence of undigested food in the pouch. Again, because of the location. That's not uncommon. You very well may see that. And then D, temperature of 99.7.
It's lower than 99.9. Remember, we want to report if it's 99.9, higher than 99.9, that's when we're concerned about infection, right? So the correct answer choice is C.
The nurse is providing discharge instructions about ileostomy care. Which patient statement indicates understanding? A, I can resume weightlifting in two weeks. B, I can go back to work in two weeks. C, I should drink at least three liters of fluid daily.
Or D, I will keep my stoma dry at all times. And the correct answer is three. Three. C, lots of liquids.
Three liquids. I can't speak. This is so annoying. I'm sorry. If you're new to my channel, I do this a lot.
I have a speech impediment and so it's very hard for me to get my words out. It's all in my brain, but sometimes I have difficulty getting it out of my mouth. So let me repeat that. Drinking three liters of fluids daily. And the reason that this is so important and the patients at risk for dehydration is because they're continuously draining this liquid or semi-liquid stool from the pouch.
And so that fluid... has to be replaced. Wrong answer choices.
Look at A and B. I can weight lift or I can work in two weeks. No, that's too early. It's going to take several weeks.
Not two. That's too early. And then choice D, I'll keep...
Really? I'll keep my stoma dry at all times. How are you going to keep that stoma dry at all times when it's continuously draining? How? And even if you're thinking about, okay, keeping it dry, not getting it wet, it getting wet in the bath shower, it getting wet, that's not going to harm the stoma.
So that's false. And we're down to our last question. A patient with an ileostomy that has been well managed is reporting sudden stomach cramps, vomiting, and watery discharge from the stoma.
What's the most appropriate nursing intervention? A, provide an anti-emetic agent. B, encourage the patient to increase fluid intake and avoid dehydration. C, encourage the patient to drink milk of magnesia to promote evacuation of the bowel.
Or D, notify the healthcare provider. And the correct answer is D, notify the health care provider. Look at the symptoms.
First of all, sudden. The first time you see sudden, you should have red flags, right? If it says sudden and whatever comes after the word sudden is not a good thing, this is something acute that's happening, we're going to be concerned.
This patient's having sudden stomach cramps, vomiting, watery discharge. We should suspect obstruction. You're going to notify the health care provider right away. And most likely that patient's what? Going into surgery.
Choice A, provide an anti-medic, not until they've been seen by the doctor, the healthcare provider. We're not giving them anything. They're not taking anything by mouth because they might be going back into surgery.
We're suspecting an obstruction. B and C would make it worse. We're not giving them any fluids if they have an obstruction. We're not giving them milk of magnesia if there's an obstruction. The only correct answer choice, guys, is D.
Before I end this video, I just wanted you guys to know, if you didn't know this already, I've kind of made the announcement on a couple other videos, but I know I'm constantly getting new viewers. Very shortly, very shortly, you're going to see the announcement or hear about the announcement from my company. I will be coming out with a Nexus Nursing Test Bank very shortly. And these questions are not questions that you get from NCLEX, but they're going to be the type of questions.
that you may see on NCLEX, right? So similar, but not the same. Let me clear that up.
Not the same, but very similar, right? So if you're preparing for NCLEX, this test bank that I have that's going to be rolling out soon, I would encourage you to go ahead and sign up so you can start practicing those kind of type of questions. It gives you an idea of the kind of...
subjects and content that NCLEX expects you to know. And so what I'm going to do to roll this out, I'm going to be giving away 50 memberships, about 25 for LPN students and 25 for RN students. And with those students that I give away those memberships, I'm going to meet with you once a week.
I want to go over the questions that you got, anything that you need clarification. You're kind of going to be my beta testers. Anything you need clarification on, anything you're struggling with. and you'll um have that opportunity pick my brain about anything even if it has nothing to do with that uh bank anything you've been struggling with if you need some advice you'll be meeting with me so that'll be the great opportunity i'm not sure how i'm going to do it's going to be like a contest but i'm just not sure how i'm going to make that contest yet i'm still thinking about it but if you have any ideas go ahead and drop that in the comments section about uh what you think the contest should be go ahead drop that in the content comment section because I'm absolutely open to ideas. This is the first time that I've ever done anything like this.
I'm nervous, but I'm very excited. I love the fact that I have a platform and I can reach so many nursing students. This is my passion. This is what I love to do. So I'm very excited about this.
Go ahead and drop a comment or idea in the comment section. Again, guys, I've got lots of resources available for you on my website. Be sure to check that out.
NexusNursingInstitute.com. And with that, guys, you guys catch me on the next video.