Question

a) What instructions would the nurse give to a patient when it is necessary to collect a stool
specimen for analysis?
b) What aids are available to assist clients to eliminate when they cannot use a bathroom?
Describe when each would use.
c) Identify the types of fecal and urinary diversions. (ostomies)
d) Explain the differences in color and consistency of effluent based on the type of ostomy.
e) Describe methods used to maintain the integrity of the peristomal skin.

Answer 1

A. The instructions that the nurse should give to a patient when it is necessary to collect a stool specimen for analysis are :-

A: Obtain specimens from three different stools.

B: The three specimens must be taken from three separate, consecutive bowel movements.

B. Some patients or residents may not be able to get out of bed at all or they may be too weak or ill to walk to the bathroom. these people may need to use:

-bedside commodes

-bedpans

-urinals

1. elimination equipment: bedside commodes

the bedside commode consists of a chair frame with a toilet seat and a removable collection bucket

for a person who is able to get out of bed but who is not able to walk to the bathroom, a bedside commode can make toileting easier

2. elimination equipment: bedpans

a bedpan is used for elimination when a person is unable to get out of bed at all

a woman who cannot get out of bed uses a bedpan to urinate and for bowel movements; a man who cannot get out of bed uses a bedpan for bowel movements, and a urinal to urinate

3. elimination equipment: fracture pans

arthritis can make using a bedpan very painful, as can fractures of the back or legs

in such cases, when using a bedpan is uncomfortable or dangerous, a special bedpan called a fracture pan is used

the fracture pan is wedge-shaped and placed underneath the person's buttocks with the thin edge toward the person's back.

C. Urinary Diversion :-

Surgical rerouting of urine from kidneys to a site other than the bladder.

- Incontinent Urinary Diversion

Clients have no control over the passage of urine and require the use of an external ostomy appliance to contain the urine.

- Continent Urinary Diverson

Gives clients control over the passage of urine either by intermittent catheterization of the internal reservoir or by strained vioiding.

1. Ileal conduit

use for incontinent urinary diversion. A segment of ileum is connected with ureters.

2. Koch pouch

use for continent urinary diversion where portion of the ileum is use to form a reservoir for urine.

3. Neobladder

replaces a diseased or damaged bladder with a piece of ileum and attached to the urethra

#. Fecal diversion :-

- Illeostomy

Origin of stoma is in ileum, entire colon is damaged, pouch is on right side, stool is liquid, stoma is small, less odor

- Colostomy

Origin of stoma is in colon, depends on location of bowl damage, stool is more solid, more odor

Transverse: middle

Sigmoid: left side

- End colosomy

Proximal bowel sewn to abdominal wall to create a stoma, distal bowel is oversewn to create a Hartmann's pouch

- Transverse loop colostomy

Rod is placed under stoma, has 2 ends, bowel will be replaced back into cavity

E. Methods used to maintain the integrity of the peristomal skin are :-

- proper dressing and irrigation

- proper pouch care

- proper hydration and diet