Ostomies (20 Questions)

1. You are overseeing a patient who has undergone a rectosigmoid resection, resulting in a stoma with an ostomy bag for fecal diversion. Recently, infection control has alerted your healthcare facility about a Vancomycin-resistant Enterococcus (VRE) outbreak. They recommend performing rectal swabs on all patients to identify carriers of VRE.

Question:
Will you perform the rectal swab? *
2. A patient who recently had a stoma placed in the upper right quadrant of his abdomen, is feeling concerned about his condition. During your rounds, he asks, "Why are my stools always liquid now? He appears anxious and worried about this change.

Question:
What is the most appropriate explanation to give the patient? *
3. A patient diagnosed with new-onset Crohn's disease has recently undergone surgery and had an ileostomy placed. A few weeks after the surgery, the patient returns for a follow-up appointment. During the visit, he mentions that he has resumed his running routine and is looking for suitable snack options to incorporate into his day. The patient states, "I've started running again, and I need some snack recommendations to keep me energized throughout the day."

Question:
What advice do you give him? *
4. You are a nurse on the surgical floor taking care of a patient named Jean-Claude, a 67-year- old man of French origin, who had a colostomy placed yesterday due to colorectal cancer. He is recovering well but has been a bit anxious about the changes to his body. While you are attending to another patient, Jean-Claude uses the call light to get your attention. When you arrive, he tells you that his surgical dressing has fallen off and he is unsure what to do.

You assess the stoma, noting that it appears healthy with no signs of excessive redness, swelling, or drainage. The skin surrounding the stoma looks intact.

Question:
You will re-apply what type of dressing over the stoma? *
5.1 You are caring for Mr. Jean-Pierre Martel, a 68-year-old patient with a medical history of type 2 diabetes, peripheral vascular disease, and a permanent ileostomy following surgery for ulcerative colitis. The physician has written a new order:
Aspirin EC 81 mg PO daily.

As you prepare to administer the medication, you review the patient's history and consider the implications of his ileostomy.

Question:
What is your next nursing action? *
5.2 Mr. Martel expresses concern about applying the wafer correctly and avoiding skin irritation. He asks, “How do I know where to cut the hole in the skin barrier so it fits properly?”

Question:
Which teaching is most appropriate when applying the stoma barrier (wafer)? *
5.3 Later in the shift, while checking Mr. Jean-Pierre Martel's ileostomy pouch and peristomal skin, you notice a concerning change. The stoma, which had previously appeared moist, pink, and healthy, now looks dark purple and slightly dry. Mr. Martel reports no pain at the site but appears concerned, asking, “Is it supposed to look like that?”

You quickly perform a full stoma assessment and check his vital signs. His BP and heart rate are within normal limits, and he is afebrile. Output from the stoma is present, though slightly decreased compared to the last measurement.

Question:
What do you suspect is happening, and what is your initial nursing intervention? *
6. Mr. Boucher, 45, is post-operative day 3 following emergency surgery for ulcerative colitis, resulting in a right lower quadrant ileostomy. You observe that his pouch has filled twice in the last three hours, producing 1,200 mL of thin, greenish output since the morning. He reports dizziness and dry mouth. His vital signs: BP 92/60, HR 112, and mucous membranes are dry.

Question:
What is the priority nursing action? *
7. Ms. Dubé, 66, has a descending colostomy following surgery for diverticulitis. On post-op day 4, she reports no stool output for 48 hours and increasing abdominal cramping. Her abdomen is mildly distended but soft. She denies nausea. Her stoma appears moist and pink.

Question:
What should the nurse do first? *
8. Mr. Thomas, 58, is on post-op day 2 after creation of a sigmoid colostomy. During assessment, you observe the stoma appears dusky, bluish, and cool to touch. He reports mild abdominal pain but no nausea.

Question:
What is the priority action? *
9. Mrs. Clément, 71, has a left-sided colostomy placed one week ago. During your care, she reports frequent leaks from her pouch and severe skin irritation around the stoma. The peristomal skin appears red, painful, and excoriated.

Question:
What is the most appropriate intervention? *
10. Ms. Lajoie, 54, is learning how to care for her new ileostomy. She appears anxious and states, “I’m scared I’ll hurt myself when removing the pouch.” You observe that her technique involves pulling the skin away quickly, causing discomfort.

Question:
What teaching should the nurse prioritize? *
11. Mr. Corriveau, 39, has had an ileostomy for Crohn’s disease for two years. Today he presents with minimal output, abdominal cramping, and a sensation of fullness. His stoma is swollen but pink, and he has not eaten anything unusual.

Question:
What is the best initial nursing intervention? *
12. Ms. Trudel, 28, is discharged after surgery that resulted in a new ileostomy. She reports discomfort and reduced output over the past 24 hours. She tells you, “I ate popcorn and celery sticks yesterday. They’re my comfort foods.”

Question:
What is the most important teaching point? *
13. Mrs. Gagné, 70, with a sigmoid colostomy, reports seeing “a little blood” on the tissue when cleaning her stoma. Upon inspection, the stoma is red, moist, and bleeds slightly when touched. There is no active bleeding.

Question:
How should the nurse respond? *
14. Ms. Fillion, 52, is recovering from surgery leading to a permanent colostomy. She tells you, “I don’t even want to look at it. I feel like my life is over.” She avoids participating in ostomy care and cries frequently during discussions.

Question:
What is the nurse’s priority intervention? *
15.1 Mr. Badour, 46 years old, had a bowel resection with colostomy placement yesterday. When you enter his hospital room, you observe that his meal tray is upside down on the floor. He is sitting at the edge of the bed, with clenched fistsresting on the bedside table near a jug of water. He appears flushed, is breathing noisily, and coughs twice. His ostomy bag is on the floor, indicating possible self-removal or dislodgement.

When he sees you, he says angrily:
“Get out of here right now. Leave me alone. Like my wife, who just left.”

Question:
What is the most appropriate therapeutic response? *
15.2 Three days have passed since Mr. Badour’s emotional outburst. His physical condition is now stable, and there are no signs of postoperative complications. Today, during your routine care, Mr. Badour shares:

“I’m still nervous about it, but I hope I’ll be able to take care of this ostomy on my own someday.”

He seems calmer, makes eye contact, and engages in the conversation more willingly. You recognize this as a sign that Mr. Badour is becoming more open to discussing his care and future independence.

Question:
What aspect will you explore further with Mr. Badour now? *
15.3 It’s now postoperative day 5, and Mr. Badour has made significant progress since his surgery and initial emotional distress. He has begun participating more actively in his care and expresses interest in managing his colostomy at home. He has also been practicing with the ostomy equipment under nursing supervision, and his vital signs, labs, and physical assessment findings are stable.

Today during your assessment, you are preparing for discharge planning and must determine whether Mr. Badour is ready to transition home safely and with confidence.

Question:
How will you know that Mr. Badour is generally ready for discharge with his new colostomy? *
16. Mr. Hamel, 63, returns to clinic 3 weeks after his colostomy surgery. The stoma appears retracted below skin level, making it difficult for the pouch to adhere properly. He reports frequent leaks and skin redness.

Question:
What is the most appropriate intervention? *