Bowel and Ostomy Care Flashcards

What is a colostomy?

Answer: A surgically created opening in the colon that allows stool to exit through the abdominal wall

A colostomy is a surgical procedure that creates a stoma (opening) in the colon on the abdominal wall, through which feces are expelled into an external pouching system.

What is an ileostomy?

Answer: A surgically created opening in the ileum (small intestine) that allows liquid stool to exit the abdomen

An ileostomy is a surgical opening in the ileum (end of the small intestine). Output is liquid to semi-liquid and contains digestive enzymes that are very irritating to skin.

A healthy stoma should appear:

Answer: Bright red or pink, moist, and slightly raised above the skin

A normal stoma is pink to red, moist, and protrudes slightly above the abdominal surface. Discoloration (purple, black, or very pale) or retraction indicates problems requiring immediate nurse notification.

Which observation of a stoma requires IMMEDIATE reporting?

Answer: The stoma is dark purple or black

Dark purple or black color indicates the stoma may be losing its blood supply (ischemia or necrosis). This is a surgical emergency and must be reported to the nurse immediately.

The skin around the stoma is called the:

Answer: Peristomal skin

Peristomal skin is the skin surrounding the stoma. It must be kept clean, dry, and protected from effluent because continuous contact with stool or urine causes severe skin breakdown.

Why is it especially important to protect the peristomal skin of an ileostomy?

Answer: Because ileostomy output contains active digestive enzymes that rapidly damage skin

Ileostomy output is liquid and contains proteolytic enzymes (digestive enzymes) that rapidly break down and erode the peristomal skin if they are allowed to contact it.

When should a CNA change an ostomy pouch?

Answer: When it is one-third to one-half full, or when there is a leak

The pouch should be emptied when one-third to one-half full to prevent the weight from breaking the seal. It should also be changed immediately if a leak is detected to protect the peristomal skin.

The CORRECT technique when removing an ostomy barrier (wafer) is to:

Answer: Gently peel it away from skin while supporting surrounding skin to prevent tearing

The barrier should be gently peeled while using one hand to support and protect the surrounding skin. Rapid removal or pulling can cause skin tears, especially in elderly or fragile patients.

When cleaning a stoma during a pouch change, the CNA should use:

Answer: Mild soap or prescribed skin cleanser and warm water, then dry thoroughly

Mild soap or prescribed cleansers with warm water are used to gently clean the stoma and peristomal skin. Alcohol, hydrogen peroxide, and strong antiseptics damage stoma tissue and peristomal skin.

It is normal for the stoma to bleed slightly when cleaned because:

Answer: The stoma tissue has many blood vessels near the surface and is similar to mucous membrane

Stoma tissue is mucous membrane with a rich blood supply close to the surface. Minor bleeding with gentle cleaning is normal. Persistent or heavy bleeding should be reported.

When does the CNA apply the new ostomy pouching system?

Answer: After the peristomal skin is thoroughly clean and completely dry

The new pouching system must be applied only after the skin is completely dry. Moisture under the barrier prevents proper adhesion, causing leaks and skin breakdown.

Constipation is BEST described as:

Answer: Infrequent, difficult, or incomplete passage of hard, dry stool

Constipation is characterized by infrequent bowel movements (less than 3 per week), hard or dry stool, straining, and a feeling of incomplete evacuation.

Which of the following BEST prevents constipation in residents?

Answer: Encouraging adequate fluid intake, dietary fiber, and regular ambulation

Adequate hydration, dietary fiber (whole grains, fruits, vegetables), and physical activity (ambulation) stimulate bowel motility and soften stool, reducing constipation risk.

Diarrhea in a resident can be dangerous because it:

Answer: Causes dehydration and electrolyte imbalances

Diarrhea causes rapid fluid and electrolyte loss, leading to dehydration, hyponatremia, hypokalemia, and acid-base imbalances, which can be life-threatening in elderly residents.

A resident has had 5 episodes of liquid stool in 4 hours. What should the CNA do?

Answer: Report immediately to the nurse and continue monitoring

Frequent liquid stools can cause rapid dehydration and may indicate infection (including C. difficile). Immediate reporting allows the nurse to assess, implement interventions, and consider isolation if needed.

Fecal impaction is BEST described as:

Answer: A hard mass of stool stuck in the rectum that cannot be expelled normally

Fecal impaction is an accumulation of hardened stool in the rectum that cannot be evacuated normally. It can cause extreme discomfort, bowel obstruction, and paradoxical liquid stool leaking around the impaction.

A sign of fecal impaction that a CNA might observe is:

Answer: Liquid stool oozing around a hard stool mass in the rectum

Liquid stool seeping around an impacted mass (overflow incontinence), combined with no normal bowel movement for days and complaints of rectal pressure, are key signs of fecal impaction.

When assisting a resident with a bedpan, the CNA should:

Answer: Raise the head of the bed to a semi-sitting position if medically allowed, for comfort and effectiveness

Elevating the head of the bed to a semi-sitting position (30–45 degrees or more if allowed) uses gravity to assist defecation and is more physiologically natural, increasing comfort and effectiveness.

What should the CNA document regarding a resident's bowel movement?

Answer: Time, frequency, amount, color, consistency, and any abnormalities

Bowel movement documentation must include time, frequency, amount (small/moderate/large), color, consistency (formed, loose, liquid), and any unusual characteristics such as blood, mucus, or odor.

Bright red blood in the stool most likely indicates bleeding:

Answer: From the lower colon or rectum

Bright red blood in the stool (hematochezia) indicates fresh bleeding from the lower colon or rectum, such as hemorrhoids, rectal tears, or colorectal lesions. It must always be reported immediately.