Page 1299 - Saunders Comprehensive Review For NCLEX-RN

the ileum, with the formation of an
abdominal stoma.
c. The urine flows into the conduit and is
propelled continuously out through
the stoma by peristalsis.
d. The client is required to wear an
appliance over the stoma to collect the
urine (Box 44-18).
e. Complications include obstruction,
pyelonephritis, leakage at the
anastomosis site, stenosis,
hydronephrosis, calculi, skin irritation
and ulceration, and stomal defects.
5. Kock pouch
a. The Kock pouch is a continent internal
ileal reservoir created from a segment
of the ileum and ascending colon.
b. The ureters are implanted into the side
of the reservoir, and a special nipple
valve is constructed to attach the
reservoir to the skin.
c. Postoperatively, the client will have a
urinary catheter in place to drain urine
continuously until the pouch has
healed.
d. The urinary catheter is irrigated gently
with normal saline to prevent
obstruction from mucus or clots.
e. Following removal of the urinary
catheter, the client is instructed in how
to self-catheterize and to drain the
reservoir at 4- to 6-hour intervals (Box
44-19).
6. Indiana pouch
a. A continent reservoir is created from
the ascending colon and terminal
ileum, making a pouch larger than the
Kock pouch (additional continent
reservoirs include the Mainz and
Florida pouch systems).
b. Postoperatively, care is similar to that
for the Kock pouch.
7. Creation of a neobladder
a. Creation of a neobladder is similar to
creation of an internal reservoir, with
the difference being that instead of
emptying through an abdominal
stoma, the bladder empties through a

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