Page 1511 - Saunders Comprehensive Review For NCLEX-RN

the entire colon (colon, rectum, and
anus, with anal closure).
c. The end of the terminal ileum forms the
stoma or ostomy, which is located in
the right lower quadrant.

6. Preoperative interventions

a. Consult with the enterostomal therapist
to help identify optimal placement of
the ostomy.
b. Instruct the client on dietary
restrictions; the client may need to
follow a low-fiber diet for 1 to 2 days
before surgery.
c. Parenteral antibiotics are administered
1 hour before the surgical opening.
d. Address body image concerns and
allow the client to express concerns; a
visit from an ostomate may be helpful
to the client.
7. Postoperative interventions
a. A pouch system with a skin barrier is
usually placed on the stoma
postoperatively; if a pouch system is
not covering the stoma, a petrolatum
gauze dressing is placed over the
stoma as prescribed to keep it moist,
followed by a dry sterile dressing.
b. Monitor the stoma for size, unusual
bleeding, or necrotic tissue.
c. Monitor for color changes in the stoma.

d. Note that the normal stoma

color is pink to bright red and shiny,
indicating high vascularity.

e. Note that a pale pink stoma

indicates low hemoglobin and
hematocrit levels and a purple-black
stoma indicates compromised
circulation, requiring PHCP
notification.

f. Assess the functioning of the

ostomy.
g. Expect that stool is liquid in the
immediate postoperative period but

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