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Related Concept Videos

Ostomy Care01:24

Ostomy Care

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Introduction
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies:
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Tracheostomy Care I: Pre-procedural Steps01:16

Tracheostomy Care I: Pre-procedural Steps

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A tracheostomy is a surgical technique that involves making an incision in the neck to provide access to the trachea. It is frequently used in medical conditions such as airway obstruction and prolonged mechanical ventilation. Effective nursing management is crucial for the long-term success of a tracheostomy.
Required Equipment
The equipment necessary for tracheostomy care includes:
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Tracheostomy Care II: Procedure01:25

Tracheostomy Care II: Procedure

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Tracheostomy care is an essential nursing skill that involves cleaning and maintaining a tracheostomy tube to prevent infection and other complications. Here's a step-by-step guide explaining each procedure with its rationale. Note that disposable gloves are to be worn at all times and changed as often as needed to maintain a sterile work environment, and to protect both patient and healthcare worker.
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask...
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Tracheostomy Decannulation01:21

Tracheostomy Decannulation

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Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
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Tracheostomy: Procedure and Tubes01:28

Tracheostomy: Procedure and Tubes

1.4K
A tracheostomy is a surgical procedure that creates an artificial opening into the trachea, typically at the second or third cartilaginous ring level. This opening allows the insertion of a tracheostomy tube, which can replace an endotracheal tube, provide mechanical ventilation, bypass an upper airway obstruction, or remove accumulated tracheobronchial secretions.
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
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Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Colonial Wig Pancreaticojejunostomy
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How to manage a high-output stoma.

Jeremy M D Nightingale1

  • 1Gastroenterology, St Marks Hospital, Harrow, UK.

Frontline Gastroenterology
|March 18, 2022
PubMed
Summary
This summary is machine-generated.

High-output stoma (HOS) management involves rehydration and fluid/medication adjustments. Parenteral support is typically needed for short bowel syndrome with less than 100cm of jejunum.

Keywords:
IBD Surgerymalabsorptionnutritional supportshort bowel syndromesurgical complications

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Area of Science:

  • Gastroenterology
  • Surgical Management
  • Nutritional Support

Background:

  • High-output stoma (HOS) and enterocutaneous fistulas can lead to significant fluid, electrolyte (sodium, magnesium), and nutrient depletion.
  • HOS affects up to 31% of small bowel stomas, characterized by output exceeding 1.5-2.0 L/24 hours.
  • Management is critical, especially when HOS is associated with short bowel syndrome.

Purpose of the Study:

  • To outline the clinical assessment and management strategies for patients experiencing high-output stoma or fistula.
  • To detail the diagnostic approach, including imaging and exclusion of other causes.
  • To describe fluid management, medication, and nutritional support options for HOS.

Main Methods:

  • Clinical assessment to exclude non-short bowel causes like obstruction.
  • Contrast follow-through studies to estimate residual small bowel length and assess its quality.
  • Implementation of fluid management protocols, including oral rehydration, restricted hypotonic fluids, and glucose-saline solutions.
  • Pharmacological interventions such as loperamide to slow transit and omeprazole to reduce gastric acid.
  • Consideration of subcutaneous or intravenous fluid support and parenteral nutrition when indicated.

Main Results:

  • Successful management hinges on prompt rehydration to resolve thirst and restore renal function.
  • Oral hypotonic fluid restriction coupled with glucose-saline sipping is a key strategy.
  • Medications like loperamide and omeprazole can aid in controlling output and secretions.
  • Parenteral support is generally required when functioning jejunum is less than 100 cm.
  • Surgical consideration for restoring continuity of defunctioned bowel may be beneficial.

Conclusions:

  • Effective management of HOS requires a multi-faceted approach addressing fluid balance, electrolyte replacement, and gut transit.
  • Early recognition and intervention are crucial to prevent complications associated with fluid and nutrient depletion.
  • Individualized treatment plans, including medication and nutritional support, are essential for optimizing patient outcomes.