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Pediatric Ostomy Surgery

Schaffner, Amy

Journal of Wound, Ostomy and Continence Nursing: September/October 2010 - Volume 37 - Issue 5 - p 546–548
doi: 10.1097/WON.0b013e3181eded6f
GETTING READY FOR CERTIFICATION
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Amy Schaffner, ARNP, FNP-BC, CWOCN, Board Liaison, WOCNCB Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, Washington.

Correspondence: Amy Schaffner, ARNP, FNP-BC, CWOCN, WOCNCB, Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, WA 99224 (farbenblinde@hotmail.com).

In this article, we will look at some sample board exam questions about issues which help make the certified WOC nurse an invaluable member of the pediatric surgery team. Pediatric ostomy surgery is performed for a variety of reasons, including congenital anomalies such as Hirschsprung's disease, necrotizing enterocolotis, colonic atresia, anorectal malformations, Crohn's disease, rare pediatric tumors, and anorectal trauma.

The certified WOC nurse caring for the pediatric ostomy patient is tasked with blending developmentally appropriate teaching and counseling with a solid understanding of pediatric problems, surgical techniques, and pouch management.

The certified WOC nurse may be called to the neonatal intensive care unit or to the adolescent ward. Working with the parents of pediatric ostomy patients to assuage concerns is a critical part of the treatment. Working directly with adolescents is also important, and with appropriate teaching and counseling, the certified WOC nurse can be rewarded with teens who can view their stomas without crying. Ultimately, CWOCNs bring parents and patients knowledge, hope, and the ability to live with minimal limitations and high quality of life.

When you look at section 2: Ostomy Care in the Content Outline in the WOCNCB Wound, Ostomy and Continence Examination Handbook, you will see there is no specific mention of pediatric care. However, because the WOC nurse treats patients across the life span, you may expect to see some pediatric questions in the examination. There are eighty (80) questions asked on the Ostomy exam. Questions are categorized as recall, application, or analysis. Here are some practice examples.

  1. An infant with an imperforate anus should be evaluated for which other abnormailites?
    1. Vertebral, cardiac, auditory
    2. Cardiac, prune belly syndrome, tethered cord
    3. Omphalocele, gastroschesis, cardiac
    4. Cardiac, limb, vertebral
  2. Of the following potential complications in a pediatric ostomy patient, which requires emergent intervention?
    1. Stoma prolapse
    2. Peristomal hernia
    3. Dehydration
    4. Change in stoma color
  3. When teaching a 3-year-old regarding upcoming ostomy, what teaching method is most appropriate?
    1. play therapy
    2. art therapy
    3. music therapy
    4. biofeedback therapy
  4. For which type of ostomy is diapering appropriate?
    1. low output colostomy
    2. high output ileostomy
    3. high output colostomy
    4. ureterostomy
  5. What is the gold standard of diagnosis for Hirschprung's disease?
    1. colonoscopy
    2. barium enema
    3. rectal biopsy
    4. contrast enema
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Answers/Discussion

  1. (d) This is a recall question—a question that tests the recognition or recall or specific information. Imperforate anus is often associated with coexisting anomalies. In particular, VACTREL syndrome should be considered.

Content Outline Location: 2B9c.

Reference

Harrison B, Boarini J. Pediatric ostomies: pathophysiology and management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:265–273.

  1. (c) In this application questions, the candidate must discern what an emergency situation is given the choices lists. Dehydration is always a critical finding in pediatrics and must be addressed immediately. If you are tempted to choose “change in stoma color,” remember that change in stoma color may occur with crying. This can frighten the parents; however, this finding is benign and short-lived.

Content Outline Location: 2C2b

Reference

Harrison B, Boarini, J. Pediatric ostomies: pathophysiology and management. In: Colwell J, Goldberg M, Carmel J. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:300–301.

  1. (a) This application question requires the exam candidate to be familiar with teaching at an age-appropriate level. With a toddler or young child, play therapy is an effective way to teach skills and basic concepts of care.

Content Outline Location 2B8

Reference

Harrison B, Boarini J. Pediatric ostomies: pathophysiology and management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:301–302.

  1. (b) This application question requires the candidate to understand that most urinary ostomies do not result in skin breakdown unless urine remains on the skin for prolonged periods of time. With urinary diversions, it is appropriate to teach parents the baby can be diapered. This is a more familiar method of urinary ostomy management for most parents.

Content Outline Location 2B9d

Reference

Harrison B, Boarini J. Pediatric ostomies: pathophysiology and management. In: Colwell J, Goldberg M, Carmel J. eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:294.

  1. (c) This is a straightforward recall question. Although other types of studies may help identify pathology associated with Hirschsprung's disease, only the rectal biopsy can identify absence of ganglion cells to make a firm diagnosis.

Content Outline Location 2B4

Reference

Harrison B, Boarini J. Pediatric ostomies: pathophysiology and management. In: Colwell J, Goldberg M, Carmel J. eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:265.

Studying for the WOCNCB certification exam is a major undertaking. Having a solid study plan based on the Content Outline is essential, and applying each of the content outline items to patients across the lifespan is a helpful exercise. Other helpful exam strategies can be found on the WOCNCB Web site, www.WOCNCB.org, or by contacting the WOCNCB office at info@WOCNCB.org.

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The ABCs of Ostomy Education for Children

Kathleen K. Otten

As experts in the ostomy specialty, we are often called upon to educate adults, patients, and their families about managing an ostomy. In my experience as a WOC nurse, I have learned that education for the child who will be having ostomy surgery is a whole different world. The difference stems from the variety of ages and maturity levels of each individual child and from the importance of keeping parents involved in the education.

Discussing surgery can be particularly frightening to parents and children because they realize a body function will be altered. Visual and hands-on learning methods help to overcome fears, especially when parents and children are allowed to see and handle pouches, clamps, caulk, and belts prior to surgery.

Many manufacturers have excellent teaching materials with diagrams and pictures of the stoma that are very useful when discussing the normal anatomy and physiology. Parents and children can see that the ostomy surgery does not change the function of the bowel or bladder but changes only the location of elimination. Information about pouching systems teaches the child methods to be comfortable and free from odor when at daycare, at school, or at social activities.

Utilizing play therapy with a doll that has an ostomy and a pouch is another method of education. I have used a Cabbage Patch doll and placed a stoma and pouch on its abdomen. Several manufacturers provide dolls and even color books with stories and explanations specifically for children.

The first post-op visit with the parents and child is a very important educational opportunity. They are often feeling overwhelmed and nervous. They are most concerned about the pouching system and how it will be changed and emptied. It is vital that they know about the normal appearance of the stoma, peristomal skin, and that the stoma will not hurt, so they can report any changes to the WOC nurse. I begin by organizing equipment needed for the pouch change, demonstrate it, and give them written instructions to refer to later.

I believe the biggest challenge is teaching the teenaged children. They are at a time in their lives when self-esteem and friends are very important. They want to look good in their clothes and be accepted by their friends and peers. They do not want to be different, so teaching them how to wear their pouches and still be “in fashion” is extremely important to them. Learning how to empty the pouch in a school restroom is a huge hurdle to overcome because of concerns with odor and noise. Teens also need to understand how various foods can affect the child's elimination process and how the ostomy impacts hygiene and other activities such as bathing, swimming, traveling, and returning to school.

Fortunately, for most children, an ostomy is a temporary situation. However, children with permanent ostomies may require more encouragement and extensive counseling along the way. Many children and teens greatly benefit from attending the ostomy camps that are available in some areas of the country.

It is a great opportunity for me to teach children with an ostomy. The reward is to see how quickly the children and their parents learn to adapt. With the guidance of the WOC nurse and practice, they learn to cope and overcome their fears. The children develop confidence that they can be accepted socially and can continue to grow, thrive, and reach for their dreams.

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Helpful WOCNCB Resources

The WOCNCB offers a variety of resources to help WOC nurses successfully certify, recertify and promote the specialty and themselves. Learn more at www.wocncb.org/resources

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Resources for Preparing for the WOC Certification Exams

WOCN Society Review Courses Each year the WOCN Society offers certification review courses from previous national conferences. You can buy online access to the courses at www.prolibraries.com/wocns/.

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Become a Certified Foot Care Nurse®

The WOCNCB offers foot care certification to RNs. No bachelors degree is required. Learn more at www.wocncb.org/WhyCFCN

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Not Recertifying Due to Economic Issues?

The WOCNCB created a Benevolence Fund in 2007 to cover exam fees in times like these. Don't let your certification lapse. Contact info#x0040;wocncb.org. All inquiries are treated with the utmost confidentiality.

Copyright © 2010 by the Wound, Ostomy and Continence Nurses Society