Ostomy

CASTLE now WOCNCB Exam Provider As of October 1, 2011, a new provider began administering certification exams. The new exam manager, Castle Worldwide, Inc, stands ready to assist you with an online application and registration system. CASTLE provides over 450 exam sites in the US and Canada and over 200 additional international sites. More information is available at www.WOCNCB.org. WOCNCB at WOCN Annual Conference Be sure to visit the WOC Nursing Certification Board's booth during the WOCN 43rd Annual Conference in June. Meet the Board, get answers to your certification and recertification questions and take a “test cruise” of the new Online PGP system. Online PGP for Recertification Faster, easier and smarter way to submit your Professional Growth Portfolio for recertification in wound, ostomy, or continence. Take a test cruise at www.wocncb.org/pgp. 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 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 [email protected]. All inquiries are treated with the utmost confidentiality. Contact the WOCNCB 1-888-496-2622 [email protected] As nurses certified by the Wound, Ostomy, Continence Certification Board (WOCNCB), we want to “nurture” our young and help new WOC nurses succeed in their quest for certification. At the same time, we encourage our experienced colleagues to recertify every 5 years, by exam or by using the online Professional Growth Program (PGP). Each article in the series of “Getting Ready for Certification” is written to help new and recertifying WOC nurses review standard WOC practice and to understand how the WOCNCB exams are structured. Each specialty exam includes 80 questions written as recall, application, or analysis questions. The sample questions in each article, as well as the actual exam questions, are written by experienced WOCNCB certified nurses who serve on the Wound, Ostomy and Continence Exam Committee. The Exam Committee meets several times each year to work closely with a psychometrician, a specialist who is experienced in the science of quantitative measurement and exam development. Together, this team strives to write exam questions that are psychometrically sound and legally defensible. This is important for 2 reasons (1) our mission to promote the highest standard of consumer care and safety by providing credentialing in our specialties and (2) our desire for you to successfully achieve and maintain your WOCNCB certification. One of the best ways to succeed in the certification exam is to study with the Detailed Content Outline in hand. Every question in the WOCNCB exams is based on the content in the Outline, which is found in the Exam Handbook. The handbook can be downloaded from www.wocncb.org. One way to use the outline is to verify the content you understand, and more importantly, to ferret out and focus on subject areas you are less confident about; these are the areas on which to concentrate your study efforts. The focus of this article, Continent Fecal and Urinary Diversions (Section D under Ostomy Care) and Fistulas and Percutaneous Drains (Section E) might be some of those areas. The Ostomy Content Outline notes that the Ostomy Exam contains 10 questions for Section D and 12 questions for Section E. Although you may not routinely care for patients with these conditions, these areas are included in the exam because the extensive WOC nurse job analysis (see sidebar article) identified them as integral to a WOC nurse's duties. The following questions are representative of those you may see on the actual exam. Following the questions is a section giving correct answers, rationales, and explanations of the question formats. Nocturnal enuresis is a common postoperative problem following what type of procedure? Urostomy Kock pouch Neobladder Indiana pouch How often should patients on continuous tube feeding have their tubes flushed with 30 mL of warm water? Every hour Every 4 hours Every 8 hours Every 12 hours A patient with a small bowel fistula will most likely require which type of nutrition? Enteral nutrition Low fiber diet Total parenteral support Liquid diet Which of the following should be included in discharge instructions for a patient with a nephrostomy tube? The importance of adequate fluid intake. The tube should be secured perpendicular to the body. The drainage system should be at level of the abdomen. The dressing around the tube should be changed daily. A patient has recently undergone stage 1 of a 2-stage procedure for Ileal Pouch Anal Anastamosis (IPAA). Which of the following is the MAIN focus of teaching? Skin protection Intubation of the stoma Ostomy care Diet and hydration Answers and Rationale 1. (C) This is an application question, defined as one that tests the ability to comprehend, relate, or apply knowledge to a new, or changing situation. You must recognize that a urostomy is an incontinent stoma requiring pouching, so nocturnal enuresis would neither be a problem, nor an acceptable answer. Kock and Indiana pouches are continent stomas that require catheterization, ruling them out as well. A neobladder is the only surgically created bladder with a native urethra, thus the only possible correct answer. Reference Tomaselli D, McGinnis D. Colwell J, Goldberg M, Carmel J. Urinary diversions: surgical interventions. In: Fecal and Urinary Diversion Management Principles. St Louis, MO:Mosby; 2004:201. Content outline: 2D4a3 – Orthotopic Neobladder, Instruct patients in control of incontinence. 2. (B) This is a recall question, which tests the ability to recall or recognize specific information, taken straightforward from texts or guidelines. In this case, flushing the tube every 4 hours with 30 mL of warm water is advised to best prevent clogging of the tube. Every hour would be too frequently, and the other answers would not be frequent enough to prevent clogging. Reference Carmel J, Scardillo J. Colwell J, Goldberg M, Carmel J. Tube management. In: Fecal and Urinary Diversion Management Principles. St Louis, MO: Mosby;2004:365. Content outline: 2E2a. Percutaneous tubes and drains, assess and manage patency and placement. 3. (C) By making the patient NPO, gut secretions are decreased, with the hope that the fistula will spontaneously close. Nutrition must be optimized with total parenteral support to facilitate healing. The other answers will stimulate gut secretions and the patient may not be able to absorb adequate nutrients through the gut. Reference Toth P, Hocevar B, Landis-Erdman J. Colwell J, Goldberg M, Carmel J. Fistula Management. In: Fecal and Urinary Diversion Management Principles. St Louis, MO: Mosby;2004:383. Content outline: 2E1b2. Fistulas and Percutaneous Tubes and Drains, Fistulas, Assess fluid and electrolyte and dietary considerations. 4. (A) The patient must be taught the importance of consuming adequate fluids to promote drainage, and to prevent urinary tract infections. Securing the tube perpendicular to the body might cause occlusion when the patient turns on the side. The drainage system needs to be placed below the kidney to promote adequate drainage. Weekly dressing changes are recommended, not daily. Reference Carmel J, Scardillo J. Colwell J, Goldberg M, Carmel J. Tube management. In: Fecal and Urinary Diversion Management Principles. St Louis, MO: Mosby;2004:371. Content outline: 2E2a. Percutaneous tubes and drains, assess, and manage patency and placement. 5. (C) Analysis questions require an ability to analyze and synthesize information. In this question, you must know what an IPAA is, and that a 2-stage procedure for IPAA involves surgery to create an ileostomy first (the first stage), so ostomy care would be the main focus. Although skin protection and diet and hydration may be part of patient teaching, they are not the focus. Answer (B) is blatantly incorrect. Reference Kiran R, Fazio V. Colwell J, Goldberg M, Carmel J. In: Fecal and Urinary Diversion Management Principles. St Louis, MO: Mosby;2004: 94. Content outline: 2D2. Ileal pouch Anal Anastamosis. As you can see, the content outline may be your “best friend” when it comes to studying for and successfully passing the board exam. Be sure you make it part of your study regimen and cover all the areas contained within it.

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