UP NHM CHO 7 Sept 2022(shift-1st)
Medical & Surgical Nursing
Medium
All of the following are indications for ureterostomy EXCEPT:
Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)
Explanation
- Megacolon is an abnormal dilation of the colon, which is part of the gastrointestinal system, not the urinary system.
- A ureterostomy is a urinary diversion procedure, indicated for pathologies of the urinary tract that require bypassing the bladder.
- The surgical procedure for a gastrointestinal issue like megacolon would be a fecal diversion, such as a colostomy or ileostomy, not a ureterostomy.
Why Other Options Were Wrong
- Option B: Spinal cord injury is a valid indication for a ureterostomy because it can cause neurogenic bladder dysfunction, leading to urinary retention and potential kidney damage.
- Option C: Spina bifida is a valid indication. This congenital neural tube defect frequently results in a neurogenic bladder, which may necessitate a urinary diversion like a ureterostomy to protect the kidneys from damage (SRC_1926, SRC_1927).
- Option D: Bladder cancer is a valid indication. Removal of the bladder (cystectomy) is a common treatment for invasive bladder cancer, which then requires a permanent urinary diversion to be created.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications and Contraindications for Ureterostomy as background academic context rather than a clinical decision trigger.
- Nurses must be able to differentiate between urinary stomas (urostomies) and fecal stomas (colostomies, ileostomies). The care, appliance type, output characteristics, and potential complications are vastly different.
- Key nursing responsibilities for a patient with a new ureterostomy include stoma and peristomal skin assessment, appliance management, monitoring urine output for color, clarity, and volume, and providing patient and family education on stoma care.
- What if? If a patient with bladder cancer was a candidate for a continent diversion, they might receive an Indiana Pouch or a neobladder instead of a ureterostomy. This would change nursing care, as the patient would perform intermittent self-catheterization through a small abdominal stoma or void volitionally, rather than wearing an external pouch.
How to Approach the Question
- First, identify the keyword 'EXCEPT'. This tells you that three of the options are correct indications for the procedure, and your task is to find the one that is not.
- Next, define the core term: 'ureterostomy'. Recognize that it is a surgical procedure involving the ureters and is a form of urinary diversion.
- Analyze each option based on the organ system it affects.
- Evaluate 'megacolon'. This affects the colon (gastrointestinal system). A urinary diversion is not relevant here.
- Evaluate 'spinal cord injury', 'spina bifida', and 'bladder cancer'. All these conditions can severely compromise bladder function or require bladder removal, making a urinary diversion a necessary intervention.
- Conclude that megacolon is the outlier as it belongs to a different organ system and does not require a urinary diversion. Therefore, it is the correct answer to the 'EXCEPT' question.
Concept Tested & Keywords
- Concept Tested: Indications and Contraindications for Ureterostomy
- Stem keywords: ureterostomy, indications
- Lead-in keywords: EXCEPT
- Negative lead-in flag: The question asks for the exception among the given options.
Question ID
QRUSWvVuFJPnOyi4zFjNb-
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1093-1095, 1094-1096
Practise the full UP NHM CHO 7 Sept 2022(shift-1st)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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