The nurse will need to assess the client’s performance of clean intermittent self catheterization (CISC) for a client with which urinary diversion?
A. Ileal conduit
B. Kock pouch
C. Neobladder
D. Vesicostomy
Correct Answer: B. Kock pouch
The ileal conduit and vesicostomy are incontinent urinary diversions, and clients are required to use an external ostomy appliance to contain the urine. In this new operation, a pouch or reservoir is fashioned out of the terminal ileum with a valve mechanism at its exit to the skin surface. This allows storage of the liquid bowel contents in an expandable container with no leakage of stool or gas and therefore no skin problems. There is no need for appliances or bags, no embarrassment from the involuntary noise and smell of flatus through the ileostomy. The stoma is created flush and within the bikini line. The patient catheterizes the pouch on an average of three times a day.
Option A: An ileal conduit aims to divert urine produced from the upper urinary tracts to a newly formed reservoir created from the terminal ileum. The ureters are disconnected from the bladder and implanted into the conduit.
Option C: Clients with a neobladder can control their voiding. During neobladder surgery, the surgeon takes out the existing bladder and forms an internal pouch from part of the intestine. The pouch, called a neobladder, stores the urine.
Option D: A vesicostomy is a stoma (opening) created between the bladder and the abdomen. This allows urine to drain freely, with low pressure, to help protect and prevent harm to the kidneys. It is a surgical procedure that typically involves an overnight stay in the hospital.