The Wound, Ostomy, Continence Certification Board (WOCNCB) is an accredited organization that provides nurses with the opportunity for certification in wound, ostomy, continence, and foot care nursing. There are currently 3577 nurses certified in ostomy care by the WOCNCB. Nurses certified by the WOCNCB have either completed a formal WOC Nursing Education Program or are qualified to take the examination through an experiential pathway.
The following reflect the type of questions on the examination.
1. A person with an ileostomy comes to the clinic complaining of frequent leakage under the wafer of the flexible one-piece pouch. The person has a soft abdomen with a shallow crease on either side of a flush stoma. The peristomal skin is reddened but remains intact. Which of the following would MOST likely allow improved wear time and reliability?
A. Two-piece flat wafer and pouch with adhesive coupling.
B. One-piece nonadhesive pouching system.
C. Two-piece firm convex wafer and pouch.
D. One-piece pouch with a flexible barrier ring.
2. The most appropriate surgical treatment for a young person with active ulcerative colitis is
A. protocolectomy with ileal pouch anal anastomosis.
B. subtotal colectomy with permanent colostomy.
C. low anterior resection with temporary ileostomy.
D. total colectomy with an ileoanal anastomosis.
3. A patient with a feeding gastrostomy tube has occasional leakage of stomach contents around the tube and hypertrophic granulation at the tube insertion site. Which of the following interventions would be appropriate for this patient?
A. Irrigate the tube and apply antibiotic ointment at the insertion site.
B. Remove the tube and replace it with a larger one.
C. Stabilize the tube and apply silver nitrate to the granulation tissue.
D. Stop the feeding for 2 days and resume feeding slowly.
Answers
1. (C) A two-piece firm convex wafer and pouch. Convexity will apply pressure against the soft abdominal wall, push the stoma into the opening in the wafer, and flatten the creases around the stoma. A two-piece flat wafer and pouch with adhesive coupling (A) is flat and flexible, but will provide little advantage over the system currently in use. A one-piece nonadhesive pouching system (B) would be indicated for a person with chronic peristomal skin breakdown or a serious adverse reaction to adhesive products. A one-piece pouch with a flexible barrier ring (D) might possibly help this person, but it is more likely that the convex wafer will solve the problem and be simpler for the person to use.
Reference
Colwell J. Principles of stoma management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO:Mosby; 2004:251.
2. (A) Proctocolectomy with ileal pouch anal anastomosis. This procedure is the preferred treatment for ulcerative colitis and allows the person to resume life without a permanent ostomy. Subtotal colectomy with permanent colostomy (B) would not be the recommended treatment, as the disease may recur in another portion of the colon and the risk of colon cancer would continue to be greater than normal if a portion of the colon is retained. Low anterior resection with temporary ileostomy (C) would only be effective as an emergency treatment for ulcerative colitis if toxic colitis or toxic megacolon were present in the lower portion of the colon. Total colectomy with an ileoanal anastomosis (D) is a possible surgical treatment, but due to the common occurrence of fecal urgency and frequency, it is no longer a treatment of choice.
Reference
Kiran R, Fazio V. Inflammatory bowel disease. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO:Mosby; 2004:92-94.
3. (C) Stabilize the tube and apply silver nitrate to the granulation tissue. Hypergranulation is frequently caused by movement of the gastrostomy tube in the tract from the skin opening into the stomach. Silver nitrate cautery is a treatment to remove this overgrowth of tissue, and stabilization of the tube will help keep it from recurring. It would not be helpful to irrigate the tube unless it was obstructed and antibiotic ointment at the insertion site (A) could promote the growth of hypergranulation. Removing the tube and replacing it with a larger one would increase the size of the tract that may cause more leakage. (B) Stopping the feeding for 2 days and resuming feeding slowly (D) would not address either problem, as the leakage of gastric effluent can still occur without feeding.
Reference
Carmel J, Scardillo J. Tube management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO:Mosby; 2004:362-363.
Resources for Preparing for the WOC Certification Exam
Self Assessment Exam
* The Self-Assessment Exam (SAE) is a computer-based test available from the testing company that produces our exam. You can find this by going to Web site http://www.goamp.org and clicking on "e-store." Then select "Health Care" and then "Wound, Ostomy, Continence Nurses." For $90, you may purchase all 3 exams or for $30, you can purchase the exams individually. The SAE has 40 questions in each specialty and you may grade it as you take the test. References and the rationale for the answers are provided. The test is available for 90 days after purchase, and when you exit from the exam for the final time, you will be provided with a score report.
* The WOCN Society has CD-ROMs of the certification review course offered each year at their national conference. These may be purchased online at http://www.prolibraries.com/wocns/.
* The WOC Nursing Education Program at Emory University has a certification review manual for sale for $65.00. The order form is available online at http://www.surgery.emory.edu/wocnec/order.form.pdf. You may also obtain this order form by calling 404-778-3159 or by faxing your request to 404-778-4778.
* The Wound Care Education Program at the Medical College of South Carolina has a Wound Care Study Guide that may be purchased for $125.00 by contacting Carol Whelan at 843-792-265 or toll free at 866-637-6835.