Ostomycare

Report
OSTOMY CARE
Patty Maloney MSN Ed, RN
Alternative Bowel Elimination
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Bowel diversion-redirection of the contents of the small or
large intestine through a surgically created exit in the
abdominal wall.
Possible reasons for bowel diversion:
Cancerous tumor
Disease process such as Crohn’s disease
Infarcted area which the bowel walls become ischemic and
die
Ruptured diverticulum
Ulcerative colitis
Traumatic abdominal injury
Ostomies
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Ostomy- surgically created opening into the
abdominal wall that serves as an exit site from the
bowel or ureter.
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Ileostomy- surgically created opening from the
small intestines to the abdominal wall allowing the
passage of feces.
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Colostomy-surgically created opening from the
large intestines to the abdominal wall allowing for
the passage of feces.
Ureterostomy
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Ureterostomysurgical procedure
creating an opening
from the ureter to
the abdominal
cavity.
Stoma
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Stoma- portion of
the bowel or ureter
that is surgically
opened and brought
out through the
abdominal wall.
Ostomy Drainage
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Type of drainage
depends on location of
the ostomy:
Ileostomy and
ascending colon-liquid
feces.
Transverse colostomymushy stool.
Descending colon-soft
to solid.
Ureterostomy
Ureterostomydrains urine.
Ostomies
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May be temporary or permanent.
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Temporary-bowel rest, eg. Chron’s disease.
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Permanent-tumor.
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Temporary may be several weeks to several
months.
Ostomies
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Temporary-generally
located at the
transverse colon.
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Permanent-usually
located at the
descending colon or
sigmoid colon.
Permanent because
the colon or rectum
have to be removed.
Ostomy Appliances
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Many types of appliances/pouches available.
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One piece-one unit bag attached to wire.
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Two piece- wafer is separated from pouch.
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Wafers- some precut and some must be
custom fit.
Ostomy Appliances
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Sealant or pastecreate a seal.
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Closure- clip or
clamp.
Ostomy Care
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Wash hands.
Don gloves.
Remove old appliance.
Note effulent (drainage)-color, amount, and
odor.
Drain effulent into commode.
Discard old appliance into biohazard bag.
Ostomy Care
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Assessing initial post-op stoma:
initially post-op stoma will be edematous and may have small
amount of bleeding.
Monitor for post-op complications:
 Excessive bleeding.
 Stoma dark in color or blanched due to lack of blood supply.
 Drying of stoma.
Signs of infection.
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May take 4-6 weeks to determine stoma size.
Ostomy Care
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Stoma assessment:
Stoma should be pink
to red and moist.
Assess for cuts,
ulcerations, or any
abnormal findings.
Assess skin around
stoma.
Note any redness or
irritation.
Challenges
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Skin breakdown is a
major challenge due
to the enzymes in the
stool.
Excoriation-chemical
injury of the skin due
to the enzymes.
Nursing Implications
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Wash stoma and skin around stoma with soap
and water and pat dry.
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Apply skin barrier substance (karaya powder,
skin prep).
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Enterostomal therapist-nurse who specializes
in care of ostomies.
Application of appliance
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Application depends on the type of appliance
used.
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Pre-cut-appropriate size is chosen and then
applied.
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Custom fituse an ostomy guide to cut the opening on the
wafer 1/16 to 1/8 larger than stoma.
key is to fit appliance around the stoma without
touching stoma or exposing surrounding skin.
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Applying Appliance
One piece system- use skin sealant.
 Two piece system- use paste.
 Appliance chosen depends on the type of ostomy,
stoma shape, location of stoma.
(Trial and error)
 May reinforce appliance with non-allergic paper
tape in picture frame.
 May wear an ostomy belt.
 Roll end of pouch upward once and apply
clip/clamp.
 Be sure clam is snug.
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Assessment of Ostomy
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GI assessment of patient.
Assess bowel sounds in all 4 quadrants.
Assess effulent from ostomy.
Empty pouch when 1/3-1/2 full.
Assess abdomen.
Report any abnormal findings immediately.
Bowel sounds and activity by day 3.
Ostomy Care
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Management of ostomy:
Ostomy should be pink & moist.
Skin should be clean, dry, & intact.
Assess for s/s of redness or irritation.
New appliances should adhere to skin without
wrinkles or gaps.
Colostomy Irrigation
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Requires Dr. order.
Procedure:
Remove appliance.
Place irrigation sleeve over stoma.
Instill lubricated cone into stoma.
Insert catheter into cone.
Instill 500cc-1000cc tap water or saline .
Start with 500cc over 5-10 minutes.
Colostomy Irrigation
Urinary Diversion
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Surgical opening on the abdomen or ostomy
through which urine is eliminaed.
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Types: Continent and incontinent.
Continent diversion-internal pouch or reservoir
created from a segment of the bowel.
Patient performs self catheterization every 4-6
hours.
No appliance used.
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Continent Urinary Diversion
Incontinent Urinary Diversion
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AKA-ileal conduit.
Ureter is transplanted into a closed off portion of the
ileum with an opening to the outer abdomen creating a
stoma.
Ureterostomy1 or 2 ureters are brought to the abdominal wall and a
stoma is formed.
Requires a pouch or appliance because of continuing
urinary drainage.
Urinary Diversion
Nursing Implications:
 Increased chance of skin breakdown due to
continuous drainage.
 Change appliance bag frequently due to weight of
urine.
 Place a tampon in stoma to absorb urine while
cleaning.
 Peristomal skin is difficult to keep free from
breakdown due to ammonia in urine.
 Use of skin barrier or topical antibiotics or
steroids.

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