Transcript Ostomycare
OSTOMY CARE
Patty Maloney MSN Ed, RN
Alternative Bowel Elimination
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
Ostomy- surgically created opening into the
abdominal wall that serves as an exit site from the
bowel or ureter.
Ileostomy- surgically created opening from the
small intestines to the abdominal wall allowing the
passage of feces.
Colostomy-surgically created opening from the
large intestines to the abdominal wall allowing for
the passage of feces.
Ureterostomy
Ureterostomysurgical procedure
creating an opening
from the ureter to
the abdominal
cavity.
Stoma
Stoma- portion of
the bowel or ureter
that is surgically
opened and brought
out through the
abdominal wall.
Ostomy Drainage
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
May be temporary or permanent.
Temporary-bowel rest, eg. Chron’s disease.
Permanent-tumor.
Temporary may be several weeks to several
months.
Ostomies
Temporary-generally
located at the
transverse colon.
Permanent-usually
located at the
descending colon or
sigmoid colon.
Permanent because
the colon or rectum
have to be removed.
Ostomy Appliances
Many types of appliances/pouches available.
One piece-one unit bag attached to wire.
Two piece- wafer is separated from pouch.
Wafers- some precut and some must be
custom fit.
Ostomy Appliances
Sealant or pastecreate a seal.
Closure- clip or
clamp.
Ostomy Care
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
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.
May take 4-6 weeks to determine stoma size.
Ostomy Care
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
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
Wash stoma and skin around stoma with soap
and water and pat dry.
Apply skin barrier substance (karaya powder,
skin prep).
Enterostomal therapist-nurse who specializes
in care of ostomies.
Application of appliance
Application depends on the type of appliance
used.
Pre-cut-appropriate size is chosen and then
applied.
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.
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.
Assessment of Ostomy
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
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
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
Surgical opening on the abdomen or ostomy
through which urine is eliminaed.
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.
Continent Urinary Diversion
Incontinent Urinary Diversion
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.