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

Ureterostomy-surgical 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 colostomy-mushy stool.

Descending colon-soft to solid.

Ureterostomy

Ureterostomy-

drains 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 paste- create 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 fit- use 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.

Ureterostomy- 1 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.