Lec 12: Ostomy Care

excoriation def

injury to the surface of the skin = abrasion

melena def

partially digested blood in stool

peristomal def

area around the stoma

occult blood def

hidden

effluent def

material discharged from stoma

steatorrha def

stool with abnormally high fat content

What is an Ostomy def

opening in the abdominal wall to eliminate feces or urine

• can be temporary or permanent

An ostomy may be required in;

• cancer

• inflammatory bowel disease

• obstruction

• necrosis

• trauma/perforation

• congenital malformation

what are the diff types of ostomies

• urostomy

• ileostomy

• colostomy

Urostomy def

diversions are surgical procedures which creates a new path for urine flow from the kidneys to a location other than the bladder

• 2 main types=continent and incontinent

Incontinent Urinary Diversion def (urostomy)

rerouting of ureters to a stoma using a part of the pts intestine ex ileal conduit, or ureterostomy

Incontinent Urinary Diversion characteristics

• may have a larger stoma (ileal conduit) or one flush with the skin (cutaneous ureterostomy)

• appliance is applied to collect urine

• peristomal skin health is essential=must never leak onto skin

• complications=infection, stomal issues, blockage, peristomal skin issues

Continent Urinary Diversion def (urostomy)

rerouting of ureters to a pouch (reservoir) and stoma created by a portion of the large intestine and ileum

Continent Urinary Diversion characteristics

• pouch emptied with a clean catheter q4hrs, and is covered by a small dressing

• gives pt more control over the passage of urine

• complications=infection, blockage, stomal and peristomal skin issues

• no drainage should leak or touch the skin=irritating, and cause skin breakdown

Ileostomy appearance and when does fecal drainage start

protruding stoma d/t f risk that fluid will irritate stomal area

• fecal drainage begins 24-48 hrs after surgery

ileostomy stool/frequency characteristics

production is frequent

• fluid like-to mushy, dark green, usually not odorous

when does the colostomy start to function with output

3 to 6 days after surgery

• stool more firm

urostomy frequency rate and consistency of output

• frequent/continuous

• urine, may have mucous threads

colostomy frequency rate and consistency of output

• less frequent, few times a day

• semi solid or formed with gas

one piece system colostomy characteristics

skin barrier is already attached to the pouch, peel/stick

• pouch lies flat against the skin and may show less under clothing

• bulge/hernia near your stoma=best fit with a one-piece pouch

two piece system colostomy characteristics

skin barrier is separate from the pouch, pieces snap together with a flange

• allow you to apply a new pouch without removing the skin barrier from your body each time

• can wear diff pouches depending on activity level

• can put your fingertips under the flange to help prevent pressure

how often are ostomy appliances changed?

changed at least every 7 days

how do we cleanse the Peristomal area

use a soft cloth moistened with warm water to cleanse peristomal area after appliance has been gently removed

• dry thoroughly

• may not need soap or cleansers, but if used rinse off

• dont use moisturizers on the peristomal skin area = reduces adherence of appliance

• only use products developed for use in ostomy care, and those rx such as a skin protectant

Measuring the stoma pic

add 1 1/8th inch

what can we use to in crevices to fill and gaps and make wafer application easier

paste

Teaching for a patient with an ostomy (GI), what to mention

• management and changing of appliance, supply acquisition

• address concerns re self image, sexuality, pregnancy etc

• supports in community

• fluids and electrolytes (Ileostomy) must monitor losses especially during hot weather, exercise, and when ill, and replace

• expected vs unexpected findings, monitoring for complications; peristomal skin issues, diarrhea, blockage, stomal issues; stomal stenosis, dehiscence, prolapse, other ex urinary calculi (stones)

dietary recommendations for ostomy pts

• if new usually begin with a low residue diet initially to allow bowels time to adapt

• few dietary restrictions but should avoid hard to digest food items=popcorn, corn, poppy seeds etc

• avoid foods that cause odor or gas

flush stoma unexpected finding

• may be intentional (by the surgeon) or occurs over time

• increased risk of peristomal skin exposure to effluent from stoma

• requires use of a convex pouching system or stoma paste or barrier ring

retracted stoma unexpected finding

• recessed slightly below the skin

• can occur as a result of internal scar tissue formation, changes in patient’s weight, or significant nutritional deficit

• requires use of a convex pouching system or stoma paste or barrier ring

prolapsed stoma unexpected finding

when the intestine extends outward, over itself much further than expected (expected is 2-3 cm)

• there is a risk that the the prolapse can progress to intussusception = this is a surgical emergency

• requires surgeon consult

peristomal candidiasis unexpected finding

• causes=leakage from stoma, perspiration, antibiotic therapy, warn/humid environments, broken skin.

• S&S=yeast irritation - itchy, bumpy red skin

• yeast infection may simultaneously occur in vaginal area, armpits, mouth, or any skin folds (ex buttocks, groin)

allergic contact dermatitis unexpected finding

• causes=exposure to irritants on the skin ex tape, tegaderm, skin barriers, soaps, powders, pastes, or even the ostomy wafer

• S&S=red itchy broken skin, yeast irritation in area under pouching system

irritant dermatitis unexpected finding

• causes=inflammation of peristomal skin from contact with urine or stool leaking from under the pouching system

• ex not a good seal of the wafer to the peristomal skin

• S&S=redness, pain, open-weeping areas of the skin

pressure injury/ulcer unexpected finding

• causes=direct contact and pressure from an ostomy appliance, tight clothing, peristomal hernia, or repetitive contact from activity or work-related habits

• S&S=pain or bleeding, irregularly shaped ulcer, pouch leaking, decreased wear time of ostomy appliance

• if left untreated, may develop into fistulas

The nurse is emptying a colostomy bag for a patient. Which of the following needs to be reported immediately?

presence of blood in the stool

should seek medical attention immediately if;

• stoma is protruding further out than usual

• stoma appears dark red/purplish in color