Timby Ch. 48 Caring for Clients With Ostomies

Ostomy

An opening between an internal body structure and the skin

Ileostomy

The most common intestinal ostomy, an opening from the distal small intestine

Colostomy

An opening from the colon

Stoma

An opening on the exterior abdominal surface that fecal material exits through

Total colectomy

Removal of the entire colon and rectum

Appliance

The collection device worn over a stoma. Consists of one piece or two piece devices with a pouch for collecting fever and a faceplate, or disk, which is attached to the abdomen with an opening through which the stoma protrudes.

Ostomate

Client with an ostomy

Karaya gum

Commonly used in place of an adhesive. It protects the skin and promotes adhesion of the ostomy appliance.

Conventional ileostomy

Stoma in the lower abdomen where there's liquid feces and you never have control over feces.

Continent ileostomy

Stoma is in the lower abdomen with liquid feces and you only have fecal control by siphoning

Ascending ileostomy

Stoma is in the middle right abdomen where feces are semiliquid and you never have control over feces

Transverse colostomy

Stoma is in the center of the abdomen below the belt line where feces are semiliquid and you never have control over feces.

Descending colostomy

Stoma is in the middle left abdomen where there's soft feces and you sometimes have fecal control

Sigmoid colostomy

Stoma is in the lower left abdomen where there's formed feces and you usually have control over feces

Some medications, especially vitamins, antibiotics, and anti tuberculosis drugs

Cause strong odors to cling to an appliance.

Enteric coated products and some modified release drugs, such as slow release beads and layered tablets

Should be avoided by clients with an ileostomy because they may pass through without being absorbed.

Potassium Chloride (slow K)

Leaves a "ghost" of the wax matrix coating, but doesn't mean the drug has been unabsorbed.

Vitamin B12 injections or intranasal vitamin B12

May be needed monthly for Clients with an ileostomy because the terminal ileum may be compromised enough to interfere with dietary absorption of the vitamin.

Potential risks from the total colectomy

Possible bladder and sexual dysfunction secondary to parasympathetic nerve injury. Sexual dysfunction in men afterwards is unusual, but sometimes occurs. Young male client's may wish to collect and store sperm for later use because this procedure may slightly diminish fertility in women.

Signs of adrenal insufficiency

Fever, sweating, increased heart rate and respirations, abdominal pain, confusion, dehydration, and weakness

Possible postoperative complications from ileostomy

Intestinal obstruction, bleeding, and impaired blood supply to, stenosis of, or prolapse or excessive protrusion of the stoma

Color of a healthy stoma

Bright pink or red

Color on an unhealthy stoma

Dusky blue or black

Length of a healthy stoma

Protrudes from or just flush with the skin

Length of an unhealthy stoma

Protrudes beyond 2 inches from the skin or retracts beneath it

Sensation of a healthy stoma

Painless

Sensation of an unhealthy stoma

Peristomal burning

Function of a healthy stoma

Regular passage of feces

Function of an unhealthy stoma

Sparser or absent elimination of feces

continent ileostomy (Kock pouch)

The creation of an internal reservoir for the storage of GI effluent

effluent

Discharged fecal material or liquid feces

Most common cause of discomfort from an ostomy placement

Reactions to adhesive or solvent used to remove it, or irritation from leaking fecal drainage. Client may experience stinging, tingling, or itching immediately after an appliance change.

Client & family teaching postoperative ileostomy care

Restrict oral intake only with medical supervision; eat slowly and chew food well with the mouth closed to help lessen the development of gas; avoid food that causes discomfort, excessive gas, or loose stools; drink extra fluids; dilate stoma if the volume of stool decreases for some unexplained reason; clean pouch to prevent odors; use an internal absorbing substance or one that can be added to the pouch to control lingering or stubborn odors; use an old or disposable pouch when medications or offending foods that cause odors are excreted; slip a plastic cover over the pouch to act as a second barrier; check with physician before self administering any drug, especially a laxative or antidiarrheal.

Ileoanal reservoir or ileoanal anastomosis

Surgical connection between two structures. Procedure maintains bowel continence. Performed on selected clients who have chronic ulcerative colitis or whose disease doesn't affect the anorectal sphincter

Ways to reduce the risk for bowel incontinence

Perform perineal exercises to establish anal sphincter control and enlarge the ileoanal reservoir. These exercises tighten the anus. Client should do 10 repetitions of this exercise 4-6 times daily.

Colostomy

An opening in the large bowel created by bringing a section of the large intestine out to the abdomen and fashioning a stoma

Single barrel colostomy

Ostomy has a single stoma through which fecal matter passes

Double barrel colostomy

Performed most often in the transverse section of the large intestine, contains both proximal and distal stoma. Each stoma is everted and sutured into place.

Proximal stoma

Expels fecal material

Distal stoma

Leads from the portion of the cut bowel to the anus. Doesn't pass feces. It may expel mucus

Loop colostomy

A loop of bowel has been lifted through the abdomen and is supported in place with a glass rod or plastic butterfly device.