Introduction to Ostomy

Definition: An ostomy is an artificial surgical opening created in the body to aid in waste elimination when normal routes are compromised due to various medical conditions. This procedure is often performed when the digestive or urinary tract is obstructed or damaged, leading to the need for an alternative pathway for waste excretion.

Types of Ostomies:

• Colostomy: Involves bringing a portion of the colon through the abdominal wall, creating an external stoma, allowing fecal waste to exit the body. Depending on the location, it can be classified as:

  • Ascending Colostomy: Located on the right side of the abdomen; typically results in more liquid waste.

  • Transverse Colostomy: Positioned across the abdominal area; allows for more formed stool than an ascending colostomy.

  • Descending Colostomy: Found on the left side, leading to stool that is more formed and similar to typical bowel movements.

  • Sigmoid Colostomy: Situated just above the rectum, leading to more solid waste.

• Ileostomy: Involves turning out the ileum (the last part of the small intestine) to the abdominal wall. It produces a liquid to semi-solid output that is typically more acidic.

• Stoma: The actual opening created during ostomy procedures, often visualized as a small button-like structure on the abdomen, may vary in size and shape, and is critical for proper ostomy management.

Anatomy and Pathway of Digestion

Digestive Pathway: Food enters through the mouth, where it is chewed and mixed with saliva, travels down the esophagus into the stomach, where it is broken down further, then it moves into the small intestine where nutrients are absorbed, followed by the large intestine for water absorption and finally into the rectum to be eliminated as feces.

Reasons for Ostomy:

Common reasons include blockages or issues preventing stool from passing through normal routes, such as diseases or conditions affecting the intestines.

Conditions Leading to Ostomy Creation

Several medical conditions can necessitate the creation of an ostomy, including:

• Crohn's Disease: A chronic inflammatory bowel disease characterized by inflammation of the digestive tract, which can lead to severe diarrhea, pain, fatigue, and malnutrition.

• Ulcerative Colitis: Another chronic inflammatory bowel condition that causes long-lasting inflammation and ulcers in the digestive tract, primarily in the colon.

• Diverticulitis: A condition that occurs when small pouches called diverticula form in the wall of the colon and become inflamed or infected.

• Bowel Obstruction: Blockages in the intestines that prevent the normal passage of waste material.

• Cancer: Tumors in the bowel may obstruct normal function, requiring surgical intervention. Each of these conditions may prevent the normal absorption of nutrients and fluids, making ostomy creation necessary to manage waste elimination.

Assessing the Ostomy and Stoma

Stoma Appearance:

• The stoma initially appears shiny and swollen after surgery; as it heals, it should take on a healthy, vibrant pink color.

• A stoma exhibiting good perfusion is a positive sign; however, discoloration may indicate potential health issues.

Monitoring Stoma Health:

Signs indicating potential complications include:

• Black or Dark Stoma: Typically indicates necrosis, which may require surgical intervention.

• Beefy Red Stoma: Could suggest infection or compromised blood circulation, warranting further assessment.

Drainage Assessment and Colostomy Management

Contents of Colostomy Bag:

• For Ileostomy: The output typically consists of dark green, watery fluid that may include minimal chunks of stool.

• For Colostomy: The colostomy output generally becomes progressively drier and more formed as it moves further along the colon, depending on the part of the colon used and the individual's diet.

Skin Care: It is crucial to protect the skin surrounding the stoma from irritation and potential infection. Skin care requires:

• Regular assessment for redness, flaking, glossy appearances, signs of irritation, or breakdown.

• Barrier Wafers: Should be cut slightly larger than the stoma to ensure a proper protective fit, preventing leakage.

Nursing Care Involves Teaching and Assessment

Patient Education: Patients must be informed about their condition and how to manage their ostomy effectively. Key education points include:

• Stoma Assessment: Teach patients how to examine their stoma and surrounding skin for any signs of complications.

• Bagging Techniques: Instructions on how to effectively manage their ostomy bag, including:

  • Emptying the bag when it is filled to one-third or half full to avoid leakage or odor.

  • Burping the bag to relieve gas buildup.

• Changing the System: Usually required every 3 to 5 days, patients should learn how to measure and cut the wafer for a snug fit around the stoma.

• Medication Considerations: Patients should understand how their medications may interact with their new ostomy, as some medications can affect stool consistency or absorption.

Conclusion

Proper assessment of the stoma along with surrounding skin care is essential for the patient's well-being following ostomy surgery. Continuous education, skills teaching, and emotional support are crucial components that empower patients to successfully manage their ostomy and maintain their quality of life.