Dawn Klecka MSN, MBA, RN Deb Losicki MSN RN FNP-BC Ostomy Care Dawn Klecka MSN, MBA, RN Deb Losicki MSN RN FNP-BC

Objectives Verbalize understanding of the anatomy and physiology of the gastrointestinal tract Verbalize the understanding of conditions that would result in the need for an artificial port (ostomy) Verbalize the understanding of the different sites of an ostomy Verbalize the understanding of the care for an ostomy Verbalize the understanding of precautions required related to diet, activity, and medication of a patient with a ostomy Consider the ethnic, age related, and sexual considerations of a patient with an ostomy

Ostomy An Ostomy is a surgical opening for elimination of intestinal contents. The Stoma - is the opening through the abd, it is created when the intestine is sutured to the skin. It allows the diseased portion of bowel to rest and heal. Ostomies can be temporary or permanent.

Types of Ostomys Colostomy– is an opening between the colon and the abd wall.

Ileostomy – is an opening from the ileum through the abdominal wall.

Purpose of Ostomy Allow the bowel to rest after trauma (GSW) Following Colectomy 2nd to CRC Tumor Resection Bowel can be anastomosed after healing Permanent Immediate anastomisis

Categorized by location and type Ascending Colostomy Descending Colostomy Ileostomy Sigmoid Colostomy Transverse Colostomy (Double Barreled) Which Ostomy will have the most formed stool? Why?

Problems/ Interventions Constipation - increase fluids, warm prune juice, increase fiber, fruit, bran & whole grain. Diarrhea - encourage fluids, bland food, small amounts, avoid spicy, hot or cold foods & high fiber. Flatulence - avoid carbonated beverages, gum, drinking from a straw, cabbage, beans, cauliflower & onions.

Diet Continued Post surgery—Clear liquids Advanced to low fiber diet Then regulate nutrition intake to meet individual needs Goal to maintain adequate nutrition and avoid blockage and pain flatus, diarrhea and constipation. Risk for deficient fluid volume Goal to avoid obstruction…fibrous meats, corn cabbage celery, green peppers, and peas. Fruit skins and seeds, nuts dried fruits, and popcorn

Care for Ostomy Site Ostomy Management

Ostomy Management Maintain privacy Remember the psychological effects: body image disturbance & self-esteem disturbance Bet to perform care between meals Fecal material is very irritating to the skin Assess stoma & surrounding skin each time you change or empty the appliance. Look for color, edema, bleeding c/o burning under skin barrier may be 2nd to skin breakdowm Can delegate to UAP’s UAP’s cannot take care of a new ostomy. UAP’s can remove and change old established devices. Whan changing the device and cleaning put some gauze over the stoma site to catch any drainage.

Characteristics of Stoma Cause Rose to brick-red Pale Blanching, dark red-purple Edema Viable stoma mucosa Anemia? Inadequate blood supply Normal post op Trauma, obstruction, allergy, gastroenteritis

Characteristics of Stoma Cause Bleeding Small amount Moderate to LARGE Oozing from stoma when touched..normal Coagulation factor deficiency Lower GI bleed

Ostomy Management Observe skin for irritation. Skin should be cleaned & dried thoroughly. Apply skin barrier cream around stoma Odor control is essential to pts self-esteem! Appliance should be cleaned in the bathroom when they are 1/3 to 1/2 full Avoid mealtimes to clean appliance! http://www.youtube.com/watch?v=t2k70UmFpXI&feature=related

Measuring The pouch must fit snugly to prevent leakage. How many of you have changed an appliance where you had to cut out the hole? Stoma measuring card. Measure to fit no more then 1/6 the opening. http://www.youtube.com/watch?v=dbVcq-5YQhM&feature=related

Colostomy Irrigation Similar to an enema. Insert lubricated cone tip before irrigation otherwise the fluid will run out. Routine irrigation's control the time of elimination's. When regular pattern is achieved the wearing of a colostomy pouch is unnecessary.

Nursing Diagnoses Risk for deficient Fluid Volume Risk for impaired skin integrity Deficient Knowledge Disturbed body image Products | C&S Ostomy Pouch CoversDiet & Fitness With An Ostomy | LIVESTRONG.COM United Ostomy Associations of America - Ostomy, Colostomy, Ileostomy, Urostomy, Continent Diversion Support Groups

Questions? Discussion & Practice http://www.youtube.com/watch?v=y0Jfapk_khM&feature=player_embedded