Ostomy Care

What is an ostomy The process whereby an opening is created in the abdominal wall for the elimination of feces or urine The process whereby an opening is created in the abdominal wall for the elimination of feces or urine “Ostomy” mean opening into the body “Ostomy” mean opening into the body May be permanent or temporary May be permanent or temporary Colostomy, ileostomy, ureterostomy Colostomy, ileostomy, ureterostomy

Why???? Cancer of the bladder or colon Cancer of the bladder or colon Trauma Trauma Inflammatory bowel disease Inflammatory bowel disease Congenital disease Congenital disease

Normal anatomy of bowel

Colostomy

ileostomy

Same principles as a colostomy however the connection is from the small bowel out through the abdomen Same principles as a colostomy however the connection is from the small bowel out through the abdomen Discharge will be quite liquid to semi- solid Discharge will be quite liquid to semi- solid Diet will have an impact on discharge Diet will have an impact on discharge Acidity will be a factor as well Acidity will be a factor as well

UROSTOMY Involves the surgical construction of the ureters to the abdomen to form a stoma which permits the discharge of urine after removal of the bladder Involves the surgical construction of the ureters to the abdomen to form a stoma which permits the discharge of urine after removal of the bladder Wearing an appliance is needed at all times, the skin around the stoma must be protected Wearing an appliance is needed at all times, the skin around the stoma must be protected

Bladder diversions

Post operative assessment of a new stoma Assess color and integrity of stoma Assess color and integrity of stoma A healthy stoma should be reddish pink, and moist, and will protrude about ¼ of an inch. A healthy stoma should be reddish pink, and moist, and will protrude about ¼ of an inch. Small amount of bleeding may be seen Small amount of bleeding may be seen Signs of ischemia and necrosis: dark red, purple or black, dry, Signs of ischemia and necrosis: dark red, purple or black, dry, Unusual bleeding Unusual bleeding

The colostomy usually starts functioning 2-4 days post –op The colostomy usually starts functioning 2-4 days post –op The pouch may need to be emptied frequently The pouch may need to be emptied frequently Peristomal skin must be assessed for breakdown Peristomal skin must be assessed for breakdown

Health Teaching Normal appearance of stoma Normal appearance of stoma Measurement of the stoma Measurement of the stoma Use of appliance to collect stool Use of appliance to collect stool Measures to protect the skin adjacent to stoma Measures to protect the skin adjacent to stoma Dietary measures to control gas Dietary measures to control gas Resumption of normal activities Resumption of normal activities 1/8-1/4 bigger than stoma (appliance) 1/8-1/4 bigger than stoma (appliance) Barrier creams, sealants, anti-fungals Barrier creams, sealants, anti-fungals Able to eat all foods but often broccoli, cabbage, brussel sprouts, cucumbers, mushrooms cause extra gas Able to eat all foods but often broccoli, cabbage, brussel sprouts, cucumbers, mushrooms cause extra gas

Lab Activities Teach the application of an ostomy device Teach the application of an ostomy device Have your peer return the demo to you Have your peer return the demo to you Discuss the psychosocial issues that may be associated with wearing a device and this type of surgery Discuss the psychosocial issues that may be associated with wearing a device and this type of surgery Wear your ostomy for 24 hours. Do you think it will have an impact on your life? Wear your ostomy for 24 hours. Do you think it will have an impact on your life?