BOWEL DIVERSION OSTOMY Prepared by: DR. IRENE ROCO Asst. Professor

Outline Definition of Bowel Diversion Ostomy Purpose Classification a. status b. Anatomic location c. surgical construction Ostomy Management Assessment Ostomy change References

Definition OSTOMY – an opening for the gastrointestinal, urinary, or respiratory tract into the skin Divert and drain fecal material PURPOSE

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 1. Status a. Permanent – to provide means of elimination when the rectum or anus is non functional ( birth defect / cancer) b. Temporary – for traumatic injuries or inflammatory conditions of the bowel, allowing the bowel to rest and heal

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 2. Anatomical location - influences the character and management of fecal drainage The farther along the bowel, The length of time, the more formed the stool and the more control over the frequency of stomal discharge can be established TYPES OF INTESTINAL OSTOMY: Gastrostomy – opening through the abdominal wall in the stomach Jejunostomy - opening through the abdominal wall in the jejunum Ileostomy - opening through the abdominal wall in the ileum Colostomy - opening through the abdominal wall in the colon

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES Type of drainage Nursing Responsibility Ileostomy / ascending colostomy Liquid fecal drainage; no control Instruct Client to wear appliance continuously and take special precautions to prevent skin breakdown Odor is minimal because fewer bacteria are present Transverse colostomy Malodorous, mushy drainage ; liquid has been reabsorbed; no control Descending colostomy Solid fecal drainage sigmoidostomy Normal or formed consistency ; can be controlled Client may not have to wear appliance at all times

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 3. Construction of the stoma single – one end of the bowel is brought out through an abdominal opening b. Loop – loop of bowel is brought into the abdominal wall and supported by a plastic bridge , or a piece of rubber tubing; has two openings (proximal and distal)

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 3. Construction of the stoma c. Divided colostomy – two edges of bowel brought out into the abdomen but separated from each other d. Double barrel - proximal and distal loops of bowel are sutured together for about 10 cm and both ends are brought up into the abdominal wall Divided colostomy – Double barrel

OSTOMY APPLIANCE Consist of : skin barrier Pouch – can be closed or dainable Adjustable Ostomy belt

OSTOMY MANAGEMENT Consists of group of nursing interventions that may be necessary after fecal diversion surgery Stoma assessment Application of stoma to collect feces and protect skin Promotion of self care

Assessment Assess for: Normal Abnormal Color Healthy pink, red and slightly moist Dusky pink / bluish (cyanosis) suggest inadequate circulation to the stoma Size and shape New stoma are swollen; swelling decreases in 2-3 weeks or as long as 6 weeks Protrude slightly from the abdomen Failure to recede may indicate blockage Position Must remain on the abdominal surface If stoma retracts, feces may enter the abdominal cavity and cause peritonitis; Prolapse must be reported to the doctor Stomal bleeding Slight bleeding Report other bleeding Complaints Burning sensation under the skin may indicate skin breakdown Abdominal discomfort / distention

OSTOMY CHANGE Can be applied for up to 7 days Twice a week Change whenever the stool leaks onto the peristomal skin Every 24 – 48 hrs if the skin is erythematous, eroded, denuded or ulcerated More frequent changes if client complains of pain or discomfort The pouch is emptied when it is one third to one half full If the pouch overfills, it can cause separation of the skin barrier and stool comes in contact with the skin

PURPOSE OF OSTOMY CHANGE To assess and care for peristomal skin To collect stool for assessment of the amount and type of output Minimize odors for the client’s comfort and self esteem

References Kozier & Erbs’ Fundamentals of Nursing . Eighth ed. 2008 Potter Perry. Basic Nursing 6th ed..Mosby, Missouri, 2006.