1. Ostomies & Care Dawn Klecka, MSN, MBA, RN Deb Losicki, MSN, RN FNP-BC
2014
Spell-Check
Nora Vetto, MSN, BSN, RN

2. Student Learning 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 medications for a patient with an ostomy
Consider the ethnic, age related, and sexual needs of a patient with an ostomy
Student Learning Objectives

3. Ostomy
An Ostomy is a surgical opening for elimination of intestinal contents.
The Stoma - is the opening through the abdomen; it is created when the intestine is sutured to the skin.
An ostomy allows the diseased or injured portion of bowel to rest and heal.
Ostomies can be temporary or permanent.
What is an ostomy & stoma

4. Types of Ostomies
Colostomy– is an opening between the colon and the abdominal wall.
Types of Ostomies

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

6. 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?
Which ostomy will have formed stool?

7. Purposes of Ostomy Allow the bowel to rest after trauma
(gun-shot wound, for example)
Following Colectomy
2nd to CRC
Tumor Resection
Bowel can be anastomosed after healing
Permanent
Immediate anastomosis
Ostomy Purposes

8. 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.
Problems & Interventions

9. Diet 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 is to avoid obstruction causes: fibrous meats, corn, cabbage, celery, green peppers, peas, fruit skins, seeds, nuts dried fruits, and popcorn are examples

10. Care of Ostomy Site
Ostomy Management
Ostomy Management

11. Ostomy Management Maintain privacy
Remember the psychological effects: body image disturbance & self-esteem disturbance
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 at color, and for edema, and bleeding
Patient c/o burning under skin barrier may be 2nd to skin breakdown
Follow hospital protocol on who may care for new ostomy and remove and change old established devices.
Place gauze over the stoma site to catch any drainage.

12. 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 color

13. Characteristics of Stoma
Cause
Bleeding
Small amount
Moderate to LARGE amount
Oozing from stoma, if touched, is normal
Coagulation factor deficiency
Lower GI bleed
Stoma Characteristics -bleeding

14. Ostomy Management Observe skin for irritation.
Skin should be cleaned & dried thoroughly.
Apply skin barrier cream around stoma
Odor control is essential to patients self-esteem!
Appliance should be cleaned in the bathroom when they are 1/3 to 1/2 full
Avoid mealtimes to clean appliance!
Ostomy Care

15. Measuring The pouch must fit snugly to prevent leakage.
Stoma measuring card.
Measure to fit no more then 1/6 the opening.

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

17. Nursing Diagnoses Risk for deficient Fluid Volume
Risk for impaired skin integrity
Deficient Knowledge
Disturbed body image
United Ostomy Associations of America - Ostomy, Colostomy, Ileostomy, Urostomy, Continent Diversion Support Groups
Nursing Dx

18. Look at ostomy supplies in skills lab…
Questions?
Look at ostomy supplies in skills lab…
Questions?