6.1 Urinary and Bowel Diversions: Ostomy Care Flashcards
1
Q
Ostomy
A
- Surgical formed opening from the inside of an organ to the outside
- Stoma is the protruding section formed
2
Q
External Appliance
A
- Urinary and bowel diversions are collected in a soft pouch
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3
Q
Changing a Pouch
A
- Inspect Stoma (Should be pink, not purple or black)
- Wafer replaced every 3-7 days.
STEPS
1 - Cleanse skin around stoma
2 - Measure stoma and cut open pouch
3 - Remove adhesive backing from wafer and apply pouch
4 - Press firmly into place over the stoma
5 - Observe appearance of stoma and surrounding skin
4
Q
Long Term Ostomy Care
A
- Explain reason for Ostomy and rationale for treatment
- Verbalize related fears and concerns
- Relate community resources available
- Encourage patient to seek follow-up care
- Patient education is essential in independence in selfcare
- Empty bag frequently (1/3 full) and odor control
- Demonstrate self care habits
- Demonstrate positive body image
- Avoid physical contact sports and heavy lifting
(Swimming is Okay) - 1-2 days worth of supply equipment on carry on bag incase luggage is lost during traveling
- Counseling dietary changes as appropriate for the type of device
5
Q
Long Term Ostomy Care
A
Size of stoma should stabilize in 6-8 weeks
- Protrudes 1/2-1 inch from abdomen. May appear swollen and edematous
- Edema subsides in 6 weeks
- If there is dressing, check frequently for drainage and bleeding. Dressing is removed in 24 hours.
6
Q
Long Term Ostomy Care
A
Moist, protruding and red
- Purple/Dry/Flush with skin Report immediately
- Pale Stoma may indicate anemia
- Blue/Dark Purple may indicate ischemia/circulation
- Notify PCP if bleeding persists/excessive
- Keep skin around Stoma Clean and Dry
- Measure patients input and output
7
Q
Urostomy
A
Obstructions/tumors in the urinary tract may require patients to have urinary flow diverted. This is called a Urostomy
8
Q
Ileal Conduit (Urostomy)
A
- Small intestines brought out of abdominal wall.
- Urine is excreted through a stoma
9
Q
Cutaneous Ureterostomy
A
- Ureters directed through abdominal wall and attach to opening in the skin. (Permanent)
- Patient wears external appliance to collect urine
- Elimination from stoma cannot be controlled voluntarily
10
Q
Continent Urinary Diversion (CUD)
A
- Alternative that uses intestines as an internal reservoir that holds urine.
- There is a catheterizable stoma
- External stoma needs to be catheterized at regular intervals
11
Q
Patient Education Urinary Diversion
A
- Patient urinary output is important to detect fluid imbalance and adequate functioning of diversion
- Mucus in urine is normal and dose not pose problem for ileal conduit but must be irrigated with normal saline for continent urinary diversion to prevent catheter blockage
- Monitor return of intestinal function and peristalsis
12
Q
Ileostomy
A
- Attached to ileum in small intestines and allows liquid fetal content
13
Q
Colostomy
A
- Attached to colon and classified to where it is attached
- Sigmoid colostomy, descending colostomy, transverse colostomy, ascending colostomy)
- Permits soft to formed feces depending how far feces descends down colon.
14
Q
J-Pouch
A
- Internal pouch that removes colon and rectum.
- Sutures small intestines directly to anus
- Reservoir pouch is created that permits liquid feces
- Patient may have frequent defecation and fecal seepage or incontinence.
15
Q
Specific Care for Colostomy (Diet)
A
- First 6-8 weeks gradually add new foods and avoid high fiber (skin, seeds, shells) and avoid foods that cause diarrhea or flatus (gas) (beans, cabbage, cauliflower, Brussel sprouts, simple carbs, potatoes)
16
Q
Specific Care for Colostomy (Hydration)
A
- Drink at least 2 quarts of fluid (water) a day.
- Ileostomies need to ensure adequate liquid intake to avoid dehydration and fluid electrolyte imbalance
- Ileostomies are commonly seen to have large liquid outputs
- Electrolyte balance should be monitored if they have increased output
17
Q
Preventing Food Blockage
A
- Ileostomies (Scar tissue narrows intestine much less than the normal 1 inch)
- Food blockage may occur
- Avoid foods like popcorn, coconuts, mushrooms, stringy vegetables, and food with skin/casings.
18
Q
Medications
A
- Medication may not be fully absorbed as small bowel is where most medication is absorbed
- Liquid, chewable, injection medication recommended
- Avoid long acting, enteric-coated or sustained release medications.
- Laxatives and enemas are dangerous
19
Q
Irrigating Colostomy
A
- Used to achieve fecal continence and control for people with left end colostomy in descending or sigmoid colon.
- Insert water through colostomy and expel through irrigation sleeve into toilet
20
Q
Irrigating Colostomy
A
- Used to establish routine for bowel continence
- Stoma cap can be used to soak up discharge and flatus (gas) instead of larger bags
- Must require patient be mentally alert, adequate vision, manual dexterity.
- Should not preform if patient has IBS, peristomal hernia, damage from radiation, diverticulitis, Crohn’s disease.
21
Q
Expected Outcomes Irrigating Colostomy
A
- Patient expels soft, formed stools
- Remains free of evidence of trauma to stoma and intestinal mucosa
- Ability to participate in care
- Voices increased confidence for ostomy care
