ATI SKILLS- OSTOMY CARE Flashcards
OSTOMY
SURGICALLY CREATED OPENING IN THE ABDOMINAL WALL TO ALLOW FOR THE ELIMINATION OF URINE OR FECES
INDICATIONS FOR AN OSTOMY SURGERY
- CONGENITAL ANOMALIES
- BLADDER, COLON, AND RECTAL CANCER
- IBD (CROHNS DISEASE, ULCERATIVE COLITIS)
- INHERITED DISORDERS
- OBSTRUCTION OF THE URETER
- STAB/GUNSHOT WOUND TO THE ABDOMEN
3 TYPES OF OSTOMY SUGERY
COLOSTOMY
ILEOSTOMY
UROSTOMY
STOMA
SURGICALLY CREATED OPENING IN THE SKIN OF THE ABDOMEN
THE COMMUNICATING END BROUGHT THROUGH THE SKIN
THE LOCATION OF THE STOMA DEPENDS ON WHAT
- LOCATION OF BELT LINE
- ANY SCARS/SKIN FOLDS
- WHERE THE DAMAGE IS
- TYPE OF OSTOMY PERFORMED
WHAT SHOULD A STOMA LOOK LIKE
SHINY, MOIST, RED, SIMILAR TO THE MUCOUS MEMBRANES OF THE MOUTH, ROUND OR OVAL, PROTRUDING, FLUSH OR RETRACTED
COLOSTOMY
CREATED FROM THE END OF THE LARGE INTESTINE TO DIVERT WASTE FROM THE DIGESTIVE SYSTEM
3 TYPES OF COLOSTOMY
END COLOSTOMY
LOOP COLOSTOMY
DOUBLE BARREL COLOSTOMY
END COLOSTOMY
DAMAGED SECTION IS REMOVED, WORKING END IS BROUGH THROUGH THE ABDOMEN
USUALLY USED WHEN IT IS MEANT TO BE PERMANENT
WHEN MAY A TEMPORARY COLOSTOMY BE PERFORMED
TO ALLOW FOR BOWEL REST/HEALING SUCH AS FOLLOWING TUMOR RESECTION
HARTMANN’S POUCH
WHAT IS CREATED WITH A TEMPORARY COLOSTOMY SURGERY WHERE THE DISTAL PORTION IS LEFT IN PLACE AND OVERSOWN FOR CLOSURE
ANASTOMOSIS
surgical connection between 2 structures. it most often means a connection that is created between tubular structures, such as blood vessels or loops of intestine
what happens in a loop colostomy
a loop of the bowel is brought through the abdomen to the skin surface and temporarily supported by a plastic bridge or rod
when would a transverse loop colostomy created
as an emergency procedure to relieve an intestinal obstruction or perforation
how is the stoma in a loop colostomy different from others
- 2 openings through one stoma (proximal drains stool and distal drains mucus)
- bridge can be removed in 7-10 days
- typically temporary
explain the stoma(s) in a double barrel colostomy
2 seperate stomas are brought through the abdomen in 2 different places. the distal colon is usually just bypassed. the proximal stoma is functional and diverts feces to the abdominal wall
distal stoma of a double barrel colostomy
aka mucous fistula
expels mucus from the distal colon
ascending colon (right abdomen)
stoma location
output is typically liquid to semi liquid and very irritating to surrounding skin
transverse colon (mid abdomen)
stoma location
used for temporary ostomy
stoma constructed as a loop
output is pasty
descending colon
left upper abdomen
stoma location
output is semi formed because more water is absorbed while fecal material is in the ascending and transverse colon
sigmoid colon
left lower abdomen
stoma location
location for a permanent colostomy
particularly for cancer of the rectum
typically located on the lower left quadrant of the abdomen and the output is formed
foods that MAY have to be avoided after a colostomy
chocolate, dried beans, fried foods, highly spiced foods, raw fruits/vegetables, and even antibiotics
foods that may cause a blockage with a colostomy
stringy vegetables, coconut, coleslaw, mushrooms, popcorn, seeds, berries, celery, fresh tomatoes
if a colostomy patient is having large amounts of effluent, what should we suggest
limit insoluble fiber intake to decrease time required for food digestion. some may have to add foods that thicken stool like applesauce, bananas, cheese, pasta, and rice
clients can prevent the passage of malodorous flatus by avoiding foods that cause odors such as
asparagus, beans, cabbage, eggs, fish, garlic, onions, some spices
why should colostomy patients use caution when using laxatives and enenmas
potential for fluid and electrolyte imbalance. should also use caution with enteric coated and sustained release meds.
ileostomy
surgical opening created in the ileum to bypass the entire large intestine
stoma of an ileostomy is typically located
right lower quadrant
a restorative proctocolectomy with ileal pouch anal anastomosis (ipaa) involves
connecting the ileum to a new rectum (anal pouch) also made out of a portion of ileum
when is ipaa procedure of choice
where rectum can be preserved. allows the client to retain anal sphincter control of bm. will have a temporary loop ileostomy while the pouch heals
kock’s continent ileostomy
internal pouch is created from the distal segment of the ileum which serves as a reservoir for stool. a one way nipple valve is constructed through the stoma so client can insert catheter and drain contents
clients who have an ileostomy are at a higher risk of what
fluid and electrolyte imbalances due to shorter transit time through the bowel, decreased absorption of fluid/nutrients, and higher volume of effluent. Na and K can be depleted quickly. prevention requires at least 80-96 ounces of h2o daily
when ileostomy is new, what are some special considerations
- chew thoroughly– narrow ileum
- avoid high fiber foods for first 6-8 weeks
- avoid foods causing intestinal gas
- caution with enteric coated meds
drainage from an ileostomy is typically
dark green, loose, odorless
when to empty ileostomy pouch
1/3-1/2 full
may require several times a day
contains enzymes and bile salts that can irritate the skin
skin barrier
protective artificial layer placed over skin to protect it and help maintain skin integrity
common manifestations of food blockage to be aware of
cramping, n&v, stoma swelling, no output for 6+ hours. will need to lie down in a knee-chest position to releive pressure and massage to promote peristalsis and fecal elimination
urostomy
urinary diversion that allows urine to exit the body after removal of a diseased or damaged section of the urinary tract
ileal conduit
isolated segment of ileum that serves as a substitution for the bladder. ureters are implanted and the lumen is connected to the skin
