lecture 16: Ostomy Care Flashcards
role of the NSWOC in continence care
- assessment and identification of various types of urinary and fecal incontinence and bladder & bowel dysfunction
- recommendation of conservative measure to manage incontinence
- selection of containment products/devices
- referral to other services
role of NSWOC in ostomy care pre-operatively
- counseling
- family support
- stoma site selection and marketing
role of NSWOC in ostomy care post-operatively
- assess stoma visibility
- assess ostomy management
- fitting of pouching system
- patient education
- prepare for discharge
- connection w community care and supports
- funding
- ongoing assessment in community
what is an ostomy
surgical opening oten exteriorized for the elimination of body waste
what is a fecal ostomy
surgical procedure that reroutes the normal movement of bowel contents out of the body when the bowel is diseased or removed
urinary ostomy
surgical procedure that reroutes the normal movement of urine when the bladder is removed
what are the 3 most common ostomies
- colostomy
- ileostomy
- urostomy
- can be temp or permanent
- usually digestive and urinary tracts
- any part of the anatomy
what is an ileostomy
- surgically created opening into the small intestine through the abdomen
- small intestine and colon have been removed or bypassed
what stoma site, output, and construction does an ileostomy have
site: RLQ
construction: end or loop
output: 650ml-900ml (liquid to pasty consistency)
when do you usually empty pouch for an ileostomy
empty 6-8 times per day
what is a colostomy
- surgically created opening into large intestine through abdomen
- section of colon have been removed or bypassed
colostomy site, output, and construction
site: LLQ
construction: end or loop
output: 200-600ml (thick paste to semi-formed)
when do you empty colostomy pouch
1-2 times per day
what is a ileal conduit (urostomy)
- surgically created opening to drain urine
- section of ileum is used as a pipeline for urine to leave body, then remaining intestine is reconnected
- new section is sewn shut on one side, and ureters are connected. end of bowel brought through abdominal wall to create stoma
urostomy site, construction, output
site: RLQ
construction: end
output: min 800ml/24hr
(clear yellow urine w small amounts of mucus)
how often should you empty a urostomy pouch
every few hrs
reason for ostomy surgery
- CANCER
- colon, rectum, bladder, gyne - TRAUMA
- stabbing, accident - DIVERTICULITIS
- INFLAMMATORY BOWEL DISEASE
- ulcerative colitis
- crohn’s disease - GENETIC CONDITIONS
- CONGENITAL ANOMALIES AND NEONATE COMPLICATIONS
5 anatomic ostomy locations
- transverse colostomy
- right colostomy
- ileostomy
- jejunostomy
- left colostomy
describe stomas
- no nerve endings in the stoma, ppl w an ostomy cannot feel when gas/stool/urine is passing
- thin layer of mucus coats bowel
- oval or round, can be swollen for 1st 6-8 weeks after surgery
- bleeds easily
- stitches dissolve in 2-3 weeks
- stoma should be red, warm, moist
no sphincter =
no control over flow of stool or urine
types of stomas
- brooke ostomy
- end ostomy
- double-barrel
- mucus fistula
- loop ostomy
- vent “blow-hole”
how are support rods used in the surgeries
- surgeon preference/technique
- stay in place for 5-7 days then removed by NSWOC or surgeon
- prevent retraction and allow mucocutaneous junction to heal
- limit patient involvement/self-care
hartmann’s procedure
removal of affected sigmoid colon while leaving an over-sewn internal rectal stump; ostomy can be reversed at a later date
abdominal perineal resection
removal of rectum and diverting w a colostomy, permanent procedure
