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
colectomy
removal of colon, leaves rectum intact; permanent or temporary ileostomy
proctocolectomy
removal of colon and rectum; permanent end ileostomy and perineal incision
ileal pouch anal anastomosis
- pelvic pouch procedure or j-pouch constructed of ileum and sewn to the anal canal
- only offered for ulcerative colitis and FAP, not Crohn’s
low anterior resection
- removal of rectal cancer and anastomosis of remaining large bowel
- temporary loop ileostomy is created to divert stool rom anastomosis
total pelvic exenteration
removal of reproductive organs, bladder, affected bowel w resulting fecal ostomy as well a urinary ostomy, permanent procedure
anterior pelvic exenteration
removal of reproductive organs and bladder w resulting ileal conduit while leaving bowel intact; permanent procedure
stoma site selection
- identifies areas to avoid
- allows for visualization of the abdomen in multipple positions for adequate adhesion and visibility
- allows for “trial” for patient under their own clothing
- marking is best practice!
stoma assessment is done
Q4hr x Q48hr then Qshift
stoma complications: necrosis
impaired blood low to/from the stoma that changes viability and causes stoma death
stoma complications: mucocutaneous separation
dehiscence btwn stoma and peristomal skin
stoma complications: prolapse
stoma becomes longer/sticks up further than normal
stoma complications: retraction
stoma no longer protrudes and is sunken into the abdomen
stoma complications: stenosis
lumen/stoma opening becomes narrowed
stoma complications: laceration
cut on stoma
stoma complications: malignancy
tumor growth on the stoma or surrounding skin
peristomal skin complications
- mechanical trauma
- skin allergens
- irritant or contact dermatitis
- infection
- diseases and dermatological skin conditions
- hernia
what do we do when we see paristomal skin breakdown? if leakage occurs what do we not do? what are the next steps if you were an RN seeing this?
- do not ignore skin breakdown
- if leakage occurs, do not reinforce a leaking system
- re-fit accordingly
- seek assistance from NSWOC nurse
challenges in ostomy care in general
- poorly created or sited ostomy
- skin breakdown due to contact w effluent
- lack of knowledge about peristomal skin disorders and ostomy management
- delay in obtaining intervention from NSWOC/ostomy nurse
- expensive
- limited help available
nursing goals for ostomy managemet
- skin protection
- containment of effluent
- odour control
- patient comfort
- accurate measurement of effluent
- pt mobility
- ease of care
- cost containment
ostomy supplies
- skin barriers (flat vs convex)
- pouching sys (1 pc vs 2 pc, type of pouch)
- belts
- convex inserts/built-in/rings
- pouch covers
- bedside drainage sys
- clamp
- deodorants
life after ostomy surgery
- pt’s usually back to work 4-6 weeks after surgery
- independent w emptying and changing the pouch
- fluid intake
- med changes
- minor clothing alterations or preferences
- minor diet alterations
- need to rebuild core and pelvic floor strength
most common cause of skin breakdown is due to…
leakage and frequent changes
would you add additional adhesives onto peristomal skin conditions
no!
