Lesson 4-7: Pre+PostOp Management Of The Ostomy Patient Flashcards
Goals of Ostomy Care
- establish a secure pouching system
- independence in self care
- patient/caregiver confidence in ability to manage
- resumption of usual activities
- positive self image
Preoperative goals
- Assure informed consent
- Provide basic understanding of ostomy management
- Begin establishing rapport between patient and enterostomal team
Preoperative teaching
- Overview of systems involved
- Explanation of surgical procedure
- Potential impact on sexual function
- Appearance and function of stoma
- Basics of ostomy management
- Impact of lifestyle
Criteria + Guidelines for Stoma Marking
Goal: site that is free of wrinkles, creases, umbilicus, bony prominences, incision line, and belt line
- Have patient lie supine
- Palpate edges of rectus muscle (or bilateral midclavicular for obese/distended abdo)
- Have patient sit and flex to assess creases and folds in abdo
- Triangulate sites in each quadrant with following landmarks:
— Upper: umbilicus, xiphoid process, and base of rib cage
— Lower: umbilicus, symphysis, and iliac crest - Use barrier wafer to trial different spots and in different positions for patient
Ie. sitting, standing, twisting
Locations for ileostomy + Ileal conduit
RUQ and RLQ
Locations for descending + sigmoid colostomy
LLQ + LUQ
Locations for transverse colostomy
LUQ and RUQ
Stoma Marking Considerations - Panus
- Stoma must be marked above panus
- Cannot extent bowel through 2 layers of tissue
Stoma Marking Considerations - Obese Abdomen
- Upper quadrants are best choice
- Identify line of site and mark
- Can be difficult for surgeon to mobilize bowel d/t adhesions
Stoma Marking Considerations - Chest/Abdo Bracd
Assess sites with brace on/off
Stoma Marking Considerations - WHeelchari Bound
- mark in and out of wheelchair
- watch patient during twisting transfers
Stoma Marking Considerations - 2 Stomas
- Ie. fecal and urinary
- Can be mirror image on opposite sides
- Recommended to have urinary stoma higher than fecal d/t fecal contamination
- Different planes allows for belts to be added
Viable Stoma - Colour
- Pink/red and moist
- Ischemia - gray, brown or black and dry
- Can be dark maroon for few days d/t stoma edema
Stoma necrosis
- If limited to stoma - proximal bowel is still viable
— Necrotic stoma can slough but will retract
- If necrosis extends to proximal bowel - back to OR
— Can assess with test tube and flashlight
Viable Stoma - Output
Fecal stoma
- Gas and stool
- Timeframe dependant on type of stoma and location
Urinary stoma
- Should be immediate
- Hematuria normal
Goals of effective pouching system
- Containment of stool/urine + odor
- Protection of peristomal skin
- Prevention of peristomal burning and itching
- Predictable wear time
Urinary Stoma Pouching
- Standard, anti-reflux, night bag
- Have spout for easy emptying
- Can add adaptor for night bag
- Anti-reflux allows urine to sit away from peristomal skin
Fecal Stoma Pouching
- Drainable, high output, or closed ended
- Drainable - wide spout for emptying
- High output - modified spout for drainage bag
- Closed-ended - no emptying capabilities
must be removed in entirely and thrown away - 1 or 2-piece available
1-piece appliance
- fewer steps in pouch change procedure
- good for patients with limited dexterity
2-piece pouch
- easier to center barrier around stoma
- can change bag without barrier
- barrier and pouch snap together
Type of barrier - Karaya
- Infrequently used
- For solid stool only
- No adhesion
Type of Barrier - Hydrocolloid standard wear
- Moldable adhesive
- Can absorb limited moisture
- For mushy/formed stool or frequent pouch changes
Type of Barrier - Hydrocolloid Extended Wear
- Greater absorption and swells with moisture
- Can seal for long periods of time
- For high volume + liquid output
Type of Barrier - Infused Hydrocolloid
- promises peristomal health
- infused with creams, manuka honey, or aloe
Shapes of Barriers
- Flat, convex
- Flat + rigid - for protruding stoma on flat surface
- Flat + flexible - for deep peristomal creases
- Convex - for stoma that empties at skin level or stoma in concave defect
Decision-Making Pathway
- assess the patient
- select the basic pouch type
- select 1 or 2-piece system
- select barrier formulation
- select barrier shape/contour
- select accessory products as needed
