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Ostomy 2.2 > Lesson 4-7: Pre+PostOp Management Of The Ostomy Patient > Flashcards

Lesson 4-7: Pre+PostOp Management Of The Ostomy Patient Flashcards

1
Q

Goals of Ostomy Care

A
  • establish a secure pouching system
  • independence in self care
  • patient/caregiver confidence in ability to manage
  • resumption of usual activities
  • positive self image
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2
Q

Preoperative goals

A
  • Assure informed consent
  • Provide basic understanding of ostomy management
  • Begin establishing rapport between patient and enterostomal team
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3
Q

Preoperative teaching

A
  • 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
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4
Q

Criteria + Guidelines for Stoma Marking

A

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
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5
Q

Locations for ileostomy + Ileal conduit

A

RUQ and RLQ

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6
Q

Locations for descending + sigmoid colostomy

A

LLQ + LUQ

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7
Q

Locations for transverse colostomy

A

LUQ and RUQ

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8
Q

Stoma Marking Considerations - Panus

A
  • Stoma must be marked above panus
  • Cannot extent bowel through 2 layers of tissue
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9
Q

Stoma Marking Considerations - Obese Abdomen

A
  • Upper quadrants are best choice
  • Identify line of site and mark
  • Can be difficult for surgeon to mobilize bowel d/t adhesions
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10
Q

Stoma Marking Considerations - Chest/Abdo Bracd

A

Assess sites with brace on/off

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11
Q

Stoma Marking Considerations - WHeelchari Bound

A
  • mark in and out of wheelchair
  • watch patient during twisting transfers
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12
Q

Stoma Marking Considerations - 2 Stomas

A
  • 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
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13
Q

Viable Stoma - Colour

A
  • 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

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14
Q

Viable Stoma - Output

A

Fecal stoma
- Gas and stool
- Timeframe dependant on type of stoma and location

Urinary stoma
- Should be immediate
- Hematuria normal

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15
Q

Goals of effective pouching system

A
  • Containment of stool/urine + odor
  • Protection of peristomal skin
  • Prevention of peristomal burning and itching
  • Predictable wear time
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16
Q

Urinary Stoma Pouching

A
  • 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
17
Q

Fecal Stoma Pouching

A
  • 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
18
Q

1-piece appliance

A
  • fewer steps in pouch change procedure
  • good for patients with limited dexterity
19
Q

2-piece pouch

A
  • easier to center barrier around stoma
  • can change bag without barrier
  • barrier and pouch snap together
20
Q

Type of barrier - Karaya

A
  • Infrequently used
  • For solid stool only
  • No adhesion
21
Q

Type of Barrier - Hydrocolloid standard wear

A
  • Moldable adhesive
  • Can absorb limited moisture
  • For mushy/formed stool or frequent pouch changes
22
Q

Type of Barrier - Hydrocolloid Extended Wear

A
  • Greater absorption and swells with moisture
  • Can seal for long periods of time
  • For high volume + liquid output
23
Q

Type of Barrier - Infused Hydrocolloid

A
  • promises peristomal health
  • infused with creams, manuka honey, or aloe
24
Q

Shapes of Barriers

A
  • 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
25
Q

Decision-Making Pathway

A
  • 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

Ostomy 2.2 (15 decks)

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