Lower GI: Ostomies Flashcards
What are ostomies?
- Surgical procedures that reroute part of the intestine through the abdominal wall, forming a stoma.
- Location of stoma dictates name.
What are the two main types of ostomies?
- Ileostomy
* Colostomy
What are the two types ileostomies?
- Ileostomy (at the ileum)
* Jejunostomy (at jejunum)
Describe an ileostomy?
- Created from the ileum
- Stoma will be located in the LRQ
- Bowel movements are loose/watery
- Ileostomy bag required
- Skin care essential
Describe jejunostomy.
- Created from the jejunum
- Stoma will be located in the URQ
- Bowel movements are loose/watery
- Ileostomy bag required
- Skin care essential
What are the four types of colostomies?
- Ascending
- Transverse (double-barreled)
- Descending
- Sigmoid
Describe the ascending colostomy.
- Created at the ascending colon
- May be located in RLQ or RUQ pending where colon was removed
- Stool will be loose, but slightly firmer than from ileostomy
- Colostomy bag required
- Skin care essential
Describe the transverse (double-barreled) colostomy.
- Two stomas are created at the transverse colon
- Proximal will drain feces, distal will drain mucous
- Often used in such emergencies as intestinal obstruction or perforation as it can be created quickly
- Stool will be semi-solid
- Colostomy bag required
- Skin care risk not as critical as ascending, but still necessary to prevent breakdown
Describe the descending colostomy.
- Created at the descending colon
- May be located in LUQ or RLQ pending where colon was removed
- Stool will formed
- Colostomy bag required
- Skin care required, but less at risk for breakdown
Describe the sigmoid colostomy.
- Created at section of colon between descending and rectum
- Located at RLQ
- Stool will formed
- Colostomy bag may not be required
- Stool formed and movements can be regulated
- Skin care as necessary
Describe J-tube.
- Created @ the jejunum
- Tube will be located in the LUQ
- Used to deliver food/medicine for those not healthy enough to eat by mouth
- Skin and j-tube care required
What should a healthy stoma look like?
- A healthy stoma is pinkish-red and moist.
- Your stoma should stick out slightly from your skin.
- It is normal to see a little mucus. Spots of blood or a small amount of bleeding from your stoma is normal.
If a stoma is a dusky (darker)-red, what should the nurse do?
• Inform doc, possible circulation issue
What is the process of attaching a colostomy/ileostomy bag?
- Clean stoma area
- Apply skin-prep (breathable skin adhesive)
- Apply skin protector
- Apply bag to skin protector
A fresh stoma should start to shrink how long post surgery?
• 3-7 days
When measuring the stoma, for skin protector placement, how much space do you want between the stoma and the skin protector opening?
• 4mm
When changing a colostomy bag, what should you do before throwing it out?
• Make sure you have a replacement bag on hand
What is the procedure when a doctor orders dilation of stoma to ensure patency?
- Put on clean gloves
- Jelly on pinky and insert into stoma
- Repeat for ring finger
- Repeat with middle finger
True or False
You should empty the colostomy bag after eating.
• False, should be before meal
When does a colostomy bag need to be emptied, changed?
- Empty when 1/3 full
* Change ever 2-4 days
If an enema is requested through the stoma, what needs to be kept in mind?
- Do not use normal enema kit as you could perforate colostomy
- Request a “cone shaped” enema kit
Why should a pt with colostomy avoid raw veggies and skins/peeled fruit?
• They are gas producing
Why should a pt with colostomy avoid dairy, high fiber, beans, wild rice and the like?
• They can block up the intestines
Why should a pt with colostomy avoid high fat/fried food?
• They are difficult to digest and will produce fatty/foul smelling stool
Why should a pt with colostomy avoid onions and garlic?
• Odor can escape stoma
Why should a pt with colostomy include yogurt, cranberries, bananas, white rice, buttermilk, tapioca and white toast?
• They are helpful in thickening stool and minimizing odors
What is a Kock pouch/ileostomy?
- An internal reservoir for stool storage, made from ileum and attached to the abdominal wall by a special stoma/one-way valve
- No bag required.
- Emptied by inserting a catheter through this stoma
What is the education required for the Kock pouch?
- How to do self catheter to empty
* Proper cleaning with clean gloves (don’t need to be sterile) between each use
What are bezoars?
- Solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage.
- Bezoars usually form in the stomach, sometimes in the small intestine or, rarely, the large intestine
- Would need to be removed surgically
What is a Jejostomy (J) pouch?
- This is done if the entire colon has been removed
- Similar to the Kock pouch, an internal reservoir is created with the intestines and is attached at the anal sphincter allowing normal bowel movement of semi-solid stool
