Ostomies

Question 1

Ostomy

Answer 1

• a surgical opening from the inside of the body to the outside
• can be permanent or temporary and located in various parts of the body
• bowel diversions through ostomies are temporary or permanent openings (stomas) in the abdominal wall to allow fecal matter to pass.
• main types of GI ostomies are:
  1) ileostomy–surgical opening into the ileum to drain stool
  2) colostomy–surgical opening into large intestine to drain stool

Question 2

Indications for Ostomies

Answer 2

1) ileostomy:
- performed when the entire colon must be removed due to disease, such as Crohn’s disease
2) colostomy:
- performed when processes such as colon cancer, severe diverticulitis, or traumatic injuries necessitate removal of a portion of the bowel

Question 3

Pre-procedure

Answer 3

1) client’s readiness for procedure should be determined.
- assessment of visual acuity, manual dexterity, cognitive status, cultural influences, and support systems is important
2) the client and a support person should be instructed regarding care and management of an ostomy before surgery

Question 4

Post-procedure

Answer 4

1) assess the type and fit of the ostomy appliance. monitor for leakage (risk to skin integrity)
2) fit the ostomy appliance based on:
- type of ostomy
- location of ostomy
- visual acuity and manual dexterity of the client
3) assess peristomal skin integrity and the appearance of the stoma–it should appear pink and moist
4) apply skin barriers and creams, such as stoma adhesive paste, when applying wafers to protect the peristomal skin.
- let sealants dry before applying a new appliance
5) evaluate output from the stoma
- the higher up an ostomy is placed in the small intestine, the more liquid and acidic the output will be
6) empty the ostomy bag when it is 1/4-1/2 full of drainage
7) assess for fluid and electrolyte imbalances, particularly with a new ileostomy

Question 5

Client Education

Answer 5

1) client should be educated regarding dietary changes and ostomy appliances that can help manage flatus and odor
2) foods that can cause odor include fish, eggs, asparagus, garlic, beans, and dark green leafy vegetables
3) foods that can cause gas include dark green leafy vegetables, beer, carbonated beverages, dairy products, and corn.
- yogurt can be ingested to help decrease gas
4) after small intestine ostomy placement, client should be instructed to avoid high-fiber foods for first 2 months after surgery, chew food well, drink plenty of fluids, and evaluate for any evidence of blockage when slowly adding high-fiber foods
5) do not put anything in the bag to mask odor such as a mint. keep appliance clean and empty frequently to decrease odor.
6) provide opportunities for client to discuss feelings about ostomy and concerns about its impact on life. encourage client to look at and touch the stoma
7) refer client to a local ostomy support group

Question 6

Complications

Answer 6

1) stomal ischemia/necrosis
- stomal appearance should be pink or red and moist.
- signs of ischemia are pale pink or bluish/purple color and dry appearance.
- if stoma appears black or purple, this indicates a serious impairment of blood flow and require immediate intervention. notify the provider
- teach client to watch for signs of stomal ischemia/necrosis following discharge
2) intestinal obstruction
- can occur for a variety of reasons
- monitor and record output from the stoma
- assess client for symptoms of obstruction, including abdominal pain, hypoactive or absent bowel sounds, distention, nausea, and vomiting
3) notify surgeon of abnormal findings
4) teach client to watch for signs of intestinal obstruction following discharge.