Ostomy Care

Question 1

What is and ostomy?

Answer 1

A surgical opening into the body for the discharge of waste

Question 2

What is a stoma?

Answer 2

end of the ureter

small bowel or large bowel that can be seen coming out of the abdominal wall

Question 3

What is an ostomy or stoma caused by?

Answer 3

Obstructions: blockage

Cancer: colon cancer

Disease processes: chrons, ulcerative collitis

Trauma

Question 4

What are the types of colostomy care?

Answer 4

Temporary: for healing, discontinues

Permanenet

Sigmoid/Descending

Transverse

Loop (2 openings; one of stool and one for mucous)

Ascending

Question 5

What are the types of Ileostomy?

Answer 5

STandard or Brooke Ileostomy: freely drains waste

Continent Ileostomy: pt has control over dainage process so there is no need to wear a bag over the stoma. A catheter or tube is inserted into pouch several times a day to frain feces from reservoir

Ileo-anal reservoid: pouch made from ileum and rectum and lead through the body to attach to anus

Question 6

What are the types of urostomy?

Answer 6

Continent Urostomy: voluntary removal of urine

Indiana pouch: ileocecal valve is relocated and used to provide continence

Question 7

What is Osotmy supples?

Answer 7

Open ended: drainable, requires clamp or tail clip

Close ended: sealed at bottom and mostly in pts that can irrigate regular elimination patterns

Two place system: allows barrier to remain attached to skin which bag is replaced. These systems have a cloing ring attached to them and allow the barrier and the bag to attach to one another similar to Tupperware

One piece system: one unit, simple, requires a complete removal when changing occurs

Question 8

What are the steps of irrigation?

Answer 8

1. fill irrigating contained with 15-50oz leukwarm water
2. attach irrigation sleeve to pt stoma
3. release air bubbles from tubing
4. moisten end of cone with lubricant or water
5. place tip of cone 3 in into pt stoma. make sure fit is snug but do not force the cone
6. remove clamp from tubing and allow water to enter stoma. 5-10 minutes
7. remove cone after allowing drainage to drain into irrigation sleeve for 5-10 minutes
8. dry end sleeve, clip bottom of sleeve to top clasp
9. 30-45 min completely drain, inform pt can still move
10. once finished draining, emptoy sleeve into toilet
11. clean around stoma with mild soap and water and pat dry

Question 9

What do you do when applying/changing the ostomy bag?

Answer 9

Ask how often change it

Remove pouch: push down on skin

Gently clean skin around stoma: rid drainage

Use pouch with right opening size

Use skin products to reduce irritation

Use slight pressure to place the pouch

Dispose of used pouch in correct manner

Question 10

How do you empty ostomy bag?

Answer 10

empty pouch when 1/3 to 1/2 full

hold pouch up by bottom end

Drain pouch

Clean the end of pouch

Close and slampt end of pouch

Question 11

How do you maintain skin integrity with ostomy bag?

Answer 11

difference in chance of skin breakdown

check the colostomy daily

keep the skin clean and dry

change the bag when needed

Use correct size of bag to ensure proper fit and less likely chance for leaking

Use skin barrier like liquid to protect skin under bag adhesive and around the stoma

Skin barrier paste can be used to fill in surface irregularities of abdominal wall behind barrier creating better seal

Question 12

What is infection prevention in ostomy bag?

Answer 12

Check for stool leakage under or outside bag

Check skin around stoma for infection signs

Make sure skin stays clean and dry to prevent infection from occuring

monitoring for signs of infection

Question 13

What do you teach the patient about ostomy?

Answer 13

Type of ostomy that they have

Reason for having the ostomy

How to apply and change the ostomy bag

Cleaning and emptying the ostomy bag

When to change the bag (1/2-1/3 full)

Keep the area clean and dry

What the stoma should look like

Monitor for signs of infection

When to call the health care provider

Question 14

What is the diet and nutrition of ostomy?

Answer 14

Diet may need to be changed after getting ostomy

Variety of healthy foods

Eat low residual foods

Easily digestible foods

Eat small portions

Drink plenty of fluids

Avoid gas producing foods

Question 15

With ostomy bag when do you c ontact care provider?

Answer 15

Severe cramps last more then 2-3 hours

unusual odor lasting more then 1 week

Unusual change in stoma size and apperance

Obstruction at the stoma and prolapse of the stoma

Excessive bleeding from stoma

Severe injury or cut to the stoma

Continuous bleeding at junction between stoma and skin

Watery discharge lasting more then 5-6 hours

chronic skin irritation

Stenosis of stoma

Unable to wear pouching system for 2-3 days without leakage