Ostomy Care Flashcards
Ostomy is?
- surgical procedure to divert waste
- permanent or temp
- elective or emergent
- fecal/urinary/other
* there are aprox 10,000 ostomy surgeries in canada per year
Stoma
> section of the colon or small intestine
is very vascular
an artificial opening btwn a body cavity or passage and the bodys surface
sensation is decreased. be careful. easier to injure
> the output from stoma is called “effluent”
Types of ostomies:
- Ileostomy- Ileal portion of the small intestine- the fecal effluent is watery to thick liquid and contains some digestive enz
- Colostomy- section of colon. the fecal effluent will depend on where the open was created
- Urostomies/Ilealconduit; sometimes interchange- transplant ureters into a closed-off portion of the intestinal ileum. permanent
- Continent Diversionse
Surgical construction of an ostomy:
temp or permanent
> end stoma (end sigmoid colostomy)
> loop stoma (rod)
> double barrel stoma (or end stoma with mucous fistula; dont see this anymore)
Temporary- surgical closure is intended after a short duration depending on PT condition, age and disease process.
> Temporary ostomies are usually for bowel rest during chemo/radiation for bowel CA or for a bowel leak causing peritonitis - ++ pain associated with peritonitis.
Permanent- no intention of closure, poor anastomotic capability and often palliative. someone that has rectal cancer
Indications for a colostomy:
- trauma
- diverticulitis
- volvulus (twisted bowel)
- IBD
- obstruction (tumor)
- cancer
factors assessed for stomal site selection
- location of rectus muscle
- type of ostomy
- adequate adhesice surface
- avoid skin folds, scars, beltline, umbilicus and bony prominence
- visibility to PT
- supportive device present
what muscle is the stoma through and why?
Through the rectus abdominal muscle which prevents hernia. It is advisable for the PT to have strong ab muscles
Abdominal Perineal Resection
Surgical removal of rectum & anus
Combined abdominal & perineal approach
Possibility of bladder & sexual dysfunction if nerve damage
Permanent colostomy
Indication
Low rectal cancer
Hartman’s Resection
> End stoma created from proximal bowel
> Distal end closed & left inside pelvis
>Usually temporary colostomy Indications: -Trauma -Diverticulitis -Palliative treatment for rectal ca -Obstruction
Ileostomy indications include:
> IBD
- Crohns
- Ulcerative Colitis
> Cancer
> Familial Polyposis= whole large bowel is full of polyps and are a high risk for CA. Often affects the whole family hence the name. there is screening tests. Ppl can have section of their bowel removed if they are genetically predisposed.
Location if Ileostomy
The ileum is a narrow lumen therefore is at risk for food blockages!!
20 minutes from mouth to exit therefore can’t use slow release medications or enteric coated meds for these patients.
Urinary Diversion
Indications:
> Cancer of the bladder (50% bc of smoking)
Trauma
Obstruction
Birth defects
Intractable urinary incontinence; parapalegic, maybe pressure sores because of skin integrity. These ppl often have colostomy and urostomy.
Standard Diversions:
Ureterostomy
cutaneous
bringing the detached ureters through the abd wall and attaching to an opening in the skin
Vesicostomy
not common. Would now do a suprapubic catheter instead; an opening make through the skin into the bladder and the bladder wall is brought up like an ileostomy or colostomy
Intestinal Conduit
attaching the ureters to a piece of ileum and one end is brought to the abd wall as a conduit for urine
Ileal conduit
most common.
Ataching the ureters to a piece of ileum and one end is brought to the abd wall as a conduit for urine.
Sigmoid
also, jejunal and colon
Ureters attached to a portion of the large intestine which allows urine to flow through the large intestine and out the rectum
Ureteral stents
Are often placed in the ureters to allow free flow of urine to maximize risk of blockage from swelling
Cutaneous Ureterostomy
Indications:
> Ureteral damage or stricture from distal obstruction
Palliative
Pouching challenges as is flush and smaller in diameter
Easier surgery with least complications. Ureterostomy is used less commonly now but when there is a distal obstruction like bladder CA with extensive invasion to muscle and tissue which causes ureter damage or strictures then this may be the surgical approach. Palliative.
characteristics of an ideal stoma
- color- red
- location of lumen- apex
- location of the body- smooth surface
- level of protrusion- 2.5cm
- shape (round). the size is permanent 6-8 weeks postsurg
Post-op assessment:
- stoma- PWR no necrosis or darkening of the bud
- Mucocutaneous Suture Line- looking to ensure there is no separation btwn the healthy skin and the stoma/suture line
- Peristomal Skin- look for any allergic reaction to tape or burn ect.
- Function- watching for flatus which balloons in the appearance until it is released. what is the drainage. Often serous for the first day
- Devices- any rod in situ
Post-operative stomal complications (early):
> Stomal necrosis- (most common 3-5 days post-op). Black or purple
> Mucocutaneous separation - (breakdown of the sutures securing stoma to abdomen. Can be filled with ostomy powder
PT teaching plan:
- Stoma characteristics & function
- Self care ( emptying and/appliance change)
- Skin care
- Diet and fluids; can no longer have a lot of fiber. Too much fiber can cause a bowel obstruction.
- Lifestyle issues
- Other( specific to type of ostomy)- best time of day for changing and types of food to avoid
Principles of Pouching
- Skin must be protected from effluent damage.
- Stoma must be protected from trauma.
- Peri-stomal skin must be protected from mechanical trauma. Trauma from removing it.
- Skin must be protected from damage caused by products used for pouching and skin protection; allergy? Try diff brands.
- Some ppl can change poutches 7 days
