Topic 7: Bowel Resection & Ostomy Surgery Flashcards
ostomy
surgically created opening on the abdomen that allows the discharge of body waste when the normal elimination route is not possible, feces drain through the stoma and not the anus
Ileostomy stool consistency
· Liquid to semiliquid stool
ascending ostomy stool consistency
· Semiliquid stool
transverse ostomy stool consistency
· Semiliquid to semi-formed stool
sigmoid ostomy stool consistency
· Formed stools
End Stoma
stoma made by dividing the bowel and bringing out the proximal end as a single stoma making a colostomy or ileostomy
loop stoma
made by bringing a loop of bowel to the abdomen surface and then opening the anterior wall of the bowel to provide fecal diversion
double-barreled stoma
HCP divides the bowel and both proximal and distal ends are brought through the abdominal wall as 2 separate stomas
pre-op care
· Psychologic preparation and emotional support because of changed in body image and elimination
· WOCN should choose the site where the ostomy will be and mark abdomen before the surgery
· Site should be flat as it makes it easier to create a good seal and avoid leakage
Post-Op Care
· Assess incision for suture integrity and s/s/ of inflammation and infection
· Reinforce dressing, change them often during the first several hours post-op
· Assess all drainage for amount, color, consistency
· Assess for bleeding, odor, edema, erythema, fever, and high WBC count
· Assess stoma,
· Gas is excessive during the first two weeks, assure patients this is temporary
· Assess for fluid and electrolyte imbalances
what color is drainage usually after surgery
serosanguineous
what should a stoma look like
should be rosy, pink to red and mildly swollen
what does a dusky blue stoma indicate
ischemia
what does a brown/black stoma indicate
necrosis
Nursing Management: Ostomy Care
· Assess and document stoma and peristomal skin appearance
· For a new patient with a new ostomy, assess patient’s psychologic preparation for ostomy care
· Choose appropriate ostomy pouching system for patient
· Place ostomy pouching system for a new ostomy
· Monitor volume, color, odor of ostomy drainage
· Develop plan of care for skin care around ostomy
· Teach ostomy care and skin care to patient and caregiver
· Irrigate new colostomy if indicates
· Teach appropriate diet choices
what can be delegated to a UAP for ostomy care
o Empty ostomy bas and measure liquid contents
o Place ostomy pouch system for an established ostomy, assist stable patient with colostomy irrigation
how can patients with an ostomy reduce the chance of blockage
chew food very well
when can the patient resume ADLs after a colostomy
· ADLs within 6-8 weeks, BUT should avoid heavy lifting
colostomy and water
· Swimming is not a problem with ostomy pouch intact
· Patient can shower and bather with or without the pouching system in place
what foods should the patient avoid with an ileostomy
o Foods like nuts, raisins, popcorn, coconut, mushrooms, olives, stringy vegetables, foods with skins, dried fruit and meat with casing must be chewed extremely well before swallowing
what should be demonstrated back to the nurse when patient performs ostomy self-care
o Remove the old skin barrier, cleanse skin, correctly apply new skin barrier
o Apply, empty, clean, and remove the pouch
o Empty the pouch before it is 1/3 full to prevent leakage
when should the ostomy pouch be emptied
Empty the pouch before it is 1/3 full
what GAS forming foods should be avoided
beans, beer, cabbage family, carbonated beverages, cheeses (strong), onions, sprouts
what DIARRHEA forming foods should be avoided
alcohol, beer, cabbage family, coffee, fruits (raw), green beans, spicy foods, spinach
what ODOR producing food should be avoided
alcohol, asparagus, broccoli, cabbage, eggs, fish, garlic, onions
