Week 12: Ostomy Care Flashcards
Allergic contact dermatitis
inflammation of the skin resulting from contact with an allergen
Anastomosis
formation of a connection between two usually distinct structures or portions of a structure
Cecostomy
surgical creation of an opening from the beginning of the large intestine (cecum) to the abdominal wall
Cohesion
ability of the skin to maintain its integrity when exposed to moisture
Colostomy
surgically created opening (stoma) from the colon (large intestine) to the abdominal wall to allow stool to pass out of the body
-created from the end of the large intestine to divert waste from the digestive system
Conduit
passageway
Cystectomy
excision or resection of the bladder
Denudation
stripping of superficial skin surface
filtered pouch
ostomy output collection bag that incorporates an odor filtration apparatus
Flange
rim used for attachment to another object, such as a ostomy pouch attaching to a skin barrier
Flatus
gas or air generated in the stomach and/or intestines and expelled via the anus or an intestinal ostomy
Hartmann Procedure
common temporary colostomy surgery that involves leaving the distal portion of the colon in place and over sewn for closure to create a Hartmann’s pouch
Hydrocolloids
substance that forms a gel as fluid is absorbed and is used in some ostomy products to absorb perspiration and other metabolic secretions while preventing fungal and bacterial invasion
Hydronephrosis
enlargement of the kidneys as urine collects in the renal pelvis and kidney tissue
Hyperplasia
abnormal increase in the volume of a tissue or organ
Ileal conduit
surgical removal of a section at the end of the small bowel (ileum) and relocation as a passageway for urine from the kidneys to the outside of the body through a stoma
Ileostomy
surgical opening created in the ileum to bypass the entire large intestine
Irritant Dermatitis
inflammation of the skin resulting from contact with an irritating substance
Kock Pouch
internal pouch created from the distal segment of the ileum to serve as a reservoir for stool or urine
Luminal Bleeding
blood seeping through the opening (lumen) of a stoma
Maceration
softening or dissolution of tissue after lengthy exposure to fluid
Mucocutaneous Separation
separation of the stoma from the peristomal skin; also called mucocutaneous detachment
Peristomal retraction
pulling in of the skin around a stoma when the stoma is drawn inward below the skin level
Peristomal skin
skin surrounding an ostomy
Pouching system
one-piece or two-piece device that includes a skin barrier/ wafer and a collection pouch for output; referred to as an appliance
Reservoir
storage place; in the case of an IPAA or kocks pouch, an internal reservoir is surgically created
Sigmoid
referring to the portion of the large intestine between the descending colon and the rectum
Skin Stripping
mechanical disruption of the epidermis, as can be caused by adhesives when an ostomy appliance is removed
Stoma
surgically created opening, usually referring to one in the abdominal wall
Stomal height
degree of protrusion of a stoma from the skin
Stomal prolapse
lengthening of a stoma due to the bowel telescoping out through the stoma
Stomal Retraction
pulling back of a stoma below skin level
Stomal stenosis
narrowing of the lumen of the stoma
Tap
device on a urostomy pouch that permits drainage of the contents
Ureter
narrow tubular duct that transports urine from the kidney to the bladder
Ureterostomy
surgically created ureteral skin opening that diverts urine away from the bladder and out of the body
Urostomy
surgically created opening that diverts urine away from the bladder and out of the body
Valsalva Maneuver
forceful exhalation against a closed glottis, which involves contraction of the abdominal muscles to propel feces out of the body
Wafer
faceplate or barrier designed to protect the peristomal skin from the stoma output and to which the pouch is attached
Ostomy
opening surgically created in the abdominal wall to allow for elimination of urine or feces
>may be temporary, to allow for healing and a return to normal elimination or permanent
Ostomy surgery
performed when a disorder or an injury keeps the urinary or gastrointestinal system from functioning properly
Ostomy surgery is indicated for?
- congenital abnormalities
- bladder, colon, and rectal cancer
- inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
- inherited disorders; familial adenomatous polyposis
- obstruction of the ureter
- stab or gunshot wounds to the abdomen
How long do you have an ostomy for?
may be temporary, to allow for healing and a return to normal elimination, or permanent
3 primary types of ostomy surgery?
- colostomy
- ileostomy
- urostomy
What should a stoma look like?
surgically created opening in the skin of the abdomen
- should be shiny, wet, and red in color; similar to mucous membranes in the mouth
- can be round, oval, or irregular in shape
- can be protruding, flush with the skin, or retracted
Colostomy
- surgically created opening (stoma) from the colon (large intestine) to the abdominal wall to allow stool to pass out of the body
- created from the end of the large intestine to divert waste from the digestive system
3 Different Colostomy types
- End colostomy
- Loop colostomy
- Double-barrel colostomy
End Colostomy
the damaged section of the bowel is removed and the working end is brought through the abdomen to the skin surface
-used when a colostomy is intended to be permanent
Loop Colostomy
a loop of the bowel is brought through the abdomen to the skin surface and temporarily supported by a plastic bridge or rod
>a transverse loop colostomy–> is typically created as an emergency procedure to relieve an intestinal obstruction or perforation; a communicating wall remains between the proximal and distal bowel; it has two opening through the one stoma- the proximal end drains the stool while distal portion drains mucous
-bridge can be removed in 7 to 10 days
-transverse loop colostomies are temporary
Double-barrel Colostomy
2 separate stomas are created
- both ends of the bowel are brought through the abdomen to the skin surface
- the distal colon is not removed but bypassed
- the proximal stoma, diverts feces to the abdominal wall
- distal expels mucus from distal colon
Locations of a colostomy
-ascending (liquid to semi-liquid)
-transverse (liquid to semi-formed)
-descending (semi-formed)
-sigmoid (formed)
>because more formed as water is absorbed
Colostomy in the ascending colon: output formation
liquid to semi-liquid and is very irritating to the surrounding skin
Colostomy in the transverse colon (mid-abdomen)
for temporary ostomy with stoma constructed as a loop
-output is liquid to semi-formed
Colostomy in the descending colon (left upper abdomen)
semi-formed because more water is absorbed while fecal material is in the ascending and transverse colon
Colostomy in the sigmoid colon (left lower abdomen)
for a permanent colostomy, particularly for cancer of the rectum
- output is formed
- stoma is typically located on the lower left quadrant
Ileostomy
a surgical opening created in the ileum to bypass the entire large intestine
-stoma located in right lower quadrant
Proctocolectomy
procedure to treat colon cancer and ulcerative colitis involves surgical removal of the entire colon, rectum, and anus
- with closure of the anus, resulting in need for stool diversion; as part of the total proctocolectomy, the end of the terminal ileum is brought out through the abdominal wall, forming a permanent ileostomy
- no more control over bowel movements
Restorative Proctocolectomy with IPAA (ileal pouch anal anastomosis)
involves connecting the ileum to a “new” rectum or (“anal pouch”) also made out of a portion of ileum; it is procedure of choice where rectum can be preserved, allowing patient to retain anal sphincter control of bowel movements; patient will have a temporary loop ileostomy to divert stool while this new anal pouch heals followed by closure of the ostomy a few months later
Kocks Continent Ileostomy “kocks pouch”
an internal pouch is created from the distal segment of the ileum, which serves as a reservoir for stool
-during surgery, a one-way nipple valve is constructed through the stoma opening so that eventually the patient can insert a catheter through the stoma and through the one-way valve to drain the fecal contents of the internal pouch
>created for ulcerative colitis or for patients who do not wish to wear an external pouch over the stoma
Urostomy
urinary diversion that allows urine to exit the body after removal of a diseased or damaged section of the urinary tract
-when the entire bladder must be removed a ileal conduct can be created
How can a ileal conduct be created?
when the entire bladder must be removed
-a loop of the intestinal ileum is separated and used as a conduit for urine; the ureters are attached to the ileal conduit and the open end is brought through the abdominal wall to form a stoma; the remaining ileum is reconnected to GI tract
How is Kocks Pouch created
created the same way ileal conduit except that nipple valves are formed by intussuscepting tissue backward into the reservoir; the pouch is connected to the skin and the ureters are connected to the pouch
Indiana Continent Urinary Reservoir
formed from the cecum and a portion of the ileum
- stoma is continent and flush with the skin
- patient self-catheterizes to empty reservoir with a ureterostomy, one or both ureters are redirected from the kidneys through the abdominal wall to form a stoma
- to avoid the need for 2 collecting devices, a transureterostomy may be performed to connect the ureters internally and bring one out through the abdominal wall
Ileostomy Management
drainage is typically dark green, loose, and odorless; drainage gradually thickens and becomes yellow to brown
- empty pouch when it is 1/3 to 1/2 full
- use skin barrier; bile contains enzymes and bile salt that can irritate skin
Ileostomy drainage
typically dark green, loose, and odorless; drainage gradually thickens and becomes yellow to brown
-empty pouch when it is 1/3 to 1/2 full
Common manifestations of Ileostomy
abdominal cramping, nausea, vomiting, stoma swelling, and no ileostomy output for 6 hours
Interventions for manifestations
- place moist towels on the abdomen
- drink hot tea
- lie down and assume a knee-chest position to relieve intraabdominal pressure
- massage the abdominal area to promote peristalsis and fecal elimination
Diet for Colostomy
can resume a regular diet
-fresh fruits, vegetables, protein-sources, and whole-grain bread and cereals
Ileostomy Diet
- higher risk for fluid + electrolyte imbalances due to shorter transit time through bowel
- 10 to 12 glasses of water per day to prevent dehydration and blockage
- chew food thoroughly to help pass it through narrow ileum
- need to avoid high-fiber foods for the first 6-8 weeks to avoid blockage after surgery
Urostomy Diet
no dietary restrictions
-consume plenty of fluid
Pouching Systems
- Closed end pouches
- Drainable pouches
- One-piece systems
- Two-piece systems
Pouching system: Closed end pouches
designed for one-time use and my meet the needs of a patient who irrigates
- sigmoid colostomies
- when full, it is removed from the skin barrier and discarded
Pouching System: Drainable pouches
can be rinsed and re-used
- use with ascending or transverse colostomy, ileostomy, and urostomy
- have a tap instead of a clip
Pouching System: One-piece systems
with an attached skin barrier, available in cut-to-fit and pre-cut types
Pouching System: Two-piece systems
permits frequent pouch changes and minimizes skin breakdown
- pouch and skin barrier connected with a flange mechanism
- pouch may be disposable or reusable
- may have a filter for gas release
