Understanding Ostomies

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Understanding Ostomies

• Get Out Your Unit 20.9 Worksheet out !!

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Ostomies

• 450,000 people in the US have an ostomy
• 120,000 Surgical Procedures a year
• There are psychological, social, financial, and
  physical implications

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Stoma

• A stoma is a permanent or temporary opening made
  in the abdominal wall through a surgical
  procedure
• Any portion of the bowel or urinary tract can be
  exteriorized to create a stoma.

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Types of Ostomies

• Permanent Ostomies Are constructed when the
  rectum, the colon, or the bladder have been
  removed

• Temporary Ostomies May be placed in the small or
  large intestine or the urinary tract. They are
  generally reversed in 3 to 6 months.

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Types of Stomas

• End Stoma The end of the bowel is inverted at
  the skin surface
• Loop Stoma The entire bowel is brought to the
  skin surface and opened to create a distal, or
  nonfunctioning end, and a proximal-functioning
  end
• Double-Barrel Stoma Similar to a loop except it
  is divided into two separate stomas one a mucous
  fistula and the other a functioning stoma.

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Complications of Stomas

• Necrotic and non-functioning

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• Prolapsed
• Resembles a Hernia

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• Retracted

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Indications for an Ileostomy

• ( Small Bowel Resection)
• Cancer
• Crohns Disease
• Ulcerative Colitis
• Any Disease that requires the removal of the
  entire Large Intestine

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Colostomies

• Ascending Colon
• Formed?

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Colostomies

• Transverse Colon
• Formed?

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Colostomy

• Descending

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Indications for Colostomies

• Cancer of the Colon or Rectum
• Acute Diverticulitis, Gunshot/Stab Wounds, and
  any other acute and destructive event
• Radiation Therapy

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Patient Assessment

• Vision Problems
• Hand Tremors, Paralysis, CVA, or Arthritis
• Live Alone
• Current Medication
• Employment
• Recreational Hobbies
• Sexual Activity

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Stool Consistency

• Colostomy Formed
• Ileostomy Liquid Consistency
• Transverse Colostomy Liquid and Pasty

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Post-Op Assessment

• Stoma Rich Blood Supply, Edema
• Round vs Oval
• Look for a Decrease after 8 weeks
• Redness
• Stitches
• Mucus

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Stoma Complications

• Candidiasis Yeast Related Infection
• Folliculitis hair trauma
• Irritant Dermatitis Inflammation of the skin
  around the stoma

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Dietary Concerns

• Few Restrictions
• Well Balanced with adequate fluid intake
• Small frequent meals
• Low fiber Diet in the first 6 weeks
• Drink 8 glasses of water a day

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Dietary Considerations

• Foods that Cause Blockage Corn, Dried Fruit,
  Bean Sprouts, Celery, Raw Vegetables in Excess,
  Bamboo, Mushrooms, and Foods with seeds
• Foods that cause Loose Stools Fruit juices,
  Baked Beans, Highly Spiced Foods, Cabbage, and
  Broccoli
• Foods that Thicken StoolCheese, Rice, and Pastas
• Foods that Cause Odor Asparagus, Cabbage, Eggs,
  Fish, Onions, Dried Beans, and Beer

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Ostomy Care

• 1. Wash your Hands
• Assemble your Equipment
• Wear Gloves
• Clean around the stoma
• Observe the Stoma
• Measure the stoma

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• Measure the Stoma
• Transfer the Measurement to the Wafer
• Cut the Wafer to Fit
• Remember to keep the area dry and be ready for
  drainage

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• Peal the Adhesive Backing off and Gently adhere
  the Wafer to the Patient
• You may use Soma Paste to further seal and
  protect the skin

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• Gently attach the Bag to the Ring around the
  Wafer
• Make sure the seal is tight and secure
• Make sure the bag is clipped at the bottom

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• Prepare for Drainage and Always Document the
  Procedure