Class 7 - Ostomies Flashcards
(26 cards)
what is an ostomy
it is a surgical procedure to divert wastes from the body
what is a stoma
the opening created surgically in the abdominal wall for an ostomy
what is a colostomy
and excretory opening in the colon (large bowel)
what is an ileostomy
an excretory opening in the ileum (small bowel)
what is a urostomy
an excretory opening that redirects urine away from the bladder.
what factors are used to choose a stoma site
- location of rectus muscle
- type of ostomy
- adequate adhesive surface
- avoid skin folds, scars, beltline, – umbilicus & bony
prominence - visibility to patient
- supportive devices present
what would cause the need for a colostomy
- trauma to small/large intestine
- diverticular disease
- obstruction
- cancer
there are 5 sites for colostomies, where are the sites
all are along the large intestine
- cecum
- ascending colon
- transverse colon
- descending colon
- sigmoid
what are the characteristics of an healthy stoma
- color should be red
- location of lumen is on the top of the stoma
- location on body is on a smooth surface
- level of protrusion 2.5 cm
- shape of stoma should be round
what skin considerations should you be aware of
- stool contains enzymes and is caustic to the skin
- essential to have all peri-stomal skin protected and a well
fitting appliance - consider the use of an “extended wear” appliance that is
more resistant to ileostomy type drainage. - ileostomies will require a “drainable” system that will
allow for frequent emptying
under what circumstances would you use a cutaneous ureterostomy
- ureteral damage or stricture from distal obstruction
- palliative treatment
- pouching challenges as ostomy is flush & small in
diameter
for a ileostomy what is the output, color and consistency
output - 500-700mLs/daily
color - varying shades of brown
consistency - paste like
for a colostomy what is the output, color and consistency
output - 1-3 formed stools daily
color - varying shades of brown
consistency - semi-formed to
formed
for a ileal conduit what is the output, color and consistency
output - wide range, usually btw
1000-2000mLs/daily
color - yellow with mucous shreds
consistency - liquid
what types of things will the patient need to be taught when having an ostomy
- stoma characteristics & function
- self care ( emptying &/appliance change)
- skin care
- diet & fluids
- lifestyle issues
- other( specific to type of ostomy)
- best time to of day to change appliance
what are the pricinples of pouching
- skin must be protected from effluent damage.
- stoma must be protected from trauma.
- peri-stomal skin must be protected from mechanical
trauma. - skin must be protected from damage caused by products
used for pouching & skin protection.
what are the pouching basics
Stoma is on a flat firm abdomen?
*flexible system
Stoma on a soft abdomen?
* firm faceplate helpful * belts may be helpful
Stoma that is flush or retracted?
* convex barrier/faceplate * stoma paste, barrier strips etc.
Stoma that is in a crease?
*flexible system so system can
“fold” with the pt
Stoma powder
*only to be used on denuded
/eroded skin
Stoma paste/strip paste
*assists in filling in defects/
gullies
Skin gel wipes
*minimizes stripping of skin
*most contain alcohol which
may be painful to open skin
*NOT an adhesive
*not effective against
ileostomy type drainage
what are some dietary considerations for ostomies
*adequate fiber and fluids after discharge.
*ileostomy patients want to ensure salt and water intake
is adequate but high fiber diet is not recommended.
*measures to control gas formation
*urostomies patient’s encourage fluids such as cranberry
juice and water
what are some special considerations for ostomies
- carry an extra appliance
- moistened paper towel or wipes in Ziploc bag
-consider use of spray deodorants if having to change
ileostomy or colostomy appliance while out
-wear a medic alert bracelet
Why are there risks of skin breakdown around a stoma site
- glues & adhesives being applied to the skin
- rubbing of the skin while cleansing
- irritations from leakage
- ill fitting devices
describe the consistency and drainage that you would get from a descending or sigmoid colostomy
- descending produces increasingly solid fecal drainage
- sigmoid is usually formed solids
- discharge can be regulated, there is some control
describe the consistency and drainage that you would get from a transverse colostomy
- produces unpleasant smelling, mushy drainage b/c some
of the liquid has been absorbed - there is no control with this type of colostomy
describe the consistency and drainage that you would get from a ileostomy
- produces liquid fecal drainage
- drainage is constant and there is no control
what are some concerns that you may hear that a patient has with an ostomy
- ileostomy: skin irritation, leakage of devices
- colostomy: has a bad smell b/c more bacteria is present
