Where is an ileostomy?
End of ileum before the colon. RLQ Very Liquid consistency because it hasn’t had time to absorb Very hard on the skin- Oozes constantly Needs a bag
What determines the consistency of the output?
Location
Consistency of stool in the LLQ?
Almost like a regular BM bc it is at the end of the GI tract.
2 different stomas
Proximal stoma is where the stool is going to come out bc it’s closer to the end of the GI.
Distal stoma-
is where the mucus fistula.
Stomas are
Temporary or permanent!
3 major types of ostomies
End stoma
Loop stoma
Double- barrel stoma
End Stoma
- Divides bowel and bringing out the proximal end as a single stoma
- Distal portion either:
- Surgically removed
- Stoma is permanent
- Oversewn and left in mesentery, called “Hartmann’s pouch
- The potential exists for bowel to re-anastomosed in future (called a “takedown”)
Loop Stoma
- Bringing a loop of bowel to surface and then opening anterior wall of bowel to provide fecal diversion; held in place by plastic rod
- One stoma w/ proximal opening (stool) and one with distal opening (mucus)
- Posterior wall separates the two openings
- Usually temporary
Double-barrel Stoma
- Bowel is divided and both proximal “and” distal ends are brought through abdominal wall as two separate stomas.
- Proximal = functioning stoma
- Distal = non-functioning; “mucus fistula”
- Usually temporary
Ileostomy
Lowest part of the small intestine is diverted through an opening in the abdomen.
Done when the colon or rectum is not working properly.
What may be required to do if the colostomy is near the rectum?
Irrigation - feces are solid
Colostomy irrigation
- Descending or sigmoid ostomies
- Irrigate every 1-2 days (whatever normal bowel pattern was)
- Similar to enema through stoma
- Large bag placed to gather contents
Post-op Stoma Care
- Assess color, edema & presence of bleeding
- Wash skin with mild soap, rinse w/ warm water, then apply skin barrier
- Pouch
- Snug fit; use stoma-measuring card… ( don’t want skin exposed to drainage)
- Ideally have an Ostomy nurse help us w/ this
What can happen to a pt w/ double-barrel stoma?
Keep in mind that the old stool/ mucus may still come out from the anus. If there’s an anus. Stool left over from the surgery. Impossible to have stool come out the other way.
Considerations
Empty bag frequently (stool/gas); remember no sphincter! Plenty of towels on hand
You need to get the air out! Smells not good
Control facial expressions
How should a ostomy appliance be applied?
Snugly and cut exactly, so the stoma fits it!
Odor producing foods
Eggs Garlic Onions Fish Asparagus Cabbage Broccoli Alcohol
Gas forming foods
Beans Cabbage family Onions Beer Carbonated beverages Cheeses (strong) Sprouts
Diarrhea causing foods
Alcohol Beer Cabbage family Spinach Green beans Coffee Spicy foods Fruits (raw)
Potential obstruction foods in Ileostomy
Nuts Raisins Popcorn Seeds Vegetables (raw) Celery Corn
Other points to consider…
- Patient teaching – may go slow; complicated by emotional responses to stoma..
- 4-5 days post-op too early to assume non-acceptance
- Body image disturbance
- Odor control
- Sexual function concerns
- Expression of feelings
- Family participation
- Ostomy support groups
