1. BOWEL DIVERSION OSTOMY Prepared by:Prepared by: DR. IRENE ROCODR. IRENE ROCO Asst. ProfessorAsst. Professor

2. Outline Definition of Bowel Diversion OstomyDefinition of Bowel Diversion OstomyPurposeClassification a. status a. status b. Anatomic location b. Anatomic location c. surgical construction c. surgical construction Ostomy ManagementOstomy Management Assessment Assessment Ostomy change Ostomy changeReferences

3. Definition OSTOMY – an opening for the gastrointestinal, urinary, or respiratory tract into the skin OSTOMY – an opening for the gastrointestinal, urinary, or respiratory tract into the skin Divert and drain fecal material Divert and drain fecal material PURPOSE

4. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 1. Status1. Status a. Permanent – to provide means of elimination when the rectum a. Permanent – to provide means of elimination when the rectum or anus is non functional ( birth defect / cancer) or anus is non functional ( birth defect / cancer) b. Temporary – for traumatic injuries or inflammatory conditions b. Temporary – for traumatic injuries or inflammatory conditions of the bowel, allowing the bowel to rest and heal of the bowel, allowing the bowel to rest and heal

5. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES TYPES OF INTESTINAL OSTOMY:TYPES OF INTESTINAL OSTOMY: 1.Gastrostomy – opening through the abdominal wall in the stomach 2.Jejunostomy - opening through the abdominal wall in the jejunum 3.Ileostomy - opening through the abdominal wall in the ileum3.Ileostomy - opening through the abdominal wall in the ileum 4.Colostomy - opening through the abdominal wall in the colon4.Colostomy - opening through the abdominal wall in the colon

6. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES Type of drainageNursing Responsibility Ileostomy / ascending colostomy Liquid fecal drainage; no control Instruct Client to wear appliance continuously and take special precautions to prevent skin breakdown Odor is minimal because fewer bacteria are present Transverse colostomy Malodorous, mushy drainage ; liquid has been reabsorbed; no control Descending colostomy Solid fecal drainage sigmoidosto my Normal or formed consistency ; can be controlled Client may not have to wear appliance at all times

7. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 3. Construction of the stoma3. Construction of the stoma a.single – one end of the bowel is brought out through an abdominal opening b. Loop – loop of bowel is brought into the abdominal wall and supported by a plastic bridge, or a piece of rubber tubing; has two openings (proximal and distal)

8. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES 3. Construction of the stoma3. Construction of the stoma c. Divided colostomy – two edges of bowel brought out into the abdomen but separated from each other d. Double barrel - proximal and distal loops of bowel are sutured together for about 10 cm and both ends are brought up into the abdominal wall Divided colostomy – Double barrel

9. OSTOMY APPLIANCE Consist of :Consist of : skin barrier skin barrier Pouch – can be closed or dainable Pouch – can be closed or dainable Adjustable Ostomy belt Adjustable Ostomy belt

10. Consists of group of nursing interventions that may be necessary after fecal diversion surgery Stoma assessment Stoma assessment Application of stoma to collect feces and protect skin Application of stoma to collect feces and protect skin Promotion of self care Promotion of self care OSTOMY MANAGEMENT

11. Assessment Assess for:NormalAbnormal ColorHealthy pink, red and slightly moist Dusky dark ( pink / bluish (cyanosis) suggest inadequate circulation to the stoma Size and shapeNew stoma are swollen; swelling decreases in 2-3 weeks or as long as 6 weeks Failure to recede may indicate blockage PositionMust remain on the abdominal surface If stoma retracts, feces may enter the abdominal cavity and cause peritonitis; Prolapse must be reported to the doctor Stomal bleeding Slight bleedingReport other bleeding ComplaintsBurning sensation under the skin may indicate skin breakdown Abdominal discomfort / distention

12. OSTOMY CHANGE Can be applied for up to 7 days Can be applied for up to 7 days Twice a week Twice a week Change whenever the stool leaks onto the peristomal skin Change whenever the stool leaks onto the peristomal skin Every 24 – 48 hrs if the skin is erythematous, eroded, or ulcerated Every 24 – 48 hrs if the skin is erythematous, eroded, or ulcerated More frequent changes if client complains of pain or discomfort More frequent changes if client complains of pain or discomfort The pouch is emptied when it is one third to one half full The pouch is emptied when it is one third to one half full If the pouch overfills, it can cause separation of the skin barrier and stool comes in contact with the skin If the pouch overfills, it can cause separation of the skin barrier and stool comes in contact with the skin

13. PURPOSE OF OSTOMY CHANGE To assess and care for peristomal skin To assess and care for peristomal skin To collect stool for assessment of the amount and type of output To collect stool for assessment of the amount and type of output Minimize odors for the client’s comfort and self esteem Minimize odors for the client’s comfort and self esteem

14. References Kozier & Erbs’ Fundamentals of Nursing. Eighth ed. 2008 Potter Perry. Basic Nursing 6th ed..Mosby, Missouri, 2006.