1. Dawn Klecka MSN, MBA, RN Deb Losicki MSN RN FNP-BC
Ostomy Care
Dawn Klecka MSN, MBA, RN
Deb Losicki MSN RN FNP-BC

2. Objectives
Verbalize understanding of the anatomy and physiology of the gastrointestinal tract
Verbalize the understanding of conditions that would result in the need for an artificial port (ostomy)
Verbalize the understanding of the different sites of an ostomy
Verbalize the understanding of the care for an ostomy
Verbalize the understanding of precautions required related to diet, activity, and medication of a patient with a ostomy
Consider the ethnic, age related, and sexual considerations of a patient with an ostomy

3. Ostomy
An Ostomy is a surgical opening for elimination of intestinal contents.
The Stoma - is the opening through the abd, it is created when the intestine is sutured to the skin.
It allows the diseased portion of bowel to rest and heal.
Ostomies can be temporary or permanent.

4. Types of Ostomys
Colostomy– is an opening between the colon and the abd wall.

5. Ileostomy – is an opening from the ileum through the abdominal wall.

6. Purpose of Ostomy Allow the bowel to rest after trauma (GSW)
Following Colectomy
2nd to CRC
Tumor Resection
Bowel can be anastomosed after healing
Permanent
Immediate anastomisis

7. Categorized by location and type
Ascending Colostomy
Descending Colostomy
Ileostomy
Sigmoid Colostomy
Transverse Colostomy (Double Barreled)
Which Ostomy will have the most formed stool?
Why?

8. Problems/ Interventions
Constipation - increase fluids, warm prune juice, increase fiber, fruit, bran & whole grain.
Diarrhea - encourage fluids, bland food, small amounts, avoid spicy, hot or cold foods & high fiber.
Flatulence - avoid carbonated beverages, gum, drinking from a straw, cabbage, beans, cauliflower & onions.

9. Diet Continued Post surgery—Clear liquids Advanced to low fiber diet
Then regulate nutrition intake to meet individual needs
Goal to maintain adequate nutrition and avoid blockage and pain flatus, diarrhea and constipation.
Risk for deficient fluid volume
Goal to avoid obstruction…fibrous meats, corn cabbage celery, green peppers, and peas. Fruit skins and seeds, nuts dried fruits, and popcorn

10. Care for Ostomy Site
Ostomy Management

11. Ostomy Management Maintain privacy
Remember the psychological effects: body image disturbance & self-esteem disturbance
Bet to perform care between meals
Fecal material is very irritating to the skin
Assess stoma & surrounding skin each time you change or empty the appliance.
Look for color, edema, bleeding
c/o burning under skin barrier may be 2nd to skin breakdowm
Can delegate to UAP’s UAP’s cannot take care of a new ostomy. UAP’s can remove and change old established devices.
Whan changing the device and cleaning put some gauze over the stoma site to catch any drainage.

12. Characteristics of Stoma
Cause
Rose to brick-red
Pale
Blanching, dark red-purple
Edema
Viable stoma mucosa
Anemia?
Inadequate blood supply
Normal post op
Trauma, obstruction, allergy, gastroenteritis

13. Characteristics of Stoma
Cause
Bleeding
Small amount
Moderate to LARGE
Oozing from stoma when touched..normal
Coagulation factor deficiency
Lower GI bleed

14. Ostomy Management Observe skin for irritation.
Skin should be cleaned & dried thoroughly.
Apply skin barrier cream around stoma
Odor control is essential to pts self-esteem!
Appliance should be cleaned in the bathroom when they are 1/3 to 1/2 full
Avoid mealtimes to clean appliance!

15. Measuring The pouch must fit snugly to prevent leakage.
How many of you have changed an appliance where you had to cut out the hole?
Stoma measuring card.
Measure to fit no more then 1/6 the opening.

16. Colostomy Irrigation Similar to an enema.
Insert lubricated cone tip before irrigation otherwise the fluid will run out.
Routine irrigation's control the time of elimination's.
When regular pattern is achieved the wearing of a colostomy pouch is unnecessary.

17. Nursing Diagnoses Risk for deficient Fluid Volume
Risk for impaired skin integrity
Deficient Knowledge
Disturbed body image
Products | C&S Ostomy Pouch CoversDiet & Fitness With An Ostomy | LIVESTRONG.COM
United Ostomy Associations of America - Ostomy, Colostomy, Ileostomy, Urostomy, Continent Diversion Support Groups

18. Questions? Discussion & Practice