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

2. Outline
Definition of Bowel Diversion Ostomy Purpose Classification a. status b. Anatomic location c. surgical construction Ostomy Management Assessment Ostomy change References

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

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

5. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES
2. Anatomical location - influences the character and management of fecal drainage
The farther along the bowel, The length of time, the more formed the stool and the more control over the frequency of stomal discharge can be established
TYPES OF INTESTINAL OSTOMY:
Gastrostomy – opening through the abdominal wall in the stomach
Jejunostomy - opening through the abdominal wall in the jejunum
Ileostomy - opening through the abdominal wall in the ileum
Colostomy - opening through the abdominal wall in the colon

6. CLASSIFICATION OF BOWEL DIVERSION OSTOMIES
Type of drainage
Nursing 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
sigmoidostomy
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 stoma
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 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 : skin barrier
Pouch – can be closed or dainable
Adjustable Ostomy belt

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

11. Assessment Assess for: Normal Abnormal Color
Healthy pink, red and slightly moist
Dusky pink / bluish (cyanosis) suggest inadequate circulation to the stoma
Size and shape
New stoma are swollen; swelling decreases in 2-3 weeks or as long as 6 weeks
Protrude slightly from the abdomen
Failure to recede may indicate blockage
Position
Must 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 bleeding
Report other bleeding
Complaints
Burning sensation under the skin may indicate skin breakdown
Abdominal discomfort / distention

12. OSTOMY CHANGE Can be applied for up to 7 days Twice a week
Change whenever the stool leaks onto the peristomal skin
Every 24 – 48 hrs if the skin is erythematous, eroded, denuded or ulcerated
More frequent changes if client complains of pain or discomfort
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

13. PURPOSE OF OSTOMY CHANGE
To assess and care for peristomal skin
To collect stool for assessment of the amount and type of output
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.