CARE OF PATIENTS WITH OSTOMIES ppt.pptx

Care of patients with ostomies

1. CARE OF PATIENTS WITH OSTOMIES

2. Ostomy - definition It means an opening which is made during surgery that brings a piece of bowel (intestines)to the outside of the abdomen. Ostomy surgeries are performed when a part of the bowel is diseased and therefore is removed

3. The artificially created opening is called stoma . The output from the stoma (urine, feces or mucous ) is called effluent

4. Characteristics of stoma Protrudes above the skin Pink to red in colour Moist Round in shape No nerve sensations

5. Colostomy It is an operation in which an artificial opening is made into the colon on the anterior abdominal wall to permit the escape of feces and flatus

6. Indications for colostomy Cancer of colon & rectum Bowel obstruction Crohn's disease Ulcerative colitis Hirschprung's disease Imperforate anus

7. Purposes of colostomy To permit escape of feces and flatus when there is an obstruction of the large bowel or a known lesion that will eventually cause obstruction To permit healing of the bowel distal to the colostomy opening since it diverts the fecal contents from the affected area To provide a permanent means of bowel evacuation when the rectum or anus are non functional as a result of disease

8. Types of colostomy: According to duration Permanent colostomy Temporary colostomy

9. According to stoma site

10. TYPE LOCATION CHARACTERISTICS OF FECES Ascending colostomy Right side of abdomen liquid form Transverse colostomy upper abdomen,either middle or towards right semisolid from Descending/sigmoid colostomy lower left side of abdomen normal bowel movement

11. Acc. to stoma number Loop colostomy End colostomy Double barrel colostomy

12. End colostomy/single barrel colostomy

13. SINGLE BARREL DOUBLE BARREL LOOP

14. Pouching systems/ Ostomy appliances Individuals with colostomy has no control over the output of stoma. Patients with ostomies must wear a pouching system to collect the effluent from the stoma and protect the skin from irritation. The pouching system must be completely sealed to prevent leaking of the effluent

15. The disposable pouching system consists of a plastic bag and a flange/wafer (skin barrier)that sit against the patient's skin The pouch has an open end to allow effluent to be drained and may be closed using a plastic clip or velcro strip Ostomy pouching systems vary based on the type of stoma, stoma characteristics, stoma location, patient abilities, skin folds and patient preferences

16. PARTS OF COLOSTOMY BAG POUCH DRAIN END SKIN BARRIER WITH FLANGE

17. Purposes of colostomy care To maintain integrity of stoma & peristomal skin To prevent infection To promote general comfort and positive self image To provide clean ostomy pouch for fecal evacuation To reduce odour from overuse of old pouch

18. Colostomy care Provide privacy for the client Wash hands Place a waterproof pad under the client to protect bed linen Empty the contents of the ostomy bag before removing the bag. Note the colour , volume, consistency and odour of the feces

19. Gently remove the skin barrier and bag while supporting the client's skin Place a gauze pad over the exposed stoma to prevent soiling from leakage Wash the skin around stoma with warm water and mild soap, and wash the stoma with clear water Thoroughly rinse the area with water and pat it dry

20. Note the colour , moisture and protrusion of the stoma and the condition of surrounding skin Use a stoma measuring guide to cut the flange or wafer into desired size Prepare skin and apply accessory products like stomadhesive powder or paste. These products are used to create a skin sealant to adhere pouching system to the skin to prevent leaking

21. Apply the wafer and bag around the stoma. Position the bag to hang in a dependent position. Dispose of the soiled bag and appliance properly

22. 1 2

23. Home care considerations Demonstrate how to clean the stoma to the care giver Tell the client to expect effluent daily. It will be watery initially, but will thicken within 2 to 4 weeks Expect excessive flatulence for 4 to 8 weeks

24. Teach caregiver to watch for manifestations of intestinal obstruction such as nausea or vomiting, body temperature exceeding 101 F, severe abdominal pain, distention, limited or no output, decreased bowel sounds Pouching system should be changed every 4 to 7 days, depending on the patient and type of pouch.

25. Factors that affect pouching system include sweating, high heat, moist or oily skin, and physical exercises Avoid taking food which give rise to odourous stool, eg.onion , garlic, meat Keep the peristomal skin near dry and apply zinc oxide cream to prevent skin excoriation Frequent consultations with ostomy nurse

26. Wound, Ostomy And Continence Nurses Society United Ostomy Association of America Colostomy clinic & Ostomy nurse