Most common ileostomy complications

Most common ileostomy complications and preventive measures and management. in service live education.

1. MOST COMMON PROBLEM ARISE FROM ILEOSTOMY PRESENTED BY :ST.TR. CHHAYA PAWAR K.E.M. HOSPITAL, MUMBAI.

2. Ostomy Greek word- A mouth or mouth like opening. Ileostomy is a surgically performed through the abdominal wall opening into the ileum or small intestine to excrete faeces from the body. Stool is liquid to semisolid consistency and contains protiolytic enzymes. Temporary or Permanent.

3. THE AIMS OF STOMA CARE To provide a service of mgt & support both pre & post operatively for the pt. with a stoma & his family & to guide & teach other nurses involved with the pt. & maintain a program of rehabilitation of pt to achieve maximum independence & regain a high quality of life.

4. MOST COMMON PROBLEM ARISE FROM ILEOSTOMY PSYCHOLOGICAL PROBLEMS. LEAKAGE OF BAG SKIN EXCORIATION FOOD BLOCKAGE DEHYDRATION ELECTROLYTE IMBALANCE B12 DEFICIENCY etc.

5. COUNSELLING

6. Explanation given by the stoma staff about anatomy & physiology to pt and relatives

7. Different types of stoma bags and accessories required to pt.after surgery

8. Visit By Ostomy Visitor before stoma surgery.

9. STOMA MARKING

10. POUCHING/ADVANTAGES.

11. Patient Teaching The first step is looking at the stoma, progressing to assisting with emptying and cleaning, and then to changing the pouch. If the patient cannot progress to the point of willingness to learn, a caregiver must be taught pouch change procedure and care until the patient is ready to learn. Pouch change should performed before eating as stoma is less active. Shaving should be done routinely.

12. OSTOMY BASIC SKIN CARE ROUTINE REMOVE CLEAN AND DRY MEASURE STOMA PROTECT APPLY

13. Adaptation to a stoma It is a gradual process because the patient experiences grief over the loss of a body part and an alteration in body image. Adjustment period is individualized. Patients are concerned about body image, sexual activity, family responsibilities and changes in lifestyle.

14. And Finally Before your patient is discharged they should be able to Demonstrate cleaning and changing the pouch Verbalize where to obtain supplies Know how to contact a resource person for problems Know how/when to follow up with physicians, WOCN, and support group.

15. PREVENTION FOR ILEOSTOMY BLOCKAGE - AVOID STRINGY, HIGH FIBER FOODS LIKE CELERY, COCONUT, CORN,COLESLAW, THE MEMBRANES ON CITRUS FRUITS, NUTS, WATERMELON, GUAVA, POMEGRANATE,CUSTARD APPLE ,VEGETABLE & FRUIT SKINS. ENTERIC COATED, TIME RELEASED MEDS OR HARD TABLETS MAY NOT BE ABSORBED SO LIQUID OR CHEWABLE MEDS ARE PREFERED.

16. IF DEVELOPED FOOD BLOCKAGE HAVE THEM GET INTO THE KNEE CHEST POSITION AND ROLLING FROM SIDE TO SIDE FOR A FEW MINUTES. GENTLY MASSAGING YOUR TUMMY AND THE AREA AROUND THE STOMA. TAKING A HOT BATH FOR 15 TO 20 MINUTES.(TO HELP RELAX MUSCLES IN YOUR TUMMY REMOVE POUCH AND REPLACE WITH TWO PIECE SYSTEM. NBM OR CONTACT TO SURGEON/ET.

17. FOOD BLOCKAGE & SKIN EXCORIATION PT’S NAME:- xyz AGE:- 31YRS MALE MARRIED ON 2009 HAVING TWO CHILDRENS M & F , R/O PANDHARPUR C/O ULCERATIVE COLLITIS OPERATED IN SASOON HOSPITAL, PUNE – TOTAL COLECTOMY WITH ILEOSTOMY ON 1 ST JAN 2014. HE CAME TO MUMBAI ON 2 ND MARCH TO ATTEND FUNCTION, FROM THAT FOOD HE UNDERGONE FOOD BLOCKAGE & HE CAME TO K.E.M. HOSPITAL .

18. NURSING DIAGNOSIS:- Risk for food blockage related to disease condition as evidenced by lack of knowledge. Risk for skin integrity related to loss of sphincter muscle at stoma / flow of effluent as evidenced by wrong type of bag application. Knowledge deficit regarding condition, prognosis, treatment, self-care, & discharge needs. Deficient fluid volume related to loss of colon function as evidenced by signs & symptoms.

19. LEAKAGE OF BAGS CAUSES:- NO PROFESSIONAL GUIDANCE, IMPROPER STOMA SITING WRONG TYPE OR SIZE OF APPLINCE OVERSTORING OF APPLIANCES ECONOMIC CONDITION OF PT. NONAVAILABILITY OF PRODUCT COMPLICATION OF SE, HPR & CT HIGH OUTPUT OF STOMA ETC.

20. HIGH OUTPUT OF STOMA PROBLEM :- DEHYDRATION FLUID & ELECTROLYTE DEFICIT SKIN EXCORIATION TREATMENT:- ASK TO DRINK 2 LOR MORE FLUIDS IF NOT REPLACED THE FLUID & ELECT. ANTI- DIARRHOEAL DRUGS POUCH – ONE PIECE DRAINABLE 2 PIECE SYSTEM OR WOUND COLLECTOR .

21. PT. xyz AGE:- 42 YRS FARMER FROM U.P. DIAGNOSIS:- NECROTISING ENTEROCULITIS SURGERY:- TOTAL COLECTOMY WITH ILEOSTOMY ON 25 TH MARCH 2012 COMPLAINT:- FREQUENTLY LEAKAGE OF BAGS PREFER:- TWO PIECE SYSTEM DRAINABLE BAG SUPPLEMENTS OF INJ.B12/TABLETS

22. PT. xyz AGE:- 23YRS. DIAGNOSIS:- ULCERATIVE COLITIS. OPERATION:- TOTAL COLECTOMY WITH ILEOSTOMY. D/O/SURGERY :- 20 th march 2015 PROBLEMS:- HIGH OUTPUT OF STOMA & FREQUENTLY LEAKAGE OF BAG/ DEFICIT OF ELECTROLYTES & FLUIDS. PREFER:- LARGER SIZE OF APPLIANCE. CORRECT THE ELECTROLYTES & REPLACEMENT OF FLUIDS. POST OP. COUNCILIING.

23. EXPLAINED TO PT & RELATIVES ABOUT EMPTYING & APPLICATION OF STOMA BAG.

24. INSERVICE EDUCATION TO HOSPITAL STAFF

25. INSERVICE EDUCATION TO HOSPITAL STAFF

26. INSERVICE EDUCATION TO STAFF & SISTER INCHARGES

27. CONT……

28. INSERVICE EDUCATION TO HOSPITAL STAFF

29. STOMA CARE LECTURE TO GNM STUDENT NURSES

30. DEMONSTRATION

31. QUESTION & ANS. SECTION