ostomy-care.pptx

care

1. OSTOMY & ITS CARE Ms. Deepsikha kakoty Dept of Medical Surgical Nursing College of Nursing, NEIGRIHMS

2. DEFINITION An ostomy is an opening in the small intestine or large intestine that is surgically created as an outlet through the anterior abdominal wall in order to pass fecal matter into a bag.

3. Frequency of Ostomies More than 700,000 Americans – from infants to senior citizens – have had ostomy surgery. Over 120,000 people each year have fecal or urinary ostomies.

4. PURPOSE OF A STOMA It reduces pain and discomfort Allows systematic defecation May help relieve symptoms of intestinal disease

5. INDICATIONS OF AN OSTOMY Inflammatory bowel disease Ulcerative colitis Cancer Perforated or complicated diverticulitis Bowel obstruction Crohn’s disease Hirschsprung disease Accidental injury Congenital deformities of anus or rectum

6. TYPES OF OSTOMIES According to the location: Colostomy, Ileostomy and Urostomy Major types of intestinal stoma can be: End stoma, Loop stoma and Double-Barreled stoma According to duration: Temporary ostomy and Permanent ostomy

7. END STOMA Surgically constructed stoma by dividing the bowel and bringing out the proximal end as a single stoma. LOOP STOMA It is constructed by bringing a loop of bowel to the abdominal surface and then opening the anterior wall of the bowel to provide fecal diversion.

8. DOUBLE-BARRELED STOMA It is constructed by dividing the bowel, and then both the proximal and distal ends are brought through the abdominal wall as two separate stomas.

9. What is an ostomy? It is a surgical opening in the abdomen where the intestine is brought up onto the skin and sutured in place to form a stoma. To bypass diseased intestine or bladder 3 types; the most common is the colostomy Then the ileostomy And last the urostomy

10. 3 types of O stomies Co l o st o m y Ileostomy Urostomy

11. Types of colostomy TRANSVERSE LOOP DOUBLE BARREL ASCENDING DESCENDING SIGMOID

12. Indications for a C olostomy : Trauma Cancer Diverticular disease Crohn’s disease Ulcerative colitis Obstruction

13. PERMANENT COLOSTOMY Blockage Injury Colorectal cancer Colonic polyps Diverticulitis Imperforate anus Irritable bowel syndrome Ulcerative colitis

14. ARTICLES REQUIRED A clean tray containing Mackintosh with draw sheet, Kidney tray / paper bag , Pair of clean gloves, Colostomy bag, Normal saline / basin with warm tap water, Gauze pieces, Gauze pad / tissue paper, Skin barrier, Stoma measuring guide, Pen or pencil and scissors. Bed pan.

15. ASS E SSME N T Identify the type & location of ostomy in the patient. Assess the skin integrity around the stoma and appearance. Note the amount and character of fecal material in pouch.

16. PROCE D URE Arrange the all necessary articles . Explain the procedure to the patient . Provide privacy and assist patient to a comfortable position. Wash hands & wear gloves to prevent infection. Spread Mackintosh & draw sheet to protect linen Remove used pouch & skin barrier gently by pushing the skin away from the barrier. Reduces t rauma,jerking , irritates skin and can cause tear. Remove clamp and empty the contents into the bed pan. rinse the pouch with tepid water or normal saline to minimize the odour & growth of microbes Discard the disposable pouch in paper bag.

17. PROCE D URE Observe stoma for : colour, swelling, trauma,& healing. Stoma should be moist and pink Cover the stoma with a gauze piece to prevent the fecal matters from contacting with skin Clean stomal region gently with warm tap water using gauze pad. Do not scrub the skin, dry completely by patting the skin with gauze . Remove gauze and clean stoma with gauze and pat dry. Measure the stoma using measuring guide.

18. Ensures accuracy in determining correct pouch size needed. Trace same circle behind the skin barrier, using scissors, cut an opening 1/16 th to 1/8 th inch larger than stoma before removing the wrapper over adhesive part. Put skin barrier and pouch over the stoma , and gently press on to the skin, for 1-2 minutes. To prevent irritation to skin. Use the pouch if it is drainable using a clamp or clip Remove gloves and wash hands. Make the patient comfortable Clean the area and replaceall articles.

19. GUIDELINES: Keep odour as free of odors as possible. Ostomy bag should be emptied frequently. Check the stoma regularly, the colour should be dark pink to red and moist. Pale colour indicates anaemia, Dark or purple blue indicates compromised circulation.

20. Size of the stoma stablizes 6-8 weeks. If dressing, check frequently for drainage and bleeding. Keep the skin around the stoma (peristomal area) site clean and dry. If not it causes skin irritation and infection. Intake and out put chart must be recorded for every 4 hours. Encourage the patient to participate in care and to look at the ostomy. Can help the patient by listening, explaining, being available and supportive.

21. Encourage the patient to avoid fibre rich diets. Encourage the patient to drink fluids. Educate the patient about the various methods of odor control measures. Chlorophyll rich diet will deodorise the feces. Direct contact sports and heavy lifting must be avoided.

22. Gastrointestinal System

23. Colostomy sites

24. New S toma

25. Hard to pouch stoma

26. Ostomy care Empty pouch when 1/3 to ½ full Change pouching system 2x/week or immediately for any leaking May shower with appliance on or off Do not use baby wipes to clean around stoma….new wafer may not stick Clean peri stomal skin with moist wash cloth

27. Skin cleansing Water Soap discouraged No diaper wipes (lanolin) Product wipes made for adherence if needed Ostomy products are made to adhere to the skin!

28. Measure stoma They can change in size After surgery Weight gain Weight loss

29. How to make appliance fit Use correct size of appliance Cut to fit each individual stoma The wafer (adhesive barrier) should fit snugly around the stoma, 1/8” close Use barrier ring or paste only if necessary Some newer wafers are “form to fit” and they turtle neck up to stoma

30. Cut to fit wafer

31. Stretch to fit appliance

32. Types of Stomas B u dd ed F l u sh Inverted

33. Peristomal skin breakdown

34. Crusting technique Clean dry (if possible) skin Apply stomahesive powder; sprinkle Dust off with gauze, paper towel etc Dab with no sting barrier wipe/lollipop Repeat process 3 times Keep effluent off peristomal skin while applying the crusting technique

35. Healthy Stoma

36. Paste/barrier rings Paste has alcohol; if needed let dry for 1 minute for evaporation of alcohol before applying to skin Barrier rings preferred; warm first apply to skin, can fill in crevices and provide protection of peristomal skin Fit right next to stoma

37. Barrier ring application

38. Stomahesive Paste

39. Perfumes for Colostomy

40. 1 or 2 piece, matter of preference

41. C onvex Use if stoma is flush or inverted

42. Drainable or closed Urostomy pouch has to be drainable Ileostomy pouch has to be drainage Colostomy pouch can be closed end or drainable

43. Pouche s Closed end Drainable

44. Two piece

45. One piece

46. Ileostomy Stoma that comes from the ileum Usually on the lower right of abdomen Effluent is loose to liquid with enzymes More issues with leaking and break down in peristomal skin More diet restrictions Blockage problems

47. Ileostomy site

48. Ileostomy stoma

49. Ileostomy is from the ileum The entire colon, rectum and anus are removed or bypassed . The small intestine (ileum) is brought through the abdominal wall creating the stoma, most often on the right lower site The stoma is smaller in diameter

50. Ileostomy diet Drink much more water/liquids; 10-12 glasses a day Avoid nuts, popcorn, seeds, celery, corn Raw crunchy vegetables must be chewed very well! Eat slowly and chew all food well Avoid time release/enteric coated pills For blockage-go to ER

51. Ileostomy tips For difficulty/constantly draining stoma Have patient/client eat 2 Tablespoons of peanut butter OR eat 6 large marshmellows 30 minutes before changing appliance This will slow down the drainage so you can get a good seal

52. Urostomy The bladder is removed or bypassed A conduit is made of small intestine tissue Ureters are implanted into the ileum and on to the urostomy stoma The urine flows from the stoma into the pouching appliance

53. TYPES OF UROSTOMY STANDARD OR CONVENTIONAL UROSTOMY CONTINENT UROSTOMY

54. Ileal Conduit

55. Urostomy tidbits The intestine produces mucous, therefore the urine will have a cloudy appearance and the mucous will need to be cleaned off the stoma during appliance changes Adequate fluid intake, 8-10 glasses a day, is very important Need to connect to a over night drainage system at night .

56. Urine crystals White, gritty deposits on and around stoma Clean with peristomal skin with 1:1 vinegar and water Clean over night container with vinegar and water

57. Percentages of the 3 types U r o st o my 20% Ile o st o m y 35% Co l o st o m y 45%

58. OSTOMY CARE PRE -OPERTATIVE CARE: Psychological preparation : Emotional support for altered body image, the lose of control over elimination and the odors. Selection of site: A flat, crease-free surface, in the patient’s visual field and within the rectus muscle. A flat site create a good seal and avoid leakage from the bag. Usually in the right lower quadrant about 2 inches below the waist. Marking of the area before surgery