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What is an ostomy?
a surgically created opening in the abdomen for the discharge of wastes.
What is a stoma?
the actual end of the ureter or small/large bowel that has been brought through the abdominal wall.
What is effluent?
the drainage or output from the stoma.
What are the three types of Ostomies?
what is an Ileostomy?
an opening from the small bowel, to allow feces to leave the body without passing through the large bowel.
What is a Colostomy?
an opening from the large bowel, allows feces to leave the body without passing through the anus.
What is an Urostomy?
an opening from the ureters, to allow urine to leave the body without passing through the bladder.
What are reasons for an Ileostomy?
- Disease or injury to large intestine
- Crohn's disease
- Ulcerative colitis
- Colorectal cancer
- Diseased or injured colon
- Birth defect
- Familial polyposis
Where is an Ileostomy located and what type of effluent?
located in the ileum of small bowel. Drains frequent watery to thick liquid. Needs to increase fluid intake.
What are reasons for a colostomy?
- Colon cancer
- Rectal cancer
- Perforated diverticulitis
- Inoperable tumors of colon, rectum, or pelvis
- Birth defect
Where is a colostomy located and what type of effluent?
located in the large bowel either ascending, transverse, descending,or sigmoid. Drains semi-liquid, soft to formed stool depending on location. Need to increase fluid intake based on location. Sigmoid portion doesnt need lots of fluid.
What part of the large bowel will have small amounts of stool and gas?
Descending and sigmoid
What are the different types of colostomies?
- Sigmoid/Descending (most common)
- Transverse (Double barrel or loop)
- Double Barrel
- Ascending (rare)
What is a double barrel colostomy?
Bowel completely transected. 2 stomas the proximal end drains stool and the distal end drains mucus.
What is a loop colostomy?
Bowel is partially transected. Brought through abdomen and held in place by a rod such that one stoma drains stool (proximal) and mucus (distal)
What are reasons for a urostomy?
- bladder cancer
- congenital anomalies
- neurogenic bladder
What is the location and drainage of a urostomy?
location depends on surgical procedure. Can be continent using portion of bowel. Can be incontinent. Drains urine.
What are the types of urostomy?
Ileal conduit= small piece of bowel and ureters attached to look like a stoma
Ureterostomy=brings ureters out to abdominal wall
How does a continent urinary diversion work?
With a Kock Pouch
When should you change an ostomy?
- -every 3-7 days and depends on contours of abdomen, condition of peristomal skin, and preference of client.
- -before breakfast or 2-4 hours after a meal when bowel is least active
- -after a shower
- -anytime client complains of burning or itching
What do you assess for with the ostomy?
- -observe existing skin barrier and pouch for leakage
- -assess stoma (appearance, size, shape, type, color, & amount of effluent)
- -observe abdominal contour, pressure areas, abdominal incision
- -assess periostomal skin (blistering, redness, irritation, cuts, rash, & skin breakdown)
What are the types of stomas and what type of pouch to use?
- 1. protruding/budding (above the skin level) use a flat wafer pouch
- 2.flush (even with skin level) use a convex wafer pouch
- 3.retracted/recessed (below skin level) use convex wafer pouch
What are the three types of barrier creams and what are they for?
- Barrier paste=to fill in gaps and creases around stoma
- Skin sealant/barrier film=if patient skin tears easily, problems with leakage, dry or oily skin, using skin barrier powder
- Barrier powder=patient skin is raw/ weepy
If using all three barrier creams what order do you apply them in?
powder, film, paste
What type of foods increase gas and stool?
Carbonated beverages, beer, beans, eggs, fish, broccoli, garlic, onions, cabbage/brussels sprouts, cucumbers
What type of foods decrease stool odors?
buttermilk, cranberry juice, parsley, yogurt
What type of foods thicken stool?
applesauce, pretzels, bananas, white rice, cheese, white toast, creamy peanut butter, yogurt, noodles
What are food restricitons on ileostomy?
high fiber foods, celery, coconut, corn, coleslaw, peas, popcorn, spinach, dried fruit and nuts
How long are ureteral stents in place for and what are they for?
In place for 5-7 days post op. Used to maintain patency of ureters during period of post-op edema, to allow healing of ureteroenteic anastamoses
Why would you use a "wick: when changing a pouch?
To catch urine drainage while changing
When should you empty a ostomy bag?
- -when the pouch is 1/3-1/2 full of stool or gas
- -when the pouch is 1/3 full of urine
When should you be most concerned about?
- -temp of 101/38.3 or higher
- -abdominal pain or severe cramps lasting longer than 2-3 hrs
- -skin around is painful, red, raw, or weeping longer than 1 week
- -deep cut in stoma
- -excessive bleeding from stoma
- -bleeding between stoma and skin
- -unusal change in stoma size and apperance
- -severe watery discharge longer than 5-6 hours
- -c/o nausea or vomiting
- -severe constipation/no output 4-6 hours
How do you help a client adapt to a stoma?
- First: have them look at stoma
- Second: have them help with emptying/cleaning
- Third: have them empty/clean on their own and help with changing pouch
- Fourth: have them change pouch on their own