ATI Ostomy Care

denudation

stripping of a body part or skin surface

One-piece Systems

transparent or opaque, odor-proof plastic pouches come with an attached adhesive or karaya seal; come in drainable or closed-end models and may have a carbon filter for gas release; some have an attached skin barrier; particularly useful for stomas that secrete watery effluent; provide added protection for peristomal skin

Fluid/electrolyte imbalances

High-volume ileostomy output can put patients at risk for

measure the pH of urine, skin care, fluid intake, pouch care and how to prevent leaks, self-catherization, S/S of infection and obstruction, odor management, how to care for drains if sent home with ileal conduit

In regards to urostomy management, what should the nurse teach the patient about home care?

where the damage is and the type of ostomy surgery performed

What does the location of the stoma depend on?

-Teach S/S of food blockage (abdominal cramping, nausea, vomiting, high-volume odorous effluent, swelling of the stoma, and no ileostomy output for at least 6 hours) -Notify Provider -Place moist towels on the abdomen, drink hot tea, lie down and assume a knee-chest position to relieve intra-abdominal pressure, and/or massage the abdominal area to promote peristalsis and fecal elimination -

What teaching should a nurse provide a patient with an ileostomy about the complication of food blockage?

Hyperplasia

abnormal increase in the volume of a tissue or organ

clip

closing device

Anastomosis

formation of a connection between two usually distinct structures or portions of a structure

Stoma

opening of an ostomy

asparagus, beans, cabbage, eggs, fish, garlic, onions, and some spices, beer, broccoli, Brussels sprouts, cabbage, carbonated drinks, cauliflower, corn, cucumbers, dairy products, dried beans, mushrooms, onions, peas, radishes, and spinach

Colostomy: What are foods that cause flatulence?

shiny, wet, and red in color, similar to the mucous membranes of the mouth Depending on the ostomy, the stoma can be round, oval, or irregular in shape, and either protruding or flush with the skin

Describe what the stoma should look like under normal circumstances.

Exercise: advise against contact sports due to the risk it poses for the stoma (football, soccer, basketball) and instead promote walking, or any other cardiovascular and musculoskeletal fitness Travel: Pack extra supplies when traveling, especially when flying Sexuality: suggest discussing body image issues with partner, assure that sexual activity will not interfere with stoma, empty and cover pouch

Follow-up care consists of educating the client on when exercise, travel, and sexuality can be resumed as normal. The nurses recommendations should match that of the HCP orders. What are some follow-up teachings in the above that the nurse should teach the patient at the visit?

-congenital anomalies such as spina bifida -bladder, colon, and rectal cancer -inflammatory bowel diseases (Crohn's disease, ulcerative colitis) -inherited disorders such as adenomatous polyposis -obstruction of the ureter -stab or gunshot wounds to the abdomen

Name some indications for ostomy surgery.

colostomy ileostomy urostomy

Name the three primary types of ostomies.

extreme thirst dry skin and oral mucous membranes decreased urine output weakness, fatigue headache, dizziness muscle cramps abdominal cramps, nausea, vomiting shortness of breath orthostatic hypotension

S/S of fluid/electrolyte balance

-increased pain in the abdomen or the incision; fever, redness, or drainage of the incision; or irritation, redness, or -breakdown of the peristomal skin -a change in bowel habits, such as diarrhea or constipation -skin irritation unrelieved by a properly fitting pouching system -problems obtaining a good seal of the wafer or skin barrier a hernia or bulge around the stoma -narrowing of the stoma lumen -separation of the stoma from the abdominal surface -lacerations or cuts in the stoma

Teach the patient to measure the stoma at each dressing change and monitor for these:

Descending colon (left upper abdomen)

This is a more common type of colostomy. The output is semi-formed because more water is absorbed while fecal material is in the ascending and transverse colon.

Ascending colon (right abdomen)

This is an uncommon type of colostomy. The output is typically liquid to semi-liquid and is very irritating to the surrounding skin.

Sigmoid colon (left lower abdomen)

This is the most common location for a permanent colostomy, particularly for cancer of the rectum. Surgery involves removal of the sigmoid colon, rectum, and anus through abdominal and perineal incisions. The anal canal is closed, and a stoma is formed from the proximal sigmoid colon. The stoma is typically located on the lower left quadrant of the abdomen, and the output is formed.

Transverse colon (mid-abdomen)

This location is used for a temporary ostomy, with the stoma constructed as a loop. Output is liquid to semi-formed.

High-fiber Hard to digest foods popcorn, nuts, corn, cucumbers, celery, fresh tomatoes, figs, strawberries, blackberries, and caraway seeds

To prevent food blockage, the nurse should teach the patient to avoid certain foods such as?

Hartmann's procedure

What is a common temporary colostomy that involves leaving the distal portion of the colon in place?

-Fluide and electrolyte imbalance (high-risk) -Drink 2-3 L/day decrease to 800-1500mL a day -Can resume a regular, balanced diet -Chew food thoroughly to help with passage through narrow ileum -May need to avoid high-fiber foods for the first 6 to 8 weeks to prevent food blockage -Take enteric-coated meds cautiously and monitor for any meds undissolved in pouch

What should a nurse consider priority teaching for a patient with an ileostomy?

any stoma that turns dusky, brown, black, or white- teach to notify HCP

What should a nurse teach a patient as to what a abnormal stoma looks like when circulation becomes compromised?

appears pink or red and moist, and should protrude about ¾ inch (2 cm) from the abdominal wall

What should a nurse teach a patient curious as to what a stoma looks like under normal circumstances?

techniques to use for cleansing, signs and symptoms of stoma or peristomal skin complications, and application and management of the pouching system

What should a nurse teach a patient in regards to ostomy care?

Abdominoperineal colostomy: Avoid rectal suppositories (rectum no longer there) If temporary, patient may feel urge to defecate Double-barrel or loop colostomy: do not irrigate distal opening- carries no fecal material, only irrigate proximal stoma if needed Advise patient of possible diet change due to foods that cause bad odor and/or gas Discuss possible pouching systems that best fit the clients needs

What should a nurse teach a patient who has a colostomy?

-Initial drainage from an ileostomy is typically dark green, viscid, and odorless -Empty pouch when one third to one half full -Contents full of enzymes and bile irritating to skin, teach patient the use of skin barrier -Watch for pouch leakage -Teach S/S of food blockage -

What should the nurse teach a patient that has an ileostomy?

typically a mild, pH-balanced soap or no soap at all and just water; any products such as alcohol promote skin breakdown and interfere for adhesion of the skin barrier

What skin products should be used to clean the stoma?

-There are no dietary restrictions -Drink plenty of fluids to prevent infection and maintain urinary function -Potential for metabolic acidosis (risk of electrolyte imbalance)

What would a nurse teach a patient with urostomy?

Loop Colostomy

a loop of the bowel is brought through the abdomen to the skin surface and temporarily supported by a plastic bridge or rod; is typically created as an emergency procedure to relieve an intestinal obstruction or perforation

Cohesion

ability of the skin barrier to maintain its integrity when exposed to moisture

Skin barriers

adheres to the skin around the stoma and performs two important functions: It protects the skin from stoma output, and it attaches the pouch to the body; cut-to-fit, pre-cut, and moldable;

Refitting

adjusting a pouching system to accommodate changes in stoma size or to address other stomal or peristomal issues

Kock's continent ileostomy

alternative to the standard ileostomy; internal pouch is created from the distal segment of the ileum, which serves as a reservoir for stool; is occasionally created to treat ulcerative colitis and may be an option for patients who do not wish to wear an external pouch over the stoma; patient empties the pouch several times a day and the stoma is covered with a protective dressing or a stoma cap; patients can be at risk of dehydration;

psoriasis

any of several related chronic, recurrent skin disorders

Closed-end pouch

are designed for one-time use and may meet the needs of a patient who irrigates, wants added security, or wants to discard the pouch after each bowel movement; some come with a filter designed to reduce odor and gas buildup; has no drain or clip, and it is not recommended for use with a urostomy; when full, it is removed from the skin barrier and discarded in an appropriate receptacle

luminal bleeding

blood seeping through the opening (lumen) of a stoma

Drainable pouches

can be rinsed and reused; recommended for use with an ascending or transverse colostomy, an ileostomy, and a urostomy; have a tap instead of a clip.

Hartmann Procedure

common temporary colostomy surgery that involves leaving the distal portion of the colon in place and oversewn for closure to create a Hartmann's pouch

Stomal height

degree of protrusion of a stoma from the skin

Tap

device on a urostomy pouch that permits drainage of the contents

hydronephrosis

enlargement of the kidneys as urine collects in the renal pelvis and kidney tissue

Cystectomy

excision or resection of the bladder

Skin barrier

faceplate designed to protect the peristomal skin from the stoma output and to which the pouch is attached

wafer

faceplate or barrier designed to protect the peristomal skin from the stoma output and to which the pouch is attached

Valsalva Maneuver

forceful exhalation against a closed glottis, which involves contraction of the abdominal muscles to propel feces out of the body

Flatus

gas or air generated in the stomach and/or intestines and expelled via the anus or an intestinal ostomy

Loop Colostomy

has to openings in the one stoma that allow for drainage of stool at the proximal end and drainage of mucus from the distal end; bridge holding the stoma together can be removed in 1-2 weeks after insertion; are generally temporary

polymers

heat-sensitive chemical compounds, usually of high molecular weight, formed by combination of simpler molecules and used to fill in the creases and crevices of the skin's surface to create a larger surface area for ostomy adhesion

pressure ulcer

impaired skin integrity and/or formation of a wound due to prolonged pressure

allergic contact dermatitis

inflammation of the skin resulting from contact with an allergen

irritant dermatitis

inflammation of the skin resulting from contact with an irritating substance

Kock's pouch

internal pouch created from the distal segment of the ileum to serve as a reservoir for stool or urine

illeostomy

is a surgical opening created in the ileum to bypass the entire large intestine; typically located in the right lower quadrant; patient has no voluntary control of bowel movements;

Urostomy

is a urinary diversion that allows urine to exit the body after removal of a diseased or damaged section of the urinary tract; ureters are attached to ileal conduit, and the open end is brought out through the abdominal wall to form a stoma; urine will flow as it is produced because the patient has no voluntary control over urine flow; require pouches that have a drainage tap on the bottom for emptying them repeatedly throughout the day

Ostomy; (ostomy surgery)

is an opening surgically created in the abdominal wall to allow for the elimination of urine or feces; performed when a disorder or an injury keeps the urinary or gastrointestinal system from functioning properly; can be permanent or temporary depending on disorder or injury

Indiana continent urinary reservoir

is formed from the colon and the cecum; patient self-catheterizes to empty the reservoir

Stomal prolapse

lengthening of a stoma due to the bowel telescoping out through the stoma

Adhesives

material used to attach two objects or surfaces, such as glue

Temporary colostomy

may be performed to allow bowel rest or healing, such as following tumor resection, traumatic injury to the colon, or inflammation of the bowel; is closed and reconnected 3-6 months after created

Skin stripping

mechanical disruption of the outermost surface layer of the epidermis, as can be caused by adhesives when an ostomy appliance is removed

ureter

narrow tubular duct that transports urine from the kidney to the bladder

Stomal stenosis

narrowing of the lumen of the stoma

Ureterostomy

one or both ureters are redirected from the kidney(s) through the abdominal wall to form a stoma; rare, typically temporary; to avoid the need for two collection devices---transureteroureterostomy may be performed

pouching system

one-piece or two-piece device that includes a skin barrier/wafer and a collection pouch for the diverted output, either stool or urine

Filtered pouch

ostomy output collection bag that incorporates an odor filtration apparatus

Conduit

passageway

transureteroureterostomy

performed to connect the ureters internally and bring one out through the abdominal wall

Two-piece system

permits frequent pouch changes and also minimizes skin breakdown; may be disposable or reusable; may have a carbon filter for gas release; to help maintain the best fit, be sure to determine the size and shape of the stoma using a measuring guide

Convex inserts

plastic discs that curve outward and are inserted inside the flange of some two-piece ostomy systems

Tackifiers

pressure-sensitive "glue" that must come into complete contact with the skin to adhere

Stomal retraction

pulling back of a stoma below skin level

peristomal retraction

pulling in of the skin around a stoma when the stoma is drawn inward below skin level

Sigmoid

referring to the portion of the large intestine between the descending colon and the rectum

Flange

rim used for attachment to another object, such as an ostomy pouch

mucocutaneous separation

separation of the stoma from the peristomal skin; also called mucocutaneous detachment

mucocutaneous detachment

separation of the stoma from the peristomal skin; also called mucocutaneous separation

peristomal skin

skin surrounding an ostomy

maceration

softening or dissolution of tissue after lengthy exposure to fluid

Reservoir

storage place

hydrocolloid

substance that forms a gel with water and is used in some ostomy products to absorb perspiration and other metabolic secretions while preventing fungal and bacterial invasion

Cecostomy

surgical creation of an opening from the beginning of the large intestine (cecum) to the abdominal wall

ileostomy

surgical opening created in the ileum to bypass the entire large intestine

ileal conduit

surgical removal of a section at the end of the small bowel (ileum) and relocation as a passageway for urine from the kidneys to the outside of the body through a stoma

Colostomy

surgically created opening (stoma) from the colon (large intestine) to the abdominal wall to allow stool to pass out of the body

ureterostomy

surgically created opening that diverts urine away from a ureter and out of the body

urostomy

surgically created opening that diverts urine away from the bladder and out of the body

End colostomy

the damaged section of the bowel is removed and the working end is brought through the abdomen to the skin surface;

Double-barrel colostomy

two separate stomas are created; Both ends of the bowel are brought through the abdomen to the skin surface as two separate sections; may be created because of trauma, tumors, or inflammation, and it may be temporary or permanent; the proximal stoma is functional and diverts feces to the abdominal wall, and the distal stoma expels mucus

illeostomy

used to treat colon cancer, total proctocolectomy, involves surgical removal of the entire colon, rectum, and anus, with closure of the anus, resulting in the need for stool diversion