Ostomy Care (ATI)

Types of Ostomies

Ileostomy Colostomy 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

Colostomy locations (depends on disease or injury)

Ascending colon (right)- liquid to semiliquid Transverse (mid)- temporary loop; liquid to semi formed Descending colon (left upper)- semi formed Sigmoid (left lower)- permanent; formed feces; typically in lower left quadrant of abdomen

Double barrel colostomy

Bowel is surgically severed and the two ends are brought out onto the abdomen with a proximal functioning and distal nonfucntioning stoma. Proximal- diverts feces; Distal- expels mucous

Types of pouches

Closed end pouch drainable pouch one-piece pouch two-piece pouch skin barriers

Drainable pouches

Some drainable pouches can be rinsed and reused. They are recommended for use with an ascending or transverse colostomy, an ileostomy, and a urostomy. Drainable urostomy pouches have a tap instead of a clip.

Transureterostomy

To avoid the need for two collecting devices, a transureteroureterostomy may be performed to connect the ureters internally and bring one out through the abdominal wall.

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.

Stoma care

check color, turgor, edema, signs of injury inspect daily cleanse properly

Ostomy care

chk for skin integrity stoma appearance pain/ tenderness clean properly follow up care procedures ostomy management education hydration hygiene electrolyte imbalance risk proper diets

Reasons for ostomies

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

indiana continent urinary reservoir

formed from the cecum and a portion of the ileum. The created stoma is continent and flush with the skin. The patient self-catheterizes to empty the reservoir.

Kock's continent ileostomy

internal alternative; catheter is inserted to drain; extra care is needed; output of feces can be as high as 1000-2000 ml/day meaning a risk for dehydration

Closed end pouches

most commonly used by colostomates who can irrigate or by patients who have regular elimination patterns; discarded after one use

Ileostomy

new opening of the ileum to the outside of the body; bypass the entire large intestine (colon) ; removes colon, rectum, anus, with closure of anus; need stool diversion; permanent; in RLQ

ureterostomy

one or both ureters are redirected from the kidney(s) through the abdominal wall to form a stoma.

continent internal ileal reservoir

or continent ileal bladder conduit (Kock's pouch) is created the same way as an ileal conduit is, except that nipple valves are formed by intussuscepting tissue backward into the reservoir; the pouch is connected to the skin and the ureters are connected to the pouch. Filling pressure closes the valves, thereby preventing leakage and reflux. An external drainage collection device is not necessary because the patient self-catheterizes about every 4 hours.

two-piece pouches

permits frequent pouch changes and also minimizes skin breakdown. The pouch and skin barrier are connected with a flange mechanism. With a two-piece system, the pouch may be disposable or reusable, and it may have a filter for gas release.

one-piece pouches

systems with an attached skin barrier are available. They are available in cut-to-fit and pre-cut types.

End colostomy

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

Tips for documenting

the date and time assessment findings (bowel sounds, flatus, abdominal distention, tenderness) the characteristics of the stoma and peristomal skin the appearance of any sutures the type of skin barrier or accessories used (paste, powder, skin sealant, strips, rings) to prevent or treat complications the measurement of the stoma the type of pouching system used, especially if this has changed any changes in the peristomal skin care procedures or products used the characteristics and amount of output any complications of the procedure performed the patient's level of participation strategies to promote self-management the patient's ability to manage the skills required for ostomy care

Urostomy

the general term used for any surgical procedure that diverts the passage of urine by redirecting the ureters

Colostomy

the surgical creation of an artificial excretory opening between the colon and the body surface. Typically end of large intestine.

Ileal conduit (ileal loop)

urinary diversion in which the client must wear an external pouch over the stoma to collect the continuous flow of urine- The ureters are attached to the ileal conduit, and the open end is brought out through the abdominal wall to form a stoma. The remaining ileum is reconnected to the rest of the digestive tract. This is the most common type of urinary diversion