Ostomy Care

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Riverside College, Inc.

Home of 21st Century Global Leaders and Professionals


College of Nursing
Faculty Meeting
AVR 2 A & B
1:30AM, August 3, 2024
Ostomy Care
Definition
The management and support of a patient
with a surgical opening created in an ileum
or colon for the temporary or permanent
passage of feces. In most cases, the
opening is covered with a temporary
disposable bag.
Objectives
Objectives
• To establish regular bowel elimination

• To keep the skin around the stoma site clean and dry

• To be able to keep the patient free of odor as possible

• To assist patient to become proficient in ostomy care


Objectives
• To determine client’s knowledge and understanding of
ostomy

• To develop client’s positive attitude toward living with


an ostomy
Assessment
1. Identify the type of ostomy the patient has and its
location.

2. Assess frequency of defecation and character of stool.

3. Assess time when client normally irrigates.


4. Assess client understanding of procedure and ability to
perform techniques.

5. Identify signs and symptoms associated with altered


elimination patterns.

6. Determine impact of underlying illness, activity patterns


and diagnostic test on bowel elimination patterns.
7. Assess skin integrity around stoma, noting presence of
scars, folds on protuberance of skin.

8. Assess condition of the existing bag for leakage and not


appearance with underlying stoma and surgical incision.

9. Assess patient’s feeling about colostomy management.


Preparation Before
the Procedure
1. Explain procedure (if client is unfamiliar with technique)
or allow client to organize steps for pouch change. Be
sure clients observe procedure.

2. Select optimal time to change pouch (when client is


comfortable between meals or before administration of
medications that may affect bowel function).

3. Collect appropriate equipment


4. Close room curtain or doors. Provide privacy.

5. Many different types of pouches/appliances are available;


the nurse should always read manufacturer’s instructions or
check with the enterostomal therapist before handling
unfamiliar equipment.
6. Flatus may cause a pouch to balloon out. This requires
immediate attention because if flatus is not released, the
pouch may separate from the skin barrier, causing seepage of
fecal contents or release of fecal odor. Open the clamp and
release the flatus. Never puncture a hole in the
pouch/appliance.
7. A one-piece appliance makes application easier for an
older patient, particularly if impaired vision or compromised
mobility from arthritis is present.
Type of Ostomies
COLOSTOMY
•a temporary or permanent opening of the
colon through the abdominal wall when it
is impossible for the feces to progress
through the colon and out the anus
because of some pathologic condition
ILEOSTOMY
•a surgical formation of an opening of the
ileum onto the surface of the abdomen,
through which fecal matter is emptied.
JEJUNOSTOMY
•a surgical-created opening between the
jejunum of the small intestine and the
abdominal wall to allow fecal elimination
Type of
Colostomies
TEMPORARY COLOSTOMY
•Often done for perforated or obstructed
bowel caused by diversities, vulvulus,
ischemia, trauma

•Allow diseased portion of the bowel to rest


and heal
PERMANENT COLOSTOMY
•Performed to provide means of elimination
when rectum or anus is non-functional as a
result of disease or birth defects

•Commonly performed for disease such as


cancer of the bowel
Location of Various Colostomies
• Sigmoid colostomy
• Descending
colostomy
• Transverse colostomy
• Ascending colostomy
• Ileostomy
Equipment Needed
Equiment
• Skin barrier (stomahesive, • Kidney basin
hollihesive, karaya paste)
• Bath towel
• Ostomy bag
• Rubber protector
• Large syringe
• Warm water
• Mild soap or NSS
• Plastic bag • Forceps
• Dry cotton balls • Disposable gloves
Procedure
STEP RATIONALE
1. Explain procedure (if
client is unfamiliar with Promotes
technique). Allow client to cooperation and
organize steps for boost confidence in
pouch change. Be sure ability to perform
client observes procedure
procedure.
STEP RATIONALE

2. Close room curtains and


Provides privacy
doors
STEP RATIONALE

3. Place protective pad


Protects bed from
under the client’s hip on
soiling
the side of the stoma
STEP RATIONALE

4. Assist client to a semi- Position the client


lateral position, with the and position the
stoma and pouch position pouch downward
downward the bed so it will drain with
surface. gravity
STEP RATIONALE

Reduces
5. Wash hand and wear
transmission of
gloves
infection
STEP RATIONALE

6. Fill large syringe (bulb or


50 cc) with warm water. Prepare for later
Place in small basin next to use
the bedside.
STEP RATIONALE

7. Remove the soiled pouch Reduces trauma to


by gently pressing on the the peristomal skin;
skin while pulling the jerking can cause
pouch. skin tears
STEP RATIONALE

Avoid odors
8. Dispose the soiled pouch
lingering the room
in the plastic bag and tie to
which is unpleasant
seal odor.
to client or staff
STEP RATIONALE
Removes fecal material and
9. Using forceps and pathogens and prepares the
cotton balls, wash skin skin for pouch reapplication.
gently with mild soap Secretion acts as irritant to
and water or with NSS skin. Bacteria in fecal
to remove secretions secretions can enter incision
area/new colostomy and
from the skin. cause infection.
STEP RATIONALE

Use of any soap could result in film


or residue being left behind. This
10. Rinse soap soap residue can result in chemical
off thoroughly. reactions or burns and can cause
Blot dry premature leakage because of
interference with pouch adhesions.
Pat dry gently to avoid trauma.
STEP RATIONALE
11. Inspect the
Peristomal skin
peristomal skin for
conditions cause
redness, altered skin
morbidity and problem
integrity or rashes;
with pouch application
consult if lesions of the
unless managed
peristomal skin are
properly.
observed.
STEP RATIONALE

12. Prepare ostomy


Avoid risk cut of
pouch. Cut hole in
stoma and ensures
center of faceplate
better seal with
1/8 inch larger than
barrier
hole in barrier
STEP RATIONALE

13. Apply skin sealant Promotes an


or skin paste if effective seal and
indicated. Apply skin protects the
barrier peristomal skin
STEP RATIONALE

14. Remove Reduces risk of wrinkling


paper backing that can occur if water is
from pouch applied to skin before
faceplate and pouch is attached; gives
apply gently better leak-proof seal.
STEP RATIONALE

15. Press into place


Creates wrinkle-
for 1 – 3 minutes
free secure seal
while smoothing out
onto skin
creases or wrinkles.
STEP RATIONALE

16. Removes gloves Reduces risk of


and discard. Wash transfer of
hands. microorganisms
STEP RATIONALE

17. Assist client to


comfortable Ensure client
position if comfort
necessary
STEP RATIONALE
18.
Proper disposal of
Dispose of used
equipment prevent
equipment
contamination from
according to
microorganism
agency policy
STEP RATIONALE

19. Note type and size of pouch,


Document client
condition of stoma, drainage
status and
amount, odor and surrounding
condition of stoma
skin, as well as client response.
Evaluation
Evaluation
•Demonstrate knowledge and positive attitude
towards colostomy care
•Colon empty of its contents such as feces,
gas, and mucus
•Patient is free from odor
Evaluation
•Demonstrate pouch changing and healthy
skin around stoma.
•Client copes with changed body image,
manages care of stoma.
Thank you!

www.riverside.edu.ph

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