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PPC: Ostomy Care & Supplies
Terms in this set (97)
What is an ostomy?
Opening or outlet through the abdominal wall, created surgically with the purpose of eliminating waste
What is the opening of the ostomy?
What are the three indications for ostomies?
Ileostomy (Congenital diseases, inflammatory bowel diseases like colitis & Chron's)
What is the food pathway?
Mouth -> Esophagus -> Stomach -> Small Intestine -> Large intestine
What are the three types of ostomies?
Ileostomy, colostomy, urostomy
Are ostomies permanent?
No, they can be temporary are usually when there is surgery with repair of colon. After healing process you can reconnect the bowel
With an ileostomy, what do they do?
An intussusception of the bowel is used to create a "nipple" that prevents stool & gas from coming out
What is an intussusception?
Inserting a portion of the intestine through an adjacent piece
Do you have an external pouch for ileostomy? ***
No external pouch needed
What is a colostomy?
A portion of the colon is brought through the abdominal wall
What are types of colostomies?
Descending & sigmoid colostomy
What are the characteristics of feces in the ascending colostomy?
Liquid to semi liquid output (Very Rare)
Are ascending colostomies common?
No they are rare
What happens with the ascending colostomies?
The ascending colon remains & the remainder of the colon is removed or bypassed
Do you need a pouch for ascending colostomies?
Yes, always need a pouch
What is the discharge like for ascending colostomies?
Discharge is semisoft
What is a transverse colostomy?
A piece of the transverse colon is lifted through an abdominal incision, a rod or bridge is placed under the loop to give it support while it heals
What is important to note about transverse colostomies?
It is the
most common site for temporary colostomies
What are the two types of transverse colostomies?
Loop and double-barrel
What happens with loop colostomy?
They have two holes & combine them into one opening
What happens with double-barrel colostomy?
Both ends of colon brought through abdominal wall
Check Slide 22
What is discharge similar to with descending & sigmoid colostomy?
Discharge is similar to a paste or formed stool
What products do they use?
Either uses a pouch or irrigation
Are digestive enzymes typically present?
No, digestive enzymes are not typically present
What are urinary diversions?
Divert through an opening in the abdominal wall
What are the types of urinary diversions?
Ileal conduit, ureterostomy, cystostomy and continent urinary diversion
What are the components of such system?
Adhesive skin barrier (face plate, flange, wafer), collection pouch and accessories
Can a diaper can be used for infants?
Yes, they don't need an osmotic pouch.. they just wear a diaper
How many types of pouches are there?
One-piece system or two-piece system
Pouch opening can be pre-cut or..?
Pre-cut or cut to fit
What can the skin barriers be?
Flat or convex
Can stomas change in size overtime?
Yes, so fit also may change
What will happen if fit is too small?
The stoma may swell
Where do you measure the stoma?
Measure from base where the mucosa meets the skin
When should you empty pouch?
When 1/3 to 1/2 full
What does the frequency change depend on?
Depends on the type of ostomy
How long can skin barriers be left in place?
3 to 7 days
What is skin barrier made from?
What is the problem with hydrocolloid material?
It becomes soft overtime and decreases the strength of the seal
Can water enter the stoma?
enter the stoma
Is it necessary to cover the stoma during swimming or bathing?
No you do not need to cover the stoma
Do you have to continuously wear the belt accessory?
No but people may use it if they want
What are problems with belts?
Can cause skin ulcers if worn too tight, latex allergies
What are the indications for belt use?
What do skin barriers do?
Protects skin from the stoma discharge and allow the punching system to fit more securely
What are the powders for?
What are pastes useful for?
Sealing the pouch
What do absorbent gel packets & flakes do?
Dissolve in liquid discharge to create a gel
What are absorbent gel packets useful for?
Useful to decrease noise, control odor and prevent skin irritation and leakage
What type of cleansing products are best?
Plain water is best
What should be avoided?
Moisturizers, lanolin, petrolatum or oils should be avoided
What are irrigating sets similar to?
Similar to using an enema at the stoma. 1,000mL of lukewarm water is used
-> Bowel expands, peristalsis occurs & waste exits stoma
How do deodorizers come?
Liquid or tablets that are placed directly into pouch to neutralize odor
-> Some pouches have charcoal filters to help control odor
When is fluid & electrolyte imbalances most common?
In patients with a liquid or semisoft discharge
When is fluid & electrolyte imbalance least common?
Descending or sigmoid colon
How much liquid does a person with a stoma lose as compared to person without one?
Lose about 500-1,000mL of liquid
Why is it important to maintain adequate fluid?
Prevent precipitation of crystals, kidney stones or gall stones
Check slide 48: She said to know the table
When are alkaline dermatitis common?
In urinary diversions
What happens to skin around pouch?
It becomes gritty & the stoma often bleeds
What are treatment options for alkaline dermatitis?
1. Solution of 1/3 white vinegar with 2/3 water
2. Acidify urine
3. Use an antireflux urinary appliance
When does hyperplasia usually happen?
When pouch opening is too large
Not associated with pain at first, but progresses to a severe pain
What is stenosis of the stoma typically from?
Due to scare tissue
What is the way stenosis of the stoma can be cured?
Re-do the stoma
What can you try if there is excessive sweating?
Skin sealant or cement and a belt may be needed to hold system in place
What is folliculitis from?
Inflammation of the hair follicle
Prevent by shaving area around the stoma
Antibacterial washes are helpful
What is a peristomal hernia?
Protrusion of the colon or ileum through an area near the stoma
-> Surgery may be required to correct
What is fistula?
Formation of an opening between two internal organs or from inside the body to the skin
What is prolapse?
Portion of bowel comes out of stoma
What may prolapse cause?
May cause decrease in blood supply to rest of bowel
Can you reverse prolapse?
Condition can be partially reversed by having the patient lie on his back & pushing on distal end of the stoma
-> Surgical correction may be needed
What happens with retraction?
Stoma moves inside below skin level
-> From weight gain, active Crohn's disease
-> May be corrected by a convex pouch or surgery
What is impotence due to?
Due to nerve and vascular disruption cause by surgery
-> Must refer patient to urologist for evaluation
How long should patients use a low fiber diet?
For the first 6 weeks after surgery
What is main counseling point for diet?
They can eat what they did before,
must chew food thoroughly
See Table on slide 61
What types of food do you want to avoid with urostomy?
The one's that cause odor
What types of food do you want to avoid with colostomies?
The one's that cause loose stools
What types of food do you want to avoid with ileostomies?
The one's that are high in fiber
Can enteric coated and sustained release tablets be absorbed completely?
They may not be absorbed completely
What medications should have extra caution?
Antibiotics, diuretics & laxatives
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