OSTOMY CARE

Definition
• An ostomy is an operation that creates an opening from
an area inside the body to the outside.
• The stoma is the part of the ostomy attached to the skin
• It may be temporary or permanent. Stool passes through
the stoma into a pouch attached to the stoma on the
outside of the abdomen.
 Overview
• Certain diseases or conditions interfere with or
prevent the normal passage of faeces through
the rectum.
• For example, the development of a colon
tumour mechanically obstructs the intestinal
lumen, blocking faecal passage.
• Such alterations necessitate the temporary or
permanent formation of an opening (stoma) on
the abdominal wall for faeces to adequately
drain.
• A stoma bag/ pouch is then attached to the
opening
 Cont’
• The pouch, stoma, and skin surrounding the stoma
require care and maintenance by the patient or caregiver.
A pouch is normally emptied one or more times daily. The
pouch itself usually needs to be changed every four to six
days.
• There are a variety of pouches available
• Over time the patient can determine which pouch type
best suits his or her needs.
 Cont’
• The part where ostomy is performed suggests the name
of the stomy e.g colostomy-colon, Iliostomy- ileum,
jejinostomy- jejunum etc
• Location of the stomy determines the consistency of stool
that is passed.
• An iliostomy bypasses the entire large intestine, thus
stools are liquid and frequent
 Cont’
• A colostomy of transverse colon generally
results in more solid, formed stools.
• The sigmoid colostomy emits stool almost
identical to that normally passed through the
rectum.
• Ostomies that emit frequent liquid stools create
a management challenge.
• Apouch must be worn all the times because
there is continuous oozing of stool.
• Pouches may be either open ended or closed.
• Open-ended pouches require a clamp for
closure
 Cont’
• They can be drained simply and reused after they are
emptied.
• Removing the colostomy appliance requires gently
pushing away the skin surrounding the stoma and pulling
the appliance downwards.
 Cont’
• Skin care is vital to prevent exposure to faecal irritants.
• The stoma should be cleaned with lukewarm- ( only moderately warm)
water and dried with a soft towel.
• The stoma should be pink or red and moist- looking, and may
bleed slightly when cleansed. The stoma normally decreases in
size slightly during the first weeks after surgery.
 Cont’
• Having a stoma is a major event and
patients can become very anxious and
depressed.
• Clients with an ostomy experience serious
body image changes, particularly if the
stomy is permanent.
• Clients often perceive the construction of
an artificial opening in the abdominal wall
for the passage of faeces as a form of
mutilation (disfigure).
 Cont’
• Foul- smelling odours, spillage or leakage of liquid stools,
and inability to regulate bowel movements give the client
a sense of powerlessness and loss of self esteem.
• The nurse must be very supportive of the client with an
ostomy so that ultimately he can accept the responsibility
of managing the stomy in the home.
 Cont’
• When the client has been independently caring for his
stomy, he should be encouraged to maintain this self care
as soon as his level of health permits.
• Know the various equipment options presently available.
• Various types of equipment are used for different types of
stomas.
 Purpose of caring for the stoma

• To assess and ease care for the peristomal skin

• Ta assess amount and type of output
• To minnimise odor for the client, comfort and self esteem.
 What a nurse should assess

• Stoma size and shape

• Color of stoma
• Presence of swelling
• Status of peristomal skin
• Amount and type of effluent (faeses)
• Allergy type and size of appliance currently used
• Complaints and discomfort
• Clients and family learning needs
• Client’s emotional status.
 Equipment:

• Disposable gloves
• Razor blade
• Skin barrier
• Pen, scissors
• Tape
• Cleaning material (warm water, tissue, soap, washcloth or cotton
balls)
• Bedpan/receiver for used pouches
• Peristomal skin paste or powder
• Measuring guide
 Procedure:
Determine the need for appliance change
Asses the used appliance for leakage of
effluent/faeces.
• Rational: to avoid irritation of periostomy skin.
Ask the client about any discomfort at or around
the stoma
Asses the fullness of the pouch , they need to be
emptied when they are one third to one half full
• Rational: the weight of an overly full bag may
loosen the faceplate and separate it from the
skin causing leakage of effluents to the skin.
 Cont’
Select an appropriate time.
• Avoid times close to meals or visiting hours
• Rational: odor and affluent may reduce appetite or embarrass
the client
• Avoid times immediately after the admission of any medication
that may stimulate bowel evacuation.
• It is best to change the pouch when drainage is least likely to
occur.
 Cont;
Prepare clients and attendant
• Explain procedure to the client and attendants
• Communicate to the client while changing the appliance to show support,
and not to convey disgust!
• Provide privacy (if possible in a separate room bath room) where the client
can learn to deal with the stoma.
• Assist the client to a comfortable lying or sitting or standing position
• Rationale: sitting and standing may facilitate smoother pouch application
i.e. avoids wrinkles
• Don gloves.
 cont’
A new stoma must be kept moist to ensure tissue integrity
Empty and remove the ostomy appliance
Empty the contents of the pouch through the bottom opening into a bed pan. Clean the
opening appropriately and close it again properly.
Rational: to minimize spilling of affluent to avoid skin irritation.

Discard disposable pouch into bed pan or other prepared receiver

 Cont’
Clean and dry the periostomy skin and stoma.
• Use toilet tissue to remove excess stool
• Use warm water, mild soap(optimal) , and cotton
swaps/ wash –cloth to clean the skin and stoma
• Use special skin cleanser to remove dried ,hard stool
• Dry the area thoroughly
 Cont’
• Remove the air out of the pouch so that the pouch can lie flat
against the abdomen.
• Tape the faceplate to the client’s abdomen using strips
Aftercare
• The nurse should assess the patient's tolerance of the
procedure and response to teaching or education about the
appliance.
• It is important to instruct the patient and/or caregiver how to
provide care independently