BOWEL DIVERSION OSTOMY Prepared by: - PowerPoint Presentation

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BOWEL DIVERSION OSTOMY

Prepared by:

DR. IRENE ROCO

Asst. Professor

Outline

Definition of Bowel Diversion Ostomy

Purpose

Classification

a. status

b. Anatomic location

c. surgical construction

Ostomy Management

Assessment

Ostomy change

References

Definition

OSTOMY

– an opening for the gastrointestinal, urinary, or respiratory tract into the skin

Divert and drain fecal material

PURPOSE

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

1. Status

a.

Permanent – to provide means of elimination when the rectum or anus is non functional ( birth defect / cancer) b. Temporary – for traumatic injuries or inflammatory conditions

of the bowel, allowing the bowel to rest and heal

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

TYPES

OF INTESTINAL OSTOMY:

Gastrostomy – opening through the abdominal wall in the stomach

Jejunostomy

- opening through the abdominal wall in the jejunumIleostomy - opening through the abdominal wall in the ileum

Colostomy - opening through the abdominal wall in the colon

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

Type of drainage

Nursing Responsibility

Ileostomy / ascending colostomy

Liquid fecal drainage; no control

Instruct Client to wear appliance continuously and take special precaution

s to prevent skin breakdown

Odor is minimal because fewer bacteria are present

Transverse colostomy

Malodorous, mushy drainage ; liquid has been reabsorbed; no control

Descending colostomy

Solid fecal drainage

sigmoidostomy

Normal or formed consistency ; can be controlled

Client may not have to wear appliance at all times

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

3. Construction

of the stoma

single

– one end of the bowel is brought out through an abdominal opening

b. Loop – loop of bowel is brought into the abdominal wall and supported by a plastic bridge , or a piece of rubber tubing; has two openings (proximal and distal)

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

3. Construction

of the stoma

c. Divided colostomy

– two edges of bowel brought out into the abdomen but separated from each other

d. Double barrel - proximal and distal loops of bowel are sutured together for about 10 cm and both ends are brought up into the abdominal wall

Divided colostomy

–

Double barrel

OSTOMY APPLIANCE

Consist of :

skin barrier

Pouch – can be closed or

dainable

Adjustable Ostomy belt

Consists

of group of nursing interventions that may be necessary after fecal diversion surgery

Stoma assessment

Application of stoma to collect feces and protect skin

Promotion of self care

OSTOMY MANAGEMENT

Assessment

Assess for:

Normal

Abnormal

Color

Healthy pink, red

and slightly moist

Dusky

dark

(

pink / bluish

(cyanosis) suggest inadequate circulation to the stoma

Size and shape

New stoma are swollen; swelling decreases in 2-3 weeks or as long as 6 weeks

Failure to recede may indicate blockage

Position

Must remain on the abdominal surface

If stoma retracts, feces may enter the abdominal cavity and cause peritonitis;

Prolapse must be reported to the doctor

Stomal

bleeding

Slight bleeding

Report other bleeding

Complaints

Burning

sensation under the skin may indicate skin breakdown

Abdominal discomfort / distention

OSTOMY CHANGE

Can be applied for up to 7 days

Twice a week

Change whenever the stool leaks onto the

peristomal

skinEvery 24 – 48 hrs if the skin is erythematous, eroded, or ulceratedMore frequent changes if client complains of pain or discomfortThe pouch is emptied when it is one third to one half fullIf the pouch overfills, it can cause separation of the skin barrier and stool comes in contact with the skin

PURPOSE OF OSTOMY CHANGE

To assess and care for

peristomal

skin

To collect stool for assessment of the amount and type of output

Minimize odors for the client’s comfort and self esteem

References

Kozier

&

E

rbs

’ Fundamentals of Nursing . Eighth ed. 2008 Potter Perry. Basic Nursing 6th ed

..Mosby,

Missouri, 2006.