BASIC OSTOMY CARE

—AN OSTOMY IS THE SURGICAL CREATION OF AN ARTIFICIAL OPENING

—THE OPENING IS CALLED A STOMA

TYPES
A COLOSTOMY IS THE SURGICAL CREATION OF AN ARTIFICIAL OPENING BETWEEN THE
COLON AND THE ABDOMINAL WALL
—
AN ILEOSTOMY IS A SURGICALLY CREATED OPENING BETWEEN THE SMALL INSTESTINE
AND THE ABDOMINAL WALL

Types of Ostomy
—Colostomy= large intestine
—Ileostomy  = small intestine
—Ileal Conduit/Urostomy=urine
Reasons for the procedure
- Birth defect ( imperforate anus)
 - Serious infection(divertivulitis)
 - Inflammtory bowel disease(IBD)
 - injury to colon or rectum
 - partial or complete intestinal or bowel blockage
 - rectal or colon cancer
 - wounds or fistula in the perinuem(abnormal connection between internal organ and the skin)
 (woman- area bet anus and vulva, male – bet anus and scrotum)
Problems that can occur with stoma
1.Stoma retraction- height  of the stoma goes down to or below the skin level.Retraction may
happen soon after surgery if the colon does not become active soon enough. May happen if patient
gain weight.
2. Peristomal hernia – part of the large intestine bulges into the area around the stoma.( sit, cough,
strain)
3. Prolapse – part of the bowel pushes out of the stoma(increased abdominl pressure- surgery to fix)
4. Stenosis  - stoma become narrow.
mild – may stretch the stoma
severe  - cause blockage-surgery is needed
FOOD THAT MAY INCREASE GAS PRODUCTION
—Beans —Garlic
—Eggs —Brussels sprouts
—Beer —Onions
—Fish —Carbonated beverages
—Broccoli —Various spices
Cabbage —
FOOD THAT MAY INCREASE STOOL ODOR
Asparagus —Garlic
—Eggs —Cabbage
—Broccoli —Onions
—Fish —Cauliflower
—Brussels sprouts —Various spices
FOOD THAT HELP THICKEN STOOL
Applesauce —Cheese
—Pretzels —White toast
—Bananas —Creamy peanut butter
—White rice —Yogurt
Noodles —
FOOD THAT MAY DECREASE ODOR
Buttermilk Cranberry juice Parsley Yogurt

COLOSTOMY/ILEOSTOMY CARE
—PURPOSE
—To provide means of fecal evacuation.
—To maintain the integrity of the stoma and peristomal area.
—To prevent lesions, ulceration, excoriation, and other skin breakdown caused by fecal
contaminants.
To promote general comfort and positive self-image

PROCEDURE
1. Gather equipment: To facilitate changing the face plate with the least
• Gloves amount of distress and discomfort to the individual
• Protective pad
• Basin of warm water
• Soap
• Washcloth/towel or gauze
• Measuring guide
 • New pouch appliance(s)
• Scissors
• Pen/pencil
• Peristomal skin paste and stoma plate (if
needed)
• Waste receptacle
2. Prepare the client, provide privacy, and Reduces embarrassment.
explain the procedure Reduces anxiety, promotes a calm approach and
eliminates fear and apprehension.
3.Wash hands and put on gloves. Reduces microorganism transfer. Avoids exposure to
individual’s body secretions.

4. Place disposable protective pads around Removes old pouch for new pouch application;
stoma pouch close to stoma, remove old stoma maintains clean environment.
plate and/or pouch, and discard contents;
(discard gloves).

5. Inspect stoma and peristomal skin. Provides data.

6. Perform stoma care: Gently clean entire Removes stool soilage and promotes secure pouch
stoma and peristomal skin with gauze or application.
washcloth soaked in warm, soapy water (if some
fecal matter is difficult to remove, leave wet
gauze or cloth on area for a few minutes before
gently removing fecal matter); rinse and pat dry.
7.Place gauze pad over stoma opening to Protects skin and linens during procedure
prevent spillage while preparing adhesive stoma
plate and pouch.

8. Measure stoma with measuring guide. Use Cuts barrier to appropriate size for stoma; allows
measuring guide to trace opening on back of pouch to be placed over stoma without adhering to it.
plate.

9. Leaving intact adhesive covering of plate, cut Prevents skin irritation of uncovered peristomal skin.
out circle, allowing an extra 1/8 inch for
placement over stoma.

10. Remove adhesive covering of plate, and place Adheres plate to skin; warmth of skin and fingers
plate on skin with hole centered over stoma; hold enhances adhesiveness once plate makes contact with
in place for about 30 seconds. skin.

11. Center pouch over stoma and place on plate. Secures pouch for collection of feces.
If applying a two-piece appliance, snap pouch on
the flange of the plate.
 12. Remove gloves and perform hand hygiene. reduces microorganism transfer.

13. Make sure the client is comfortable and To maintain the individual’s mental and physical well
tolerated the procedure well. being.

14. Restore or discard all equipment Provides clean environment.

appropriately.

15. Document nursing care done. To provide information and encourage client feedback.
• Record date and time treatment
completed.
• Record color, consistency, and amount of
feces in pouch (small, medium, large).
• Record condition of stoma and peristomal
skin.
• Record size of stoma.
• Record individual’s response.
• instruct client to report any problems
that were encountered.

GENTLY REMOVE THE COLOSTOMY

APPLIANCE (COLOSTOMY BAG) AND
PLACE IT IN THE BEDPAN

CLEAN AROUND THE STOMA WITH SOAP

(MILD) AND WATER

REMOVE THE ADHESIVE BACKING AND

CENTER THE POUCH OVER THE STOMA.
APPLY GENTLE PRESSURE.
FASTEN THE CLAMP AT THE BOTTOM OF
THE BAG.

DO NOT LET THE PERSON SHOWER OR

BATHE FOR 1-2 HOURS AFTER APPLYING
THE POUCH.

THE WAFER MAY HAVE TO BE CUT TO - normal stoma is moist, pink or red colored
THE PROPER STOMA SIZE

1.Empty the pouch when it is 1/3 to ½ full 2.Do not wait until the pouch is completely full
General rule; change the pouch no more than once a day, but not less that every 3-4 days .

STOMA IRRIGATION
Irrigation- putting of fluid into stoma to empty the bowel , to stimulate regular, controlled bowel movements

 Fill the irrigating container with about 16 to 50 ounces(500-1500ml) of lukewarm water

 Hang the irrigatin container so that it is level with your shoulder. Sit up straight on the toilet or a
chair next to a toilet.

 Attach the irrigation sleeve to the stoma

 Release air bubble from the tubing

 Moisten the end of the cone(water or water soluble lubricant)

 Place the tip of the cone 3 inches into your stoma(release the clamp on the tubing again and slowly
allow the water to flow into the stoma-5-10 minutes. Keep the cone in place for another 10 seconds.

 Remove the cone. Allow the output to drain into the irrigation sleeve for 10-15 minutes. Dry the end
of the irrigation sleeve. Clip the bottom of the sleeve to the top with a clasp or close the end of the
sleeve with the tail closure(30-45 minutes to drain). Empty the output from the sleeve into the tiolet.

 Clean the area around the stoma with mild soap and water and pat dry.