MRS. ROSARIO A.

RESPICIO
Clinical Instructor
 Ostomy

• It is a surgical opening made

through the abdominal wall
that connects part of the
intestinal tract to the
abdCOLOSTOMY CARE
ominal opening allowing fecal
elimination.
 Indication
• As a part of an abdomino-
pelvic resection for rectal
cancer
 Indication
• A fecal diversion for
unresectable cancer
 Indication
• A temporary medicine to
protect an anastomosis
 Indication

• A surgical treatment for

inflammatory bowel disease,
trauma, ischemic bowel and
congenital conditions
 STOMA

• It is the part of the intestinal

(large or small) that is brought
above the abdominal wall and
that becomes the outlet for
discharge of intestinal
contents.
 NORMAL STOMA
CHARACTERISTICS
• Pink-red
• Moist
• Bleeds slightly when rubbed
• No feeling to touch
• Stool functions involuntarily
• Postoperative swelling
gradually decreases over
several months
 End Stoma

• After a bowel is divided, the

proximal bowel is eteriorized to
abdominal wall, everted and
sutured to dermis or
subcutaneous tissue.
 End Stoma

There is only one opening that

drains stool. The distal bowel
is either surgical removed or
sutured closed within
abdominal cavity.
End Stoma
 Double-barrel Stoma

• After a bowel is divided, the

proximal and distal ends of
bowel are exteriorized to
abdominal wall, everted and
sutured to dermis or
subcutaneous tissue.
 Double-barrel Stoma

the stomas are brought up

next to each other requiring
them to be pouched together
Double-barrel Stoma
 Loop Stoma

• A bowel is brought to the

abdominal wall through an
incision and stabilized
temporarily with a rod, catheter
or a skin or facial bridge.
 Loop Stoma
The anterior wall of the bowel is
opened surgically or by
electrocautery to expose the
proximal and distal openings.
The posterior wall of the bowel
remains intact and separates the
functioning distal opening.
Loop Stoma
 Complications
• Mucocutaneous separation
(between skin and stoma)
• Stomal ischemia
• Stomal stricture or stenosis
• Stomal prolapse
 Complications

• Peristomal hernia
• Peristomal skin breakdown from
exposure
• to fecal output
• Allergic reaction to products
• Infection
 Nursing Interventions

• 1. Educating the patient

 Nursing Interventions

• 2. Promoting a positive self-

image
Nursing Interventions

• 3. Reducing anxiety
 Nursing Interventions

• 4. Maintaining skin integrity

 Nursing Interventions

• 5. Maximizing nutritional intake

 Nursing Interventions

• 6. Achieving sexual well-being

Nursing Interventions

• 7. Odor Control
Nursing Interventions

• 8. Gas Control
 Nursing Interventions

• 9. Activities of daily living

 Equipment

• Duplicate wafer and pouch

• Tail closure
• Washcloth and towel
• Mild non-oily soap (optional)
• Accessory products prescribed
for patient
 Implementation
• Nursing Action • Rationale
• Preparatory • Patient must
phase see stoma site
• Have patient to learn care
assume a relax
position and
provide privacy.
• Best position –
sitting/reclining/
standing
 Implementation
• Performance
phase
• 1. To remove
pouching • Maintains
system universal
• Wear non-sterile precautions
gloves
 Implementation

• Push down • Minimizes skin

gently on skin trauma
while lifting up
on the wafer
(ostomy
adhesive
remover may be
used).
 Implementation
• Discard soiled • Removes room
pouch and odor and
water in a maintains
plastic bag. universal
Save tail closure precautions
for reuse
 Implementation
• To cleanse
2. • Stoma may
skin function during
• Use toilet tissue the change
to remove feces
from stoma and
skin if needed
• Cleanse stoma • Minimizes skin
and peristomal breakdown and
skin with soft promotes
cloth and water, hygiene.
soap (optional).
The patient may
shower with or
without pouching
system in place.
Clip or shave
peristomal hair if
appropriate.
 Implementation
• Rinse and dry • Removes
skin thoroughly residue, which
after cleansing. may interfere
It is normal for with adhesion of
the stoma to wafer.
bleed slightly
during cleansing
and drying.
 Implementation
• 3. To apply • This step is
wafer omitted when
• Use measuring stomal
guide to shrinkage is
determine complete about
stoma size. 2 months post-
op.
 Implementation
• Trace correct • Avoids wafer
size onto back rubbing stoma.
of wafer and cut Omit this step is
to stoma size. It the wafer is pre-
is acceptable to cut.
cut 1/16 to 1/8
inch larger than
stoma.
 Implementation
• Apply a line of • Extra skin
skin barrier protection is
paste around imperative for
the stoma or on ileostomy and
lip or wafer right-sided
opening. colostomy.
• A left-sided
colostomy may
not need a
secondary
barrier because
form stool is
less harmful to
skin. Paste acts
as caulking to
prevent
undermining of
feces.
 Implementation
• Remove paper • Ensures
backings from adherence
the wafer,
center opening
over stoma and
press wafer
down onto
peristomal skin.
 Implementation
• 4. Snap pouch • If attached
onto the flange properly, there
of the wafer will be no
according to leakage or odor.
manufacturer's
direction
 Implementation
• 5. Apply tail • Proper
closure to pouch
tail. closure
controls odor
 Implementation
• Follow-up phase
• 1. Dispose of • Complies with
plastic bag with universal
waste materials precautions
 Implementation
• 2. Clean • Controls odor,
drainable pouch reduces cost
with soap and
water if
appropriate.
Drainable
pouches may be
use for several
times
 Implementation
• 3. A commercial
deodorant can
be placed in the
pouch to
remove odor.
 Implementation
• 4.Gas can be • Destroys the
released from odor-proof seal
the pouch by
releasing the tail
closure or by
snapping off an
area on the
pouch flange.
Never make a
pinhole in the
pouch to
release gas.
 Unexpected Situations and
Associated interventions

• Peristomal skin is excoriated or

irritated
 Unexpected Situations and
Associated interventions

• Patient continues to notice odor

 Unexpected Situations and
Associated interventions

• Bag continues to come loose or

fall off
 Unexpected Situations and
Associated interventions

• Stoma is protruding into bag