OSTOMY MANAGEMENT

FKUI/RSUPN-CM

Ns.Heriyanti , SKp
Renal Physiology Anatomy
 STOMA

Stoma is the mouth

Ostomy is a permanent or temporary
Surgical procedure for the direct discharge
of water or urine and refeeding
 Function Stoma

Intestinal contents
diversion
Provision of enteral
nutrition
(Gastrostomi, jejunostomy)
 Type stoma

Colostomy Ileostomy
Cancer Cancer
Stoppage
Congenital Malformation (
Trauma
atresia ani, hirschprung dll,)
Ulcerative colitis,
Familial polyposis

Urostomy
Cancer
Trauma
Blader Neoplasma
Stone renal
 Stoma sitting

Making a mark (Site Marking) ---- with the

condition of patient when sitting, sleeping,
standing.
Avoid the occurrence of a stoma prolapsed
stoma is not due to the rectus abdominalis
Ease ostomate in stoma care
 Siting stoma care

Ostomate physical abilities: review of physical

ability if there is weakness, contractures,
sitting in a wheelchair, or using a stick
Abdominal Conditions: Assess the skin folds,
the former suture surgery, scar, keloid, belt
line, bony ridge iliaca, mammary big, hernia,
and the ability of vision
Ostomate Condition: diagnosis, radiation
history, age, occupation
Type stoma surgery, multiple stomas or single
Stoma Siting
Ileal Conduit / Urostomy
 Preparation before operation

The emotional condition of the patient

Do routine work like before surgery
Physical condition:
-examination of patients

-preparation of the bowel smooth

-determination of location of stoma: positions typically

determined by the dokterperawat, location
the appropriate muscle rectus, away from the bone
that sticks out and patients can see it
 Management Post operation

Condition of the patient's psychic

Perform daily activities
vitality stoma
- herniation of leakage around the stoma
- infection
- retraksi-stoma
Knowledge of health ( intake and out put)
replacement of the stoma bag
connection to the urine bag
 MANAGEMENT OF UROSTOMY

Clean the infected area of skin and then dry with a

cotton swab or could use a blow dryer slowly
slowly
Give your stoma powder infected skin kedaerah
Use a two piece drainable bag containing
hidrocoloid
Replacement bags can be 1 or 2 x a week
Attention to the needs of the intake and output of
fluid
Handelling bag urin if activity ; Working, Sleeping
 how to maintain the flow of urine ;

Wafer urostomy bag properly fixed

Slang fixed properly
Slang do not be folded / bent / jam when walking
or resting
When the activity of the urine bag maintain
position remains lower than slang
 Proses Keperawatan

1. Pengkajian

2. Diagnosa dan perencanaan

3. Implementasi termasuk monitoring

Evaluasi
 1. Pengkajian keperawatan

Sesuai standar pengkajian Rawat Inap dilakukan

dalam 24 jam dan rawat jalan 2 jam
Adanya format pengkajian yang baku mencakup pre,
intra dan paska operasi untuk asuhan keperawatan
Adanya petunjuk teknis pengisian format pengkajian
Adanya alat dan sarana untuk melakukan pengkajian
 2. Diagnosa Keperawatan/Masalah Keperawatan

Masalah keperawatan prioritas pada pre operasi :

Risiko cedera

Risiko cemas
Risiko nyeri akut
Masalah keperawatan prioritas pada intra operasi :
Risiko pola nafas tidak efektif
Risiko gangguan integritas kulit ( adanya sfingter stoma,karakter/aliran urine dari
stoma)
Risiko cedera
Risiko hypothermia

Masalah keperawatan prioritas pada paska operasi :

Pola nafas yang tidak efektif
Risiko gangguan volume cairan dan elektrolit
Gangguan nyeri akut
 3. Perencanaan

1. Tersusunnya tindakan keperawatan untuk mencapai

tujuan yang memenuhi kriteria SMART (Spesific,
Measureable,Achievable, Reliable, Time)
2. Adanya rencana tindakan keperawatan bersifat mandiri
dan kolaboratif
3. Adanya rencana tindakan keperawatan yang
didokumentasikan pada catatan keperawatan
 4. Pelaksanaan Tindakan Keperawatan

Melakukan tindakan keperawatan mengacu rencana

tindakan sesuai standar operasional prosedur (SPO),
meliputi pre, intra dan paska operasi
Melakukan monitoring respon klien terhadap tindakan
keperawatan
Melakukan modifikasi tindakan berdasarkan respon klien.
Mengutamakan prinsip keselamatan klien (patient safety),
privacy.
Menerapkan prinsip kewaspadaan baku (standar
precaution).
Mendokumentasikan tindakan keperawatan.
Melakukan monev ( monitoring dan evaluasi )
 5. EVALUASI

Melakukan evaluasi dengan cara membandingkan hasil tindakan dengan tujuan dan kriteria hasil yang
ditetapkan (evaluasi hasil) :
Pre operasi :
Tidak terjadi cemas
Tidak ada rasa nyeri
Ada dokumentasi tertulis.

Intra operasi :
Telah dilakukan pencegahan infeksi
Tidak terjadi cedera kulit akibat elektromedik (Cauter).
Tidak terjadi hipotermi.
Ada dokumentasi tertulis

Paska operasi :
Pola napas adekuat.
Bersihan jalan napas efektif.
Tanda-tanda vital dan tekanan darah stabil.
Tidak terjadi gangguan keseimbangan cairan
Ada dokumentasi tertulis
 Urostomy products

Protect the skin

Comfortable
Secure (not easy)
easily visible or monitored
No need to replace every day
 Classification of urostomy bag

One piece system Two piece system

- Easy to use - Easy to use
- Flexible with strong adhesive Face plate flexible with strong
- No rigid adhesive
- easily removed
The bags are selected according
to needs
The bag can be replaced to use
Stoma can be observed
Cleaned by removing the
 urostomy products
- Face plate to protect the skin around the stoma
- Transparent pockets making it easier for observation
- The filter bags are fitted with adapters
- One piece system, with filters and skin barrier could be
cut
urostomy products
(twopiece type)
 onepiece type

C D
U

Uc

Cc
Dc
C : Closed
Cc : Closed Convex
D : Drainable
Dc : Drainable Convex
U : Urinary
Uc: Urinary Convex Clip
 ILEOSTOMY BAG

Drainable (50mm)

Drainable cap
(30,40,50mm)
Skin Barier Soft Wafer Ring

Convenient to use
Easy to use
Ring model is very easy to use In of
peristomal skin
2 advance wafer that can be
attached to the face plate (flange)
 KOMPLIKASI STOMA

Retraction Prolapse Necrosis

Stenosis Hernia
PERISTOMAL SKIN PROBLEM

Excoriation Epidermal Folliculitis

hyperplasia

Alkaline Contact
encrustation dermatitis
stoma siting rectus abominalis
Memberikan tanda stoma
Urostomi Post Operasi
Urostomy Bag Use
APLIKASI
 Refrensi

Brunner & Suddarths Textbook of Medical Surgical

Nursing 1996
Gruendermann, et al. Perioperative Nursing Care 1995
Sigrid .R Physiology and anotomy 1994 , for Nursing
and Health care
Dongoes M,dkk. 1992. Rencana Asuhan Keperawatan
Edisi 3.Jakarta : EGC.
Smeltzer,Suzanne C.2001. Buku Ajar Keperawatan
Medikal-Bedah Brunner & Suddart,Ed.8. Jakarta : EGC.
Masfuri .Materi askep intraoperatif perioperatif
Potter dan Perry. 2005. Buku Ajar Fundamental
Keperawatan : Konsep,Proses, dan Praktik,E/4,Vol.2.
Jakarta : EGC.