12.17: Ostomy Care

Introduction

An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.

There are different types of ostomies, including colostomies, ileostomies, and urostomies:

1. A colostomy involves bringing a part or section of the colon, or large intestine, to the abdominal surface to create a stoma, typically on the left side of the abdomen. Colostomies are often necessary when part of the colon is removed or needs to be bypassed due to conditions such as colorectal cancer, diverticulitis, or injury. Waste from the colon is collected in a colostomy bag attached to the stoma. Depending on the medical condition, colostomies can be temporary or permanent.
2. Ileostomy involves bringing out the terminal part of the small intestine, known as the ileum, through the abdominal wall. Ileostomies are performed when the entire colon must be bypassed or removed. Waste is collected in a unique bag, similar to a colostomy. This type of ostomy is often temporary but may also be permanent and is commonly required for conditions like Crohn's disease or ulcerative colitis.
3. Urostomy is another type of ostomy where urine is diverted through an opening in the abdomen. It is typically performed when the bladder is removed or bypassed due to conditions like bladder cancer.

Ostomy Care Steps

1. Preparation and Hygiene: Begin with thorough handwashing to prevent infection. Wear disposable gloves for hygienic handling of stoma and supplies.
2. Gathering Supplies: Collect necessary items, including a new ostomy pouch, skin barrier/wafer, scissors (for resizing the barrier if needed), stoma measuring guide, clean washcloths or wipes, warm water (use soaps or creams only if recommended), and a disposal bag for the used pouch.
3. Removing the Old Pouch: Gently peel the old pouch from the skin to avoid skin irritation and dispose of it properly.
4. Cleaning the Stoma and Skin: Inspect the stoma and surrounding skin for inflammation, necrosis, persistent bleeding, discharge, pus, or other abnormal changes. Promptly consult a healthcare provider if any irregularities are observed. Clean the skin around the stoma with warm water, using a soft cloth or wipe, and pat dry.
5. Measuring and Preparing the Skin Barrier: Resize the skin barrier using a stoma measuring guide. Cut it to fit closely around the stoma without touching it.
6. Applying the New Pouch: Place the skin barrier around the stoma, ensuring a snug fit. Attach the pouch securely, following the manufacturer's instructions.
7. Disposing of Used Materials and Hand Hygiene: Properly dispose of all used materials. Remove gloves and wash hands thoroughly.
8. Documentation and Communication: Record the procedure in the patient's medical record, noting the stoma and skin condition. Report any abnormalities to a healthcare professional.

The change frequency of the ostomy pouch varies based on pouch type and individual needs. Providing emotional support and education to patients and caregivers on ostomy care is also vital. Educating them about signs of complications, such as changes in the stoma's appearance, unusual odors, or skin irritation around the stoma, is essential.

An ostomy is a surgical procedure that creates an artificial opening in the intestines leading to the body's exterior.

This opening, called a stoma, redirects bodily waste outside the body. There are various forms of ostomies, including colostomies and ileostomies.

Ostomy care begins with gathering the necessary supplies, including a new ostomy bag or pouch, a skin barrier, scissors, warm water, soft cloths, and a disposal bag.

Afterward, the nurse should thoroughly wash their hands and put on a fresh pair of gloves.

Then, carefully remove the old pouching system, discard the used gloves, and the new pair of gloves is donned.

Next, the stoma and adjacent skin are delicately cleansed with warm water using a soft cloth while observing any changes in the stoma's color or size.

Suppose the skin barrier needs resizing to fit the stoma, trace and cut it to fit snugly around the stoma without applying pressure.

Then, the barrier should be applied smoothly, ensuring it adheres without wrinkles or gaps.

After the procedure, dispose of the used pouch in a designated bag, remove gloves, wash hands, and document the process.

• Ostomy - A surgical procedure for creating an artificial opening (stoma) from the intestine to the outside of the body.
• Stoma - Rerouted opening of the intestine on the skin surface for waste removal.
• Colostomy - An ostomy involving the rerouting of the colon due to conditions like colorectal cancer or diverticulitis.
• Ileostomy - An ostomy involving the rerouting of the ileum, relevant for conditions such as Crohn's disease.
• Urostomy - An ostomy diverting urine through an abdominal opening due to conditions such as bladder cancer.

• Define Ostomy - Understand the concept of creating artificial openings (e.g., ostomies).
• Contrast Colostomy, Ileostomy, and Urostomy - Assess key differences (e.g., ostomy types).
• Explore Ostomy Care Steps - Gain knowledge on care steps (e.g., stoma and ostomy care procedures).
• Explain Importance of Hygiene - Understand the importance of hygiene for care (e.g., hand hygiene, disposables).
• Apply Ostomy Care in Practical Scenario - Understand how to apply steps in real-life situations (stoma care, ostomy care).

• What is ostomy and why is it necessary?
• What are the different types of ostomy procedures and their purposes?
• What are the essential steps in ostomy care?

• Nursing Students - Understand the different types of ostomies and how their care can support patient recovery.
• Healthcare Educators - Gain a clear framework on ostomies and their care for teaching purposes.
• Medical Researchers - Discover the relevance of ostomy procedures and care in surgical study and methodologies.
• Medical Enthusiasts - Learn about ostomies and their care out of personal interest or preparation for patient care.