Na Ii Ppt Module 10


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Na Ii Ppt Module 10

  1. 2. Ostomy Care and Irrigation
  2. 3. Elimination: Ostomy Care <ul><li>Terms: </li></ul><ul><li>Ostomy-a surgically created opening into the body </li></ul><ul><li>Stoma-opening to the outside of the body. Location is determined by the part of the colon that is injured or diseased. </li></ul><ul><li>Ileostomy- permanent artificial opening in the ileum (refer to the graph on page 201 in the text) </li></ul>
  3. 4. Elimination-Terminology <ul><li>Cecostomy-permanent artificial opening in the cecum </li></ul><ul><li>refer to the graph on page 201 in the text) </li></ul><ul><li>Colostomy-most common type of ostomy. Permanent artificial opening in the large intestine. </li></ul><ul><li>Bowel Diversions- other methods of bringing the intestines to the abdominal wall to preserve its vitality while avoiding non-functioning and/or ill intestines </li></ul>
  4. 5. Elimination- Stoma <ul><li>A normal Stoma should appear: </li></ul><ul><li>Meaty red </li></ul><ul><li>Moist </li></ul><ul><li>smooth </li></ul><ul><li>The stoma is actual intestinal tissue </li></ul><ul><li>Peri-skin should be clean and dry with no s/s of infection or irritation </li></ul>
  5. 6. Elimination: Stool Specimen <ul><li>Procedures for the Different Types of Specimen Collections: </li></ul><ul><li>Stool: </li></ul><ul><li>Receive instructions from RN </li></ul><ul><li>Gather supplies (to include specimen container and label) </li></ul><ul><li>Explain procedure to the patient (inform not to put toilet paper or urine in the collection apparatus </li></ul><ul><li>Observe standard precautions </li></ul><ul><li>Use tongue blade to remove approx 2 Tablespoons of stool from the collection apparatus and place into the specimen container </li></ul><ul><li>Complete ending procedures </li></ul>
  6. 7. Elimination: Urine Specimen <ul><li>Urine: </li></ul><ul><li>Receive instructions for the RN </li></ul><ul><li>Gather equipment (to include sterile specimen container and label) </li></ul><ul><li>Explain procedure to patient (to include not to put toilet paper or stool into the collection apparatus) </li></ul><ul><li>Observe Standard Precautions </li></ul>
  7. 8. Elimination: Urine Specimen <ul><li>Clean peri area </li></ul><ul><li>Use clean collection container only </li></ul><ul><li>Measure urine from collection apparatus into a graduated cylinder </li></ul><ul><li>Pour from the cylinder into the specimen container observing sterile technique with container </li></ul><ul><li>Complete ending procedures </li></ul>
  8. 9. Elimination: Routine Stoma Care <ul><li>Purpose of Routine Stoma Care: </li></ul><ul><li>Done to keep the tissue around the stoma healthy </li></ul><ul><li>Waste eliminated from the stoma may be very irritating to the tissue. </li></ul><ul><li>The stool from an ileostomy is more acidic than the stool from a colostomy </li></ul>
  9. 10. Elimination: Routine Stoma Care <ul><li>Equipment: </li></ul><ul><li>Apply Standard Precautions- gloves </li></ul><ul><li>Washcloth and towel and basin of warm water </li></ul><ul><li>Disposable appliance bag, belt and adhesive wafer </li></ul><ul><li>Bedpan </li></ul><ul><li>Skin lotion as directed </li></ul><ul><li>4x4 gauze squares </li></ul><ul><li>Toilet tissue </li></ul>
  10. 11. Elimination: Routine Ostomy Care <ul><li>Explanation to patient: </li></ul><ul><li>These patients require a lot of support and reassurance </li></ul><ul><li>They can be worried about strong offensive odors </li></ul><ul><li>They can worry about the bag showing under their clothing </li></ul><ul><li>You need to be very professional, tactful, patient and understanding </li></ul>
  11. 12. Elimination: Routine Ostomy Care <ul><li>Skin Care: </li></ul><ul><li>Apply standard precautions </li></ul><ul><li>Remove the soiled disposable stoma bag and belt </li></ul><ul><li>Empty the appliance when it is ½ to 2/3 full </li></ul><ul><li>If a leak develops, change the pouch immediately. </li></ul><ul><li>Empty the reusable bag and wash it thoroughly with soap and water after each bowel movement </li></ul>
  12. 13. Elimination: Routine Ostomy Care <ul><li>Skin Care: </li></ul><ul><li>Gently cleanse area around stoma with toilet tissue </li></ul><ul><li>Wash area around stoma with soap and water. </li></ul><ul><li>Rinse and dry. </li></ul><ul><li>Apply barrier around stoma if directed </li></ul><ul><li>Observe the skin around the stoma for redness, irritation, and skin breakdown and report to the RN </li></ul><ul><li>Observe the color, character, amount and frequency of stools and report any abnormalities. </li></ul>
  13. 14. Elimination: Routine Stoma Care <ul><li>Recording and Reporting: </li></ul><ul><li>Observe the skin around the stoma for redness, irritation, and skin breakdown, and report to the RN </li></ul><ul><li>Observe the color, character, amount and frequency of stools, and report abnormalities to the RN </li></ul><ul><li>Report any abnormalities or patient complaints to the RN </li></ul><ul><li>Record completion of task. </li></ul>
  14. 16. Elimination: Ileostomy Care <ul><li>An ileostomy is a permanent artificial opening in the ileum that drains through a stoma on the surface of the abdomen </li></ul><ul><li>The drainage from the ileum is in liquid form and contains digestive enzymes that are irritating to the skin. </li></ul><ul><li>The fit of the ileostomy ring is critical to prevent leakage. This is true for both disposable and reusable types of appliances. </li></ul>
  15. 17. Elimination: Ileostomy Care <ul><li>Apply clean stoma bag </li></ul><ul><li>There are many different types of pouches. </li></ul><ul><li>Reusable and disposable; One piece or two piece. </li></ul><ul><li>Self adhering or those that require adhesive to be applied to the wafer. </li></ul><ul><li>Center the pouch ring over the wafer ring and press firmly but gently to snap the rings together. </li></ul><ul><li>Secure the clamp at the bottom of the bag to prevent leaking </li></ul><ul><li>Secure belt, ensuring that the skin beneath the belt is not irritated or broken. </li></ul>
  16. 18. Elimination: Ileostomy Care <ul><li>It may be necessary to apply a clean adhesive wafer along with the pouch </li></ul><ul><li>When removing the wafer, apply gentle traction to the skin next to the wafer to prevent skin irritation </li></ul><ul><li>You may be required to cut the wafer to fit around the stoma before applying to the skin. Cut the area 1/8 inch larger than the size of the stoma </li></ul><ul><li>Remove the paper backing from the adhesive wafer </li></ul><ul><li>Seal the entire area surrounding the stoma to prevent leaking. Holding your hand over the area for about a minute will help. </li></ul><ul><li>The heat from your hands promotes a good seal. </li></ul><ul><li>Ensure the wafer is wrinkle free </li></ul>
  17. 20. Elimination: Colostomy Care <ul><li>Colostomy is the most common type of ostomy </li></ul><ul><li>It is located between the colon and the abdomen </li></ul><ul><li>The intestines are brought to the outside of the body to create the stoma </li></ul><ul><li>When the ostomy is first performed, the stool is loose and watery but it becomes soft and formed over time </li></ul><ul><li>The function of the colon is to absorb water from the chyme for the body to use. Once the water is removed from the chyme, stool is formed. </li></ul><ul><li>If a portion of the colon has been removed, the body will not be able to absorb the water and the stool will be more liquid. </li></ul>
  18. 21. Elimination: Colostomy Care <ul><li>Care of the skin, removing and apply the pouch and wafer is very similar to how it is done for an ileostomy </li></ul><ul><li>The stoma will be located in a different area on the abdomen. </li></ul>
  19. 23. Elimination: Ostomy Irrigation <ul><li>Irrigation is done: </li></ul><ul><li>to regulate elimination -which can take 4-6 weeks </li></ul><ul><li>to cleanse the bowel before tests or procedures </li></ul><ul><li>This procedure should be done by an RN on newly created colostomies </li></ul>
  20. 24. Elimination: Ostomy Irrigation <ul><li>Before beginning the procedure: </li></ul><ul><li>Determine that you are permitted to perform this skill on the patient </li></ul><ul><li>Identify the patient before beginning the procedure </li></ul><ul><li>Explain the procedure to the patient </li></ul><ul><li>Gather your equipment </li></ul><ul><li>Observe Standard Precautions </li></ul>
  21. 25. Elimination: Ostomy Irrigation <ul><li>Gather your Equipment: </li></ul><ul><li>2 incontinent pads, if being done in the bed </li></ul><ul><li>Bedpan, if being done in the bed </li></ul><ul><li>Irrigation sleeve with belt or self adhesive ring </li></ul><ul><li>IV Standard </li></ul><ul><li>Irrigation bag with 1000cc’s warm water </li></ul><ul><li>Gauze sponges </li></ul><ul><li>Towels </li></ul><ul><li>Water –soluble lubricant </li></ul>
  22. 26. Elimination: Ostomy Irrigation <ul><li>Position the Patient: </li></ul><ul><li>Assist to the bathroom if being done on the toilet, and have them sit on the toilet . </li></ul><ul><li>The drainage sleeve will be positioned between the legs </li></ul><ul><li>If being done in the bed, place the patient in the supine position with head slightly elevated </li></ul><ul><li>Position the incontinent pad to prevent soiling. </li></ul><ul><li>Position a second pad on a chair next to the bed and place a bedpan on the pad. </li></ul><ul><li>The drainage sleeve will be positioned to the side </li></ul>
  23. 27. Elimination: Ostomy Irrigation <ul><li>Procedure: </li></ul><ul><li>Hang irrigation bag approximately 20 inches above the patient ( the bottom of the bag should be at about the patient’s shoulder level to prevent water from entering the bowel too quickly) </li></ul><ul><li>Prime the tubing if not done previously </li></ul><ul><li>Remove colostomy bag and wafer </li></ul><ul><li>Apply irrigation sleeve using belt or adhesive backing </li></ul>
  24. 28. Eliminiation: Ostomy Irrigation <ul><li>Procedure continued : </li></ul><ul><li>Place open end of irrigation sleeve in the toilet or bedpan sitting on the seat of a chair beside the bed </li></ul><ul><li>It is important the end of the drainage sleeve not hang in the water of the toilet bowl. It may be necessary to cut the sleeve if it is too long. </li></ul>
  25. 29. Elimination: Ostomy Irrigation <ul><li>Procedure continued: </li></ul><ul><li>Lubricate the gloved pinky finger </li></ul><ul><li>Gently insert into the stoma. Determine the bowel angle with your finger. </li></ul><ul><li>Lubricate the irrigation cone well. </li></ul><ul><li>Gently insert the cone in the direction of the bowel determined by your finger. </li></ul>
  26. 30. Elimination: Ostomy Irrigation <ul><li>Procedure continues: </li></ul><ul><li>Unclamp the tubing and allow the fluid to run in slowly </li></ul><ul><li>Adjust the rate with the roller clamp or pinch the tubing </li></ul><ul><li>The bag should flow in over 10-15 minutes </li></ul><ul><li>When empty, remove the cone. </li></ul><ul><li>Close the tip of the sleeve if the patient will be ambulating </li></ul>
  27. 31. Elimination: Ostomy Irrigation <ul><li>Procedure continues: </li></ul><ul><li>After irrigation is complete, remove the sleeve and discard </li></ul><ul><li>Wash peri skin with warm water, rinse and dry. </li></ul><ul><li>Apply barrier, if directed </li></ul><ul><li>Apply clean appliance </li></ul><ul><li>Perform procedure completion actions. </li></ul>
  28. 32. Elimination: Ostomy Irrigation <ul><li>Common Problems: </li></ul><ul><li>Patient complains of abdominal cramping </li></ul><ul><li>Stop the flow of solution, leaving the cone in place </li></ul><ul><li>Cramping can be due to: </li></ul><ul><li>air in the tubing or </li></ul><ul><li>if the flow is too fast or </li></ul><ul><li>The water is too cold or </li></ul><ul><li>The bowel is ready to empty </li></ul><ul><li>Trouble shoot and correct the problem then restart the solution </li></ul>
  29. 33. Elimination: Ostomy Irrigation <ul><li>The three probable signs of fecal impaction are: </li></ul><ul><li>Seepage of liquid stool instead of formed stools </li></ul><ul><li>This seepage may have a strong odor </li></ul><ul><li>Abdominal Distention </li></ul><ul><li>As the stool sits in the intestines, it continues to ferment and the intestines continue to secrete mucous to try to flush the stool out, this creates a gas that expands the intestines and in turn expands the abdomen </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Due to the backing up of stool, causing a full feeling in the stomach, the build up of gas and toxins in the intestines all lead to an upset stomach and possibly vomiting </li></ul>
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