2. There are two types of fecal
ostomies..
1. Colostomy
2. Iliostomy
3. It is a surgically created opening between
the colon and the abdominal wall to allow
fecal elimination
It may be a temporary or permanent
diversion.
It may be placed in any segment of the
large intestine (colon),
According to the place of colostomy
nature of feces changed.
Colostomy
4. Types of colostomy
According to anatomic location
Ascending colostomy
Transverse colostomy
Descending colostomy
Sigmoid colostomy
9. Ileostomy
A surgically created opening between the
ileum of the small intestine and the
abdominal wall to allow elimination of
small bowel effluent.
It is usually formed at the terminal ileum of
the small bowel
It is usually placed in the right lower
quadrant of the abdomen.
Stool from an ileostomy drains frequently
(average four to five times per day)
10. Ileostomy
It contains proteolytic enzymes,
which can be harmful to skin.
may be temporary or permanent
ileostomy include ulcerative colitis,
Crohn’s disease, familial polyposis,
cancer, congenital defects, and
trauma.
11.
12. Characteristics of Stomas
stoma is the part of the intestine (small or
large) that is brought above the abdominal
wall to become the outlet for discharge of
intestinal waste.
Normal stoma
Pink red, moist, shiny
Bleeds slightly when rubbed
No feeling to touch
Stool functions involuntary
Postoperative swelling gradually
decreases over several months.
13. Indications for fecal ostomy
Cancer of colon and rectum
Diverticular diseases
Crohn’s diseases
Ulcerative colitis
Trauma
Congenital defect
14. Types of stoma
End stoma/terminal colostomy
Loop colostomy
Double barrel colostomy
15. Cont….
According to construction
of stoma
End stoma/terminal
colostomy
There is only one
opening that drains
stool.
The distal bowel is either
surgically removed or
sutured closed within
abdominal cavity.
Proximal end of colon
brought out of the
17. Cont….
Loop colostomy
A loop of bowel
brought out of the
abdominal wall
stabilized temporarily
with a rod, catheter,
or a skin or fascial
bridge.
18.
19. Cont…
Double barrel colostomy
Both proximal & distal cut
ends of colon brought out
of the abdominal wall.
an end stoma (proximal),
drains stool, and distal
stoma, ( mucous fistula)
drains mucus.
This type of stoma is
usually temporary.
20.
21. Preop: Management and Nursing
Care
Prepare as general abdominal surgery
Psychological preparation-
patient/family
Bowel preparation
Low fiber diet, enema, AB, clean
prep....
Mark and explaining ostomy site
(Marked by the ostomy specialty nurse
or surgeon)
22. Considerations when selecting a
stoma site
Anatomical location of bowel segment
Positioning within rectus muscle
Clearance from umbilicus, scars, &
creases
Avoidance of bony prominences
Avoidance of beltline
Positioning within patient's visibility
23. Postoperative Management
Administer general & abdominal
surgical care
Assess stoma - color and record
findings:
Normal color: pink-red
Ischemic sign: Dusky: dark red
Necrotic: brown or black; may be
dry
27. Cont….
Apply pouching system
Evaluate and empty drains and
ostomy pouch frequently
Stoma function - usually after 24-48
h
Check for abdominal distention
Monitor intake and output
41. Cont...
Time
Every 3 to 7 days
Change when the bowel is least
active
Early morning before breakfast
2 to 4 hours after a meal
Before bedtime
42. Cont….
Change immediately if
Leakage is imminent
Itching or burning of peristomal skin
Odor is detected with a closed
system
Wafer is dissolving
43. Nursing diagnosis
Deficient Knowledge related to surgical
procedures and ostomy management
Disturbed Body Image related to change in
structure, function, and appearance
Anxiety related to loss of bowel control and
autonomy
Impaired Skin Integrity related to irritation of
peristomal skin by drainage and equipment
Imbalanced Nutrition: Less Than Body
Requirements related to increased output and
inadequate intake
Sexual Dysfunction related to altered body
45. 1. Explain surgical procedure with the patient, Clarify
any misunderstandings.
Assess the patient’s response to teaching.
provide alternative times for teaching and review.
2. Avoid overwhelming the patient with information.
3. Discuss with family.
4. Use available educational materials, including
pictures and drawings.
5. Involve the ostomy specialty nurse in ostomy
teaching, and reinforce information, including lifestyle
modifications.
6. Use a team approach;
7. Consider the psychosocial issues of the patient and
their effect on learning.
Educating the Patient
46. Promoting a Positive Self-
Image
Encourage express feeling
Counseling, as necessary
Provide support during initial phase
Arrange a visit and shear the
experience with other stoma patient
Encourage spouse or significant
others
47. Relieve anxiety
Provide information regarding expected
outcomes,
type and consistency of bowel function.
Educate regarding ostomy management
Observe stoma, pouch change, and emptying
procedure.
Learn tail closure application and removal.
Empty and rinse pouch.
Assist with pouching system change until
independent.
48. If patient unable to manage ostomy
advice to take additional assistance
and encouragement.
Teach colostomy irrigation procedure,
if appropriate.
49. Maintaining Skin Integrity
Select appropriate pouching system
Empty pouch when 1/3 to ½ full to
avoid overfilling
Change pouching system regularly
Periostmal care
Treat peristomal skin breakdown
50. Maintain adequate nutrition
Review patient's dietary habits
patterns,preferences, and bowel irritants.
Assess nutritional status
Weight daily, monitor vital signs and
electrolytes
Consult with nutritionist, as needed
Introduce food guide
Avoid gas, odor forming food
51. Patient Education & home care
Periostomal skin care
Cleaning around stoma
Changing pouching system
regularly
Watch for complications
Use right size appliances
Remove the skin barrier gently
Keep dry & intact
52. Cont....
Odor Control
Encourage pouch hygiene
Use of deodorants
Use an odor-resistant pouch
Diet modification
Increase odor- eggs, garlic,
cabbage
Decrease odor- yoghurt, parsley...
53. Cont...
Gas Control
Reduce swallowed air
Chewing gum, drinking through
straw
Avoid gas-forming foods
Cabbage, onion, carbonated
drinks..
Regular eating
56. Cont...
Other education
Normal bathing habits
Clothing modifications
Extra ostomy supply kit when travel
Refer to support group
57. Seek medical advice when....
Ab: Cramps lasting > 2/3 hours
Continuous nausea and vomiting
No ostomy output for 4-6 hours with
cramping and nausea
Injury to the stoma
Bad skin irritation or deep sores
(ulcers)
Unusual change stoma size or color
Continuous bleeding
