The document discusses the most common problems arising from ileostomy, including psychological issues, leakage, skin excoriation, and nutritional deficiencies. It emphasizes the importance of stoma care management for patients and their families, including education on pouching techniques, dietary restrictions, and addressing complications like food blockage. Additionally, it highlights the need for ongoing support and adjustment to lifestyle changes post-surgery.

1. MOSTCOMMONPROBLEMARISEFROM
ILEOSTOMY
PRESENTED BY :ST.TR. CHHAYA PAWAR
K.E.M. HOSPITAL, MUMBAI.

4. Ostomy
 Greek word- A mouth or mouth like
opening.
 Ileostomy is a surgically performed
through the abdominal wall opening into
the ileum or small intestine to excrete
faeces from the body.
 Stool is liquid to semisolid consistency
and contains protiolytic enzymes.
 Temporary or Permanent.

5. THE AIMS OF STOMA CARE
• To provide a service of mgt & support
both pre & post operatively for the pt.
with a stoma & his family & to guide &
teach other nurses involved with the pt.
& maintain a program of rehabilitation of
pt to achieve maximum independence &
regain a high quality of life.

6. MOST COMMON PROBLEM ARISE
FROM ILEOSTOMY
• PSYCHOLOGICAL PROBLEMS.
• LEAKAGE OF BAG
• SKIN EXCORIATION
• FOOD BLOCKAGE
• DEHYDRATION
• ELECTROLYTE IMBALANCE
• B12 DEFICIENCY etc.

7. COUNSELLING

8. Explanation given by the stoma staff
about anatomy & physiology to pt and
relatives

9. Different types of stoma bags and
accessories required to pt.after
surgery

10. Visit By Ostomy Visitor
before stoma surgery.

11. STOMA MARKING

12. POUCHING/ADVANTAGES.

13. Patient Teaching
• The first step is looking at the stoma, progressing to
assisting with emptying and cleaning, and then to
changing the pouch.
• If the patient cannot progress to the point of
willingness to learn, a caregiver must be taught
pouch change procedure and care until the patient is
ready to learn.
• Pouch change should performed before eating as
stoma is less active.
• Shaving should be done routinely.

14. OSTOMY BASIC SKIN CARE ROUTINE
• REMOVE
• CLEAN AND DRY
• MEASURE STOMA
• PROTECT
• APPLY

16. Adaptation to a stoma
• It is a gradual process because the patient
experiences grief over the loss of a body part and an
alteration in body image.
• Adjustment period is individualized.
• Patients are concerned about body image, sexual
activity, family responsibilities and changes in
lifestyle.

17. And Finally
• Before your patient is discharged they should
be able to
– Demonstrate cleaning and changing the pouch
– Verbalize where to obtain supplies
– Know how to contact a resource person for
problems
– Know how/when to follow up with physicians,
WOCN, and support group.

18. PREVENTION FOR ILEOSTOMY
BLOCKAGE - AVOID
• STRINGY, HIGH FIBER FOODS LIKE CELERY,
COCONUT, CORN,COLESLAW, THE
MEMBRANES ON CITRUS FRUITS, NUTS,
WATERMELON, GUAVA,
POMEGRANATE,CUSTARD APPLE
,VEGETABLE & FRUIT SKINS.
• ENTERIC COATED, TIME RELEASED MEDS
OR HARD TABLETS MAY NOT BE ABSORBED
SO LIQUID OR CHEWABLE MEDS ARE
PREFERED.

19. IF DEVELOPED FOOD BLOCKAGE
• HAVE THEM GET INTO THE KNEE CHEST POSITION
AND ROLLING FROM SIDE TO SIDE FOR A FEW
MINUTES.
• GENTLY MASSAGING YOUR TUMMY AND THE
AREAAROUND THE STOMA.
• TAKING A HOT BATH FOR 15 TO 20 MINUTES.(TO
HELP RELAX MUSCLES IN YOUR TUMMY
• REMOVE POUCH AND REPLACE WITH TWO PIECE
SYSTEM.
• NBM OR CONTACT TO SURGEON/ET.

20. FOOD BLOCKAGE & SKIN
EXCORIATION
• PT’S NAME:- xyz
• AGE:- 31YRS MALE MARRIED ON 2009 HAVING
TWO CHILDRENS M & F , R/O PANDHARPUR C/O
ULCERATIVE COLLITIS OPERATED IN SASOON
HOSPITAL, PUNE – TOTAL COLECTOMY WITH
ILEOSTOMY ON 1ST JAN 2014. HE CAME TO
MUMBAI ON 2ND MARCH TO ATTEND FUNCTION,
FROM THAT FOOD HE UNDERGONE FOOD
BLOCKAGE & HE CAME TO K.E.M. HOSPITAL .

25. NURSING DIAGNOSIS:-
• Risk for food blockage related to disease
condition as evidenced by lack of knowledge.
• Risk for skin integrity related to loss of sphincter
muscle at stoma / flow of effluent as evidenced
by wrong type of bag application.
• Knowledge deficit regarding condition, prognosis,
treatment, self-care, & discharge needs.
• Deficient fluid volume related to loss of colon
function as evidenced by signs & symptoms.

26. LEAKAGE OF BAGS
CAUSES:- NO PROFESSIONAL GUIDANCE,
IMPROPER STOMA SITING
WRONG TYPE OR SIZE OF APPLINCE
OVERSTORING OF APPLIANCES
ECONOMIC CONDITION OF PT.
NONAVAILABILITY OF PRODUCT
COMPLICATION OF SE, HPR & CT
HIGH OUTPUT OF STOMA ETC.

27. HIGH OUTPUT OF STOMA
• PROBLEM:-
DEHYDRATION
FLUID & ELECTROLYTE DEFICIT
SKIN EXCORIATION
• TREATMENT:-
ASK TO DRINK 2 LOR MORE
FLUIDS IF NOT
REPLACED THE FLUID & ELECT.
ANTI- DIARRHOEAL DRUGS
POUCH – ONE PIECE DRAINABLE
2 PIECE SYSTEM OR WOUND COLLECTOR
.

28. PT. xyz
AGE:- 42 YRS FARMER FROM U.P.
DIAGNOSIS:- NECROTISING ENTEROCULITIS
SURGERY:- TOTAL COLECTOMY WITH
ILEOSTOMY ON 25TH MARCH 2012
COMPLAINT:- FREQUENTLY LEAKAGE OF BAGS
PREFER:- TWO PIECE SYSTEM DRAINABLE BAG
SUPPLEMENTS OF INJ.B12/TABLETS

29. PT. xyz
AGE:- 23YRS.
DIAGNOSIS:- ULCERATIVE COLITIS.
OPERATION:- TOTAL COLECTOMY WITH ILEOSTOMY.
D/O/SURGERY :- 20th march 2015
PROBLEMS:- HIGH OUTPUT OF STOMA & FREQUENTLY
LEAKAGE OF BAG/ DEFICIT OF ELECTROLYTES &
FLUIDS.
PREFER:- LARGER SIZE OF APPLIANCE.
CORRECT THE ELECTROLYTES & REPLACEMENT OF
FLUIDS.
POST OP. COUNCILIING.

32. EXPLAINED TO PT & RELATIVES ABOUT EMPTYING & APPLICATION OF STOMA BAG.

33. INSERVICE EDUCATION TO HOSPITAL
STAFF

35. INSERVICE EDUCATION TO HOSPITAL
STAFF

36. INSERVICE EDUCATION TO STAFF &
SISTER INCHARGES

37. CONT……

39. INSERVICE EDUCATION TO HOSPITAL
STAFF

40. STOMA CARE LECTURE TO GNM STUDENT NURSES

41. DEMONSTRATION

42. QUESTION & ANS. SECTION