An ostomy is a surgically created opening in the small or large intestine to divert fecal matter. It is indicated for various intestinal diseases and injuries. There are three main types - colostomy, ileostomy, and urostomy - which are located and have characteristics depending on the portion of intestine used. Proper ostomy care involves assessing the stoma, applying pouches and barriers to protect the skin, managing diet and output, and educating patients.

1. OSTOMY & ITS CARE
• Ms. Deepsikha kakoty
• Dept of Medical Surgical Nursing
• College of Nursing, NEIGRIHMS

2. DEFINITION
An ostomy is an opening in the small
intestine or large intestine that is surgically
created as an outlet through the anterior
abdominal wall in order to pass fecal
matter into a bag.

3. PURPOSE OF A STOMA
• It reduces pain and discomfort
• Allows systematic defecation
• May help relieve symptoms of intestinal
disease

4. INDICATIONS OF AN OSTOMY
• Inflammatory bowel disease
• Ulcerative colitis
• Cancer
• Perforated or complicated diverticulitis
• Bowel obstruction
• Crohn’s disease
• Hirschsprung disease
• Accidental injury
• Congenital deformities of anus or rectum

5. TYPES OF OSTOMIES
• According to the location:
Colostomy, Ileostomy and Urostomy
• Major types of intestinal stoma can be:
End stoma, Loop stoma and Double-Barreled
stoma
• According to duration:
Temporary ostomy and Permanent ostomy

6. END STOMA
• Surgically
constructed stoma
by dividing the
bowel and bringing
out the proximal
end as a single
stoma.
LOOP STOMA
• It is constructed by
bringing a loop of
bowel to the
abdominal surface
and then opening
the anterior wall of
the bowel to
provide fecal
diversion.

7. DOUBLE-BARRELED STOMA
It is constructed by dividing the bowel, and
then both the proximal and distal ends are
brought through the abdominal wall as two
separate stomas.

8.  Colostomy
 Ileostomy
 Urostomy

11. Indications for a Colostomy:
 Trauma
 Cancer
 Diverticular disease
 Crohn’s disease
 Ulcerative colitis
 Obstruction

12. ARTICLES REQUIRED
⚫ A clean tray containing
⚫ Mackintosh with draw sheet,
⚫ Kidney tray / paper bag ,
⚫ Pair of clean gloves,
⚫ Colostomy bag,
⚫ Normal saline / basin with
warm tap water,
⚫ Gauze pieces,
⚫ Gauze pad / tissue paper,
⚫ Skin barrier,
⚫ Stoma measuring guide,
⚫ Pen or pencil and scissors.
⚫ Bed pan.

13. GUIDELINES:
⚫Keep odour as free of odors as possible.
⚫Ostomy bag should be emptied frequently.
⚫Check the stoma regularly, the colour
should be dark pink to red and moist.
⚫Pale colour indicates anaemia,
⚫Dark or purple blue indicates
compromised circulation.

14. Size of the stoma stablizes 6-8 weeks.
If dressing, check frequently for drainage and
bleeding.
Keep the skin around the stoma (peristomal
area) site clean and dry.
If not it causes skin irritation and infection.
Intake and out put chart must be recorded for
every 4 hours.
Encourage the patient to participate in care
and to look at the ostomy.
Can help the patient by listening, explaining,
being available and supportive.

15. ⚫Encourage the patient to avoid fibre
rich diets.
⚫Encourage the patient to drink fluids.
⚫Educate the patient about the various
methods of odor control measures.
⚫Chlorophyll rich diet will deodorise the
feces.
⚫Direct contact sports and heavy lifting
must be avoided.

18. Colostomy
sites

19. New Stoma

20. Hard to pouch stoma

21. Measure
stoma
 They can change in size
 After surgery
 Weight gain
 Weight loss

22. Cut to fit wafer

23. Stretch to fit appliance

24. Types of Stomas
Budded
Flush Inverted

25. Peristomal skin breakdown

26. Crusting technique
 Clean dry (if possible) skin
 Apply stomahesive powder; sprinkle
 Dust off with gauze, paper towel etc
 Dab with no sting barrier wipe/lollipop
 Repeat process 3 times
 Keep effluent off peristomal skin while
applying the crusting technique

27. Healthy
Stoma

28. Paste/barrier rings
 Paste has alcohol; if needed let dry for
1 minute for evaporation of alcohol
before applying to skin
 Barrier rings preferred; warm first apply
to skin, can fill in crevices and provide
protection of peristomal skin
 Fit right next to stoma

29. Barrier ring application

30. Stomahesive
Paste

31. Perfumes for Colostomy

32. 1 or 2 piece, matter of preference

33. Drainable or
closed
 Urostomy pouch has to be drainable
 Ileostomy pouch has to be drainage
 Colostomy pouch can be closed end or
drainable

34. Pouche
s
 Closed end  Drainable

35. Two piece

36. One
piece

37. Ileostomy
 Stoma that comes from the ileum
 Usually on the lower right of abdomen
 Effluent is loose to liquid with enzymes
 More issues with leaking and break
down in peristomal skin
 More diet restrictions
 Blockage problems

38. Ileostomy site

39. Ileostomy stoma

40. Ileostomy is from the ileum
 The entire colon, rectum and anus are
removed or bypassed.
 The small intestine (ileum) is brought
through the abdominal wall creating the
stoma, most often on the right lower site
 The stoma is smaller in diameter

41. Ileostomy diet
 Drink much more water/liquids; 10-12
glasses a day
 Avoid nuts, popcorn, seeds, celery, corn
 Raw crunchy vegetables must be
chewed very well!
 Eat slowly and chew all food well
 Avoid time release/enteric coated pills
 For blockage-go to ER

42. Ileostomy tips
 For difficulty/constantly draining stoma
 Have patient/client eat 2 Tablespoons
of peanut butter
 OR eat 6 large marshmellows
 30 minutes before changing appliance
 This will slow down the drainage so you
can get a good seal

43. Urostom
y
 The bladder is removed or bypassed
 A conduit is made of small intestine
tissue
 Ureters are implanted into the ileum
and on to the urostomy stoma
 The urine flows from the stoma into the
pouching appliance

44. TYPES OF UROSTOMY
STANDARD OR CONVENTIONAL
UROSTOMY CONTINENT UROSTOMY

45. Ileal Conduit

46. Urostomy tidbits
 The intestine produces mucous, therefore
the urine will have a cloudy appearance and
the mucous will need to be cleaned off the
stoma during appliance changes
 Adequate fluid intake, 8-10 glasses a day, is
very important
 Need to connect to a over night
drainage system at night.

47. Urine
crystals
 White, gritty deposits on and around
stoma
 Clean with peristomal skin with 1:1
vinegar and water
 Clean over night container with vinegar
and water

48. Percentages of the 3
types
 Urostomy 20%
 Ileostomy 35%
 Colostomy 45%

49. OSTOMY CARE
PRE -OPERTATIVE CARE:
Psychological preparation:
• Emotional support for altered body image, the lose of
control over elimination and the odors.
Selection of site:
• A flat, crease-free surface, in the patient’s visual field
and within the rectus muscle.
• A flat site create a good seal and avoid leakage from
the bag.
• Usually in the right lower quadrant about 2 inches
below the waist.
• Marking of the area before surgery

50. ………………………..CONT’
Preoperative teaching:
• Provide thorough understanding of the
surgery
• Management of drainage from the stoma
• The nature of drainage
• Care of skin surface and ostomy
• Diet

51. ………………………..CONT’
Bowel preparation:
• Emptying the intestine before surgery
• Neomycin and erythromycin are given
orally
• Low residue diet

52. POST OPERATIVE CARE
• Assessment of the stoma
Color, edema, bleeding
• Provision of appropriate
pouching system
• Managing skin and stoma care
• Colostomy/Ileostomy irrigation
• Managing dietary and fluid needs
• Encouraging for early ambulation

53. COLOTOMY/ILEOSTOMY
IRRIGATIONS
• It is used to empty or to clean colon in order
to achieve a regular bowel pattern.
• Assessment before irrigation
• Assess for time when patient normally
irrigates. Consult with physician in case of
new colostomy/ileostomy.
• Assemble equipments
and maintain privacy.

54. PROCEDURE OF IRRIGATION

55. COLOSTOMY/ILEOSTOMY
IRRIGATIONS

56. DOCUMENTATION
⚫ Record the procedure
with following details
(with date & time ).
⚫ Amount,
⚫ colour,
⚫ and consistency of the
fecal matter in the
pouch.

57. Questions???
?

58. Resources:
 United Ostomy Associations of America,
Inc. (UOAA) 1-800-826-0826
www.ostomy.org
 Wound, Ostomy, Continence Nurses
Society (WOCN) www.wocn.org
 WCC-www.nawccb.org
 www.phoenixuoaa.org
 ABQ Ostomy support group
 505 830-2135