Certain diseases and injuries may necessitate an alternative form of bowel elimination through a surgically created ostomy. An ostomy diverts bowel contents through an opening in the abdominal wall. There are different types of ostomies including ileostomies, colostomies, and ureterostomies. Proper ostomy care involves assessing the ostomy and surrounding skin, emptying or changing the ostomy appliance as needed, and ensuring the new appliance adheres securely without irritation. Regular assessment and management of the ostomy is important for the patient's wellbeing.

1. Ostomy Care
Alternative Bowel Elimination
Bowel diversion-redirection of the contents of the small or large intestine through a surgically
created exit in the abdominal wall.
Possible reasons for bowel diversion:
• Cancerous tumor
• Disease process such as Crohn’s disease.
• Infarcted area which the bowel walls become ischemic and die
• Ruptured diverticulum
• Ulcerative colitis
• Traumatic abdominal injury
Certain Disease processes and injuries can necessitate that a patient be provided with an
alternative form of bowel elimination by surgically creating a bowel diversion. The fecal
material or effluent empties into an ostomy appliance, otherwise known as a bag or pouch.
Ostomies
Ostomy- surgically created opening into the abdominal wall that serves as an exit site from
the bowel or ureter.
Ileostomy- surgically created opening from the small intestines to the abdominal wall
allowing the passage of feces.
Colostomy-surgically created opening from the large intestines to the abdominal wall
allowing for the passage of feces.
Colostomy
• A colostomy stoma will have a single opening, this is a single barreled or end stoma, if the
distal colon is permanently removed.
• Occurs with
→ Cancer of descending colon
→ Severe Chron’s disease
→ With Chron’s disease there is an inflammation of the bowel. The colon may need time to
heal and rest. In this situation the colon may be completely incised, or cut into two pieces
creating to stomas.
Stoma
Portion of the bowel or ureter that is surgically opened and brought out through the
abdominal wall.
A Healthy Stoma is shiny, moist and red.
Ureterostomy
Surgical procedure creating an opening from the ureter to the abdominal cavity.
Ostomy Drainage
Type of drainage depends on location of the ostomy:
• Ileostomy and ascending colon-liquid feces.
• Transverse colostomy- mushy stool.
• Descending colon-soft to solid.

2. Kock Pouch
• Is a diversion that uses the terminal portion of the ileum to form an internal pouch, or
reservoir, to collect and store the effluent prior to evacuation from the body.
• A flap is formed that closes the reservoir, preventing leakage onto the skin.
• The patient inserts a catheter several times a day to drain the reservoir.
• The type of stoma is considered a continent ostomy since the patient has control over when
it is drained.
Ostomies
• May be temporary or permanent.
• Temporary - bowel rest, e.g. Chron’s disease.
• Permanent - Tumor.
• Temporary may be several weeks to several months.
Temporary- generally located at the transverse colon.
Permanent- usually located at the descending colon or sigmoid colon. Permanent because
the colon or rectum have to be removed.
Nursing Care of Ostomies
• Many hospitals are now utilizing nurses specially trained to provide ostomy care.
• They not only provide direct care but are consultants.
• They provide patient teaching.
• Recommend appliances and products depending on patients type of ostomy
devices/products.
Ostomy Appliances
• Many types of appliances/pouches available.
→ One piece- one unit bag attached to an adhesive disc that applies directly to a patents
abdomen after peeling off the protective backing off the adhesive disc.
→ Two piece- wafer is separated from pouch. The bag adheres to an adhesive disc called a
wafer faceplate.
→ Wafers- some precut and some must be custom fit. Look like a tuperware seal. The face
plate is changed every 3-5 days and prn.
Ostomy appliances come in different sizes. The determine the correct size the stoma must be
measured. The stoma size is determined using a stoma device made of card stock. The card
has different sizes of holes cut out with a corresponding size. The correct size will fit around
the stoma and allow 1/8 to ¼ inch of peristomal skin to show. The appliances also come in
different sizes. Once you determine the correct size required to fit as above around the stoma,
it will be used to determined the correct flange or ostomy bag to use.
• Once the adhesive begins to loose contact with the skin, it allows the effluent to leak
underneath the face plate, which can create excoriation of the skin.
• If leakage continues unheeded, infection and or ulceration can occur. Sealant or paste-
create a seal.
• Closure- clip or clamp.

3. Ostomy Care
• Wash hands.
• Don gloves.
• Remove old appliance.
• Note effluent (drainage)- colour, amount, and odour.
• Drain effluent into commode.
• Discard old appliance into biohazard bag.
Ostomy Appliances
• The ostomy bag should be emptied when 1/3 to ½ half full to prevent leakage and odour.
• Most bags have a drain on the bottom edge of the bag that can be opened and emptied.
• Some patients prefer to change the bag, others empty and rinse with cool water, dry and
reapply.
• Ostomy supplies are expensive
Ostomy Care
Assessing initial post-operative stoma:
• Initially post-op stoma will be edematous and may have small amount of bleeding.
Monitor for post-operative complications:
• Excessive bleeding.
• Stoma dark in colour or blanched due to lack of blood supply.
• Drying of stoma.
• Signs of infection.
• May shrink 2-3 weeks post surgery. May take 4-6 weeks to determine stoma size.
Stoma assessment:
• Stoma should be pink to red and moist. Pallor, cyanosis or dusky color indicates poor blood
supply. Black indicates necrosis.
• Initially there may be some edema.
• Assess for cuts, ulcerations, or any abnormal findings.
• Assess skin around stoma.
• Note any redness or irritation.
Challenges
• Excoriation – chemical injury of the skin due to the enzymes .
• Numerous products are available Skin breakdown is a major challenge due to the enzymes
in the stool.
Nursing Implications
• Wash stoma and skin around stoma with soap and water and pat dry.
• Apply skin barrier substance (karaya powder, skin prep).
• Enterostomal therapist-nurse who specializes in care of ostomies.
Application of appliance
• Application depends on the type of appliance used.
• Pre-cut-appropriate size is chosen and then applied.
• Custom fit-use an ostomy guide to cut the opening on the wafer 1/16 to 1/8 larger than
stoma.

4. • Key is to fit appliance around the stoma without touching stoma or exposing surrounding
skin.
• One piece system - use skin sealant.
• Two piece system - use paste.
• Appliance chosen depends on the type of ostomy, stoma shape, location of stoma. (Trial and
error).
• May reinforce appliance with non-allergic paper tape in picture frame.
• May wear an ostomy belt.
• Roll end of pouch upward once and apply clip/clamp.
• Be sure clam is snug.
Assessment of Ostomy
• GI assessment of patient.
• Assess bowel sounds in all 4 quadrants.
• Assess effluent from ostomy.
• Empty pouch when 1/3-1/2 full.
• Assess abdomen.
• Report any abnormal findings immediately.
• Bowel sounds and activity by day 3.
Ostomy Care
Management of ostomy:
• Ostomy should be pink & moist.
• Skin should be clean, dry, & intact.
• Assess for s/s of redness or irritation.
• New appliances should adhere to skin without wrinkles or gaps.
Colostomy Irrigation
• Is similar to an enema.
• Colostomies may be irrigated to evacuate due to constipation.
• May be ordered post op for stomas located in the descending colon.
• When irrigating a descending or sigmoid colostomy the goal is to train the ostomy to
evacuate the same time every day.
• Requires Dr. order.
Procedure:
• Remove appliance.
• Place irrigation sleeve over stoma.
• Instill lubricated cone into stoma.
• Insert catheter into cone.
• Instill 500cc-1000cc tap water or saline.
• Start with 500cc over 5-10 minutes.