CARE OF OSTOMIES PREPARED BY : CHRISTIAN RAVEINA

DEFINITION

• An ostomy is a surgically made opening from the inside of an organ to the outside. The stoma is the part of the ostomy attached to the skin. A stoma bag is then attached to the opening, in the case of colostomies, ileostomies , jejunostomy & gastrostomy

OSTOMIES • Colostomy - opening from the large intestine to the

abdominal wall so faeces bypass the anal canal.• Ileostomy - opening from the small intestine to the

abdominal wall so faeces bypass the large intestine and the anal canal.• Gastrostomy and jejunostomy - openings between the

stomach and jejunum respectively and the abdominal wall, used predominantly for enteral feeding tubes.

FEATURES OF A HEALTHY STOMA

• When inspecting a stoma the presence of the following indicates a healthy stoma:• Stoma should be above the skin level.• Red and moist stoma (pallor may suggest anaemia; dark hue

may represent ischaemia).• No separation between the mucocutaneous edge and the skin.• No evidence of erythema, rash, ulceration or inflammation in

the surrounding skin.

CARE OF PATIENT WITH OSTOMIES

IRREGULAR BOWEL ACTION

• Emotional states especially fear & anxiety cause irregular bowel movements • Wearing a colostomy bag over the stoma ,helps to collect

the faeces which can be cleaned at a convenient place & time • The patient should find out what is agreeable & what is

disagreeable to him 7 thereafter regulate his diet • Irrigation is done at same time to establish a habit

DIARRHOEA WITH FLUID & ELECTROLYTE IMBALANCE• The patient with the colostomy are more prone for diarrhoea

therefore avoid those factor that precipitate an attack of diarrhoea• Patients with wet colostomy are prone to electrolyte imbalance

they should be encouraged for adequate fluid intake• Do not irrigate the colostomy when the patient develops diarrhoea

but patient has ingested irritant food ,colostomy irrigation may help

FAECAL IMPACTION & OBSTRUCTION • Faecal impaction may occur if the patient is having a sigmoid

colostomy & it becomes difficult to evacuate the bowel . A dietary regulation may prevent such complication

• Regulation of bowel with irrigations will prevent such problems • Oil instilled directly into the stoma at bed time or several hours

before irrigation will usually help to evacuate the bowel• Be careful to introduce only a small amount ( 5 to 10 ml ) of oil into

the stoma or oil will leak after the irrigation

FLATULENCE FORMATION IN THE INTESTINE & FOUL SMELL ON ITS EXPULSION• Odour proof disposable bags with charcol filter discs are

available for use • The patient has to avoid the foods which may produce the

gas• Swallowing of air cause flatulence .patient should be

instructed to eat food slowly • Charcol & antacid may help to relieve the flatulence

EXCORIATION OF SKIN

• Digestive juice irritate the skin therefore prevent the contact of stool with stoma

• The stool should be emptied at frequent intervals through the opening at the bottom of the bag

• A protective ointment such as zinc oxide or petroleum jelly applied around the opening

• Application of Tr. Banzoin may help to keep up integrity of the skin • The skin should be washed with soap & water & the dressing

should be changed as often as necessary to prevent the skin irritation

PSYCHOLOGICAL PROBLEM

• Patient instruction • They may be given a chance with the another patient with

a colostomy • Constant encouragement & teaching

THANK YOU…