DEFINITION OF TERMS:

1. OSTOMY- is surgery to create an opening (stoma) from an area inside the body to
the outside.

2. GASTROSTOMY- is a surgical procedure in which an opening is created into the

stomach for the purpose of administering foods and fluids via tube.
3. STOMA - the opening created in the abdominal wall by ostomy.

4. PERIOSTOMAL SKIN - the area of skin surrounding a stoma in the abdominal wall.

PURPOSE OF GASTROSTOMY
PURPOSE RATIONALE
1. provide route for feeding. - alternative method for feeding.

2. administer medications directly - Alternative method of feeding

GI tract.

3. to remove fluid and gas from GIT - Prevent bloating of the stomach
thus reducing pressure within
stomach.

4. to prevent nausea, vomiting and - It can drain gastric secretions.

gastric distention.

5. to restore or maintain nutritional

status. - It is another way of giving
correct nutrition.

INDICATIONS OF GASTROSTOMY
INDICATIONS RATIONALE

1. patient with head and neck - Prevention of further

trauma. complications.

2. patient with injuries in mouth and

throat. - unable to tolerate adequate oral
intake.
 3. stroke patient
- neurological dysphagia occurs
4. patient with oral or esophageal
cancer. - since swallowing can’t be
tolerated.
5. Chronic unresolved
gastrointestinal stenosis or ileus. - to drain gastric secretions and
resolve persistent nausea and
vomiting

CONTRAINDICATIONS OF GASTROSTOMY
CONTRAINDICATIONS RATIONALE
1. obstruction of GIT -Cannot provide adequate
nutrition.

2. previous abdominal surgery - to prevent further injury

3. ascites - due to concerns regarding

ascitic fluid leakage.

4. pregnancy - potential risks of uterine and

fetal injury.

COMPLICATIONS OF GASTROSTOMY
 wound infection  periostomal leakage
 aspiration  peritonitis
 septicemia  cellulites
 hemorrhage  fluid and electrolyte imbalance
 tube dislodgement  cramping

GUIDELINES IN THE CARE MANAGEMENT OF PATIENTS WITH

GASTROSTOMY
1. Do medical hand washing.
2. Position patient in a semi-Fowlers.
3. Inspect the skin surrounding the insertion site for healing, redness, swelling and
the presence of any drainage.
4. Assess the abdomen for distention, bowel sounds and tenderness.
5. After the introduction of gastroscope into the oral cavity of the patient is asked to
do a swallowing movement that facilitates the promotion of the device into the
esophagus.
6. In order to suppress the gag reflex patient should be observed calm deep
breathing.
7. until the stoma is well healed, use sterile technique for dressing changes and site
care.
8. wearing clean gloves, remove old dressing. Cleanse the site with saline or soap
and water and rinse appropriate. Pat dry with 4x4 gauze pads and allow to air dry.
9. redress the wound using a stoma dressing or folded 4x4 gauze pads.
 10. irrigate the tube with 30-60 ml water, and clean the tube
inside and out as indicated or ordered.
11. provide mouth care or remind patient to do so.

PRINCIPLES INVOVLED IN THE CARE MANAGEMENT OF PATIENTS WITH

GASTROTOMY

Anatomy and Physiology

 it determines the involved human parts and their function and its passageway in
the procedure.
Chemistry
 it involves in giving medication about the proper amount and mixing of the
medications given.
Microbiology
 it involves in wearing gloves in the procedure and to show a clean technique to
avoid contamination of bacteria.
Body Mechanics
 the nurse must observe the proper body mechanics to avoid musculoskeletal
strain.
Time and Energy
 to conserve time and energy in the doing the procedure.

NURSING RESPONSIBILITIES IN GASTROSTOMY FEEDING

BEFORE:
 check the patient’s chart
 explain procedure to the patient
 prepare all necessary equipment
 wash hands
 provide patient privacy
 prepare warm food
 check for residual gastric content
 let patient taste, smell and chew food
 place patient in an upright or semi-fowlers position
 check for tube patency

DURING:
 expose the insertion site
 remove the small dressing attached to the tip of gastrostomy tube and kink tube
 check the patency of the tube
 attach syringe to the tube then kink again as you get the asepto bulb infuse
feeding.
 hold the syringe 3-6 inches above the insertion site
 fill syringe with feeding and allow to flow into gastrostomy tube
 follow the medication, then water for flushing (30-60 ml water)
 do not allow syringe to empty until feeding water infusion are completed
 . clamp or put a small dressing secured with a rubber band in the gastrostomy
tube
 remain patient in semi-Fowlers position

AFTER:
 wash hands
 do after care
 documents all assessment and interventions

CARE MANAGEMENT OF PATIENTS WITH GASTROSTOMY

 check the tube daily
 keep the hub of the tube clean
 routine skin care
 wound care
 nutritional support
 clean the stoma site with sterile saline
 dry the area with gauze
 provide oral care