OSTOMIES

LESSON
LEARNING OBJECTIVES
1. Enumerate medical conditions for creating ostomies.

2. Differentiate the major types of ostomies.

3. Know the correct use of various products for colostomy care.

4. Outline the purposes of colostomy care.

5. Perform colostomy care correctly.

6. Provide patient education for patients with colostomy.

 An ostomy, by definition, is an artificial opening. The site of the
opening is called a stoma. Ostomies can be created because of
trauma to the intestines, severe inflammation, or diseases such
as cancer that involve part of the intestine.
OSTOMIES They can be temporary or permanent, depending on the reason
they are present, and the characteristics of the fecal material vary
according to where the ostomy is located along the intestine.
Fecal material in the ileum is liquid, and fecal matter in the
rectum is solid.
ILEOSTOMY
An ileostomy is an opening in the ileum. An
ileostomy is needed when the entire colon needs
to be removed or bypassed, as in cases of
congenital defects, cancer, inflammatory bowel
disease, or bowel trauma.
COLOSTOMY
A colostomy is the surgical creation of a stoma on
the abdominal wall to where the colon is normally
attached. The colostomy then diverts stool
through the stoma. The procedure is performed
for patients with cancer of the colon, intestinal
obstructions, intestinal trauma, or inflammatory
diseases of the colon.
UROSTOMY
A urostomy is the diversion of
urine away from a diseased or
defective bladder through a
surgically created opening or
stoma in the skin. This may be
necessary in the presence of
a congenital anomaly or when
the bladder must be removed
because of disease, trauma,
or obstruction.
COLOSTOMY CARE
To be able to provide optimal colostomy care, it Is important for the nurse to know the correct use
of various products used for colostomy care and to educate the patient about appropriate care
and use of these products.

Purposes:

1. To assess and care for the peristomal skin.

2. To collect stool for assessment of the amount and type of output.

3. To minimize odors for the client’s comfort and self-esteem.

 COLOSTOMY CARE
Assessment:
1. Assess the type of ostomy and its placement in the abdomen.
2. The type and size of appliance and the special barrier substance applied to the skin.
3. Color of the stoma. It should appear reddish-pink and slightly moist. A dusky, blueish color indicates impaired
blood circulation to the area. Notify surgeon immediately.
4. Size and shape . Most stomas protrude slightly from the abdomen.
5. Assess for stomal bleeding. A new stoma may have a slight bleeding, which is normal, but other bleeding should
be reported.
6. Assess amount and type of feces. Assess color, odor, and consistency.
7. Assess for complaints of burning sensation under the skin, which may indicate skin breakdown. Presence of
abdominal discomfort / distention needs to be reported.
PLANNING
Review features of the appliance to ensure that all parts are present and are functioning correctly.

Equipment needed:

- Clean gloves.

- Bed pan.

- Moisture-proof bags, for disposable pouches,

- Cleaning materials (warm water, mild soap, wash cloth).

PLANNING
Review features of the appliance to ensure that all
parts are present and are functioning correctly.
Equipment needed:
- Tissue or gauze pad.
- Skin barrier paste / skin sealant wipes.
- Stoma measuring guide.
- Scissors.
- Tail closure clamp.
COLOSTOMY CARE
One-pouch systems have a skin barrier (wafer) that is pre-
attached to the pouch; two-piece systems have a pouch that is
separate from the water. Some skin barriers are precut,
whereas others must be cut to fit the stoma. When skin
barriers are cut to fit the stoma, the nurse should ensure that
the ostomy appliance opening is small enough to form a proper
seal.

An ill-fitting appliance can cause a pressure sore and can lead

to gangrene.
PERFORMANCE
1. Refer to patient’s record / nursing care plan for special interventions. Rationale: Provides basis for care.

2. Assemble equipment. Rationale: Organizes procedure, saves time and effort.

3. Introduce self. Rationale: Reduces patient’s anxiety.

4. Identify patient using two identifier. Rationale: Ensures procedure is performed with the correct patient.

5. Explain procedure. Rationale: Ensures cooperation from patient.

6. Perform hand hygiene. Rationale: Reduces spread of microorganism.

7. Prepare patient for intervention. Provide privacy and adjust bed level for safe working height. Rationale: Promotes
good body mechanics.

8. Position patient comfortably in a supine position.

PERFORMANCE
9. Don gloves and carefully remove wafer seal from skin. Adhesive solvent can be used. Rationale:
Reduces trauma, jerking irritates the skin and sometimes cause skin tearing.

10. Place a reusable pouch in bed pan or disposable pouch in plastic bag. Rationale: Reduces the
transmission of microorganism.

11. Cleanse skin around the stoma with warm water and mild soap; pat dry.

12. Measure stoma opening using the measuring guide. Rationale: To ensure proper fit.

13. Place tissue over stoma, use gauze for ileostomy. Rationale: Prevents expelled stool from
leaking during the procedure. If skin sealant is to be used, apply to skin and allow to dry.
 PERFORMANCE
14. Apply protective skin barrier about 1/16 inch from stoma. Rationale:
Decreases chance of skin irritation.

15. Cut out the traced stoma pattern to make an opening.

16. Remove the backing to expose the sticky, adhesive side.

For a one-piece pouching system, center the one-piece skin barrier

and pouch over the stoma and gently press it on the client’s skin for 30
seconds.

For a two-piece pouching system, center the skin barrier over the
stoma, and gently press it onto the client’s skin for 30 seconds. Then, snap
the pouch onto the flange or skin barrier wafer.
PERFORMANCE
17. For drainable pouches, drain the pouch according to the manufacturer’s directions.

18. Document the procedure.

Document the date and time, the type of pouch used, amount and appearance of feces,
condition of stoma, peristomal skin, and patient teaching.
 VARIATION: EMPTYING
A DRAINABLE POUCH
• Empty the pouch when it is one third to one half full of stool or gas.
Rationale: Emptying before it is overfull helps avoid breaking the seal with
the skin and prevent the skin from coming in contact with the stool.

• While wearing gloves, hold the pouch outlet over the bedpan or toilet. Lift
the lower edge up.

• Unclamp or unseal the pouch.

• Drain the pouch. Loosen feces from sides by moving fingers down the
pouch.

• Clean the inside of the tail of the pouch with a tissue or a premoistened
towelette.
 VARIATION:
EMPTYING A
DRAINABLE
POUCH

• Apply the clamp or seal the

pouch.
• Dispose of used supplies.
• Remove and discard gloves.
• Perform hand hygiene.
• Document the amount,
consistency, and color of
stool.
COLOSTOMY
IRRIGATION
Colostomy irrigation is sometimes used to maintain a regular elimination
pattern.

For colostomy irrigation, patient needs a cone-tipped irrigation

device, an irrigation sleeve, and irrigation solution.

Patient places the cone-tipped irrigation device to the stoma from the
sleeve. The sleeve is used to contain the drainage from the stoma as it
passes into the commode.

Approximately 500 to 1000 mL is slowly instilled into the stoma and

the patient must sit on the commode while it drains out.

Note: If patient complains of cramping, stop the flow without removing

the cone until cramps subside.
COLOSTOMY IRRIGATION
After all solution is instilled, remove the cone and close top of sleeve to prevent spillage of feces.

Instruct the patient to remain seated about 15 to 20 minutes while the returning solution flows into
the toilet.

Drain the sleeve, rinse and remove it. Some irrigation sleeves are reusable.

Observe patient and results of irrigation.

Perform care around peri stomal site.

Document the following; date and time, solution used, amount of solution, results, and
observations.
REFERENCES
Cooper, Kim et. Al

Foundations of Nursing, 7th Edition, Mosby 2015

Berman, Audrey et. Al

Kozier & Erb’s Fundamentals of Nursing, Concept, Process, and Practice Volume 2 10th Edition,
Pearson 2018

Nutrition For Nursing, 4th edition Content Mastery Series Module

American Technical Institute for Nursing Education 2010

LEARNING ACTIVITY
1. Watch the uploaded video clips; Inserting an NG
Feeding Tube, Nasogastric Tube Feeding, Ostomy Bag
Pouch Change.
2. Group case presentation based on clinical scenario