BOWEL DIVERSION OSTOMY

Prepared by:

DR. IRENE ROCO

Asst. Professor

Outline

Definition of Bowel Diversion Ostomy

Purpose

Classification

a. status

b. Anatomic location

c. surgical construction

Ostomy Management

Assessment

Ostomy change

References

Definition

OSTOMY – an opening for the gastrointestinal, urinary, or respiratory tract into the skin

• Divert and drain fecal material

PURPOSE

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

1. Status

a. Permanent – to provide means of elimination when the rectum

or anus is non functional ( birth defect / cancer)

b. Temporary – for traumatic injuries or inflammatory conditions

of the bowel, allowing the bowel to rest and heal

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

2. Anatomical location - influences the character and management of fecal drainage • The farther along the bowel, The length of time, the more formed

the stool and the more control over the frequency of stomal discharge can be established

TYPES OF INTESTINAL OSTOMY:

1. Gastrostomy – opening through the abdominal wall in the stomach

2. Jejunostomy - opening through the abdominal wall in the jejunum

3. Ileostomy - opening through the abdominal wall in the ileum

4. Colostomy - opening through the abdominal wall in the colon

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

Type of drainage Nursing Responsibility

Ileostomy / ascending colostomy

Liquid fecal drainage; no control

Instruct Client to wear appliance continuously and take special precautions to prevent skin breakdownOdor is minimal because fewer bacteria are present

Transverse colostomy

Malodorous, mushy drainage ; liquid has been reabsorbed; no control

Descending colostomy

Solid fecal drainage

sigmoidostomy

Normal or formed consistency ; can be controlled

Client may not have to wear appliance at all times

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

3. Construction of the stoma

a. single – one end of the bowel is brought out through an abdominal opening

b. Loop – loop of bowel is brought into the abdominal wall and supported by a plastic bridge , or a piece of rubber tubing; has two openings (proximal and distal)

CLASSIFICATION OF BOWEL DIVERSION OSTOMIES

3. Construction of the stoma

c. Divided colostomy – two edges of bowel brought out into the abdomen but separated from each other

d. Double barrel - proximal and distal loops of bowel are sutured together for about 10 cm and both ends are brought up into the abdominal wall

Divided colostomy –

Double barrel

OSTOMY APPLIANCE

Consist of :

• skin barrier

• Pouch – can be closed or dainable

• Adjustable Ostomy belt

Consists of group of nursing interventions that may be necessary after fecal diversion surgery

• Stoma assessment

• Application of stoma to collect feces and protect skin

• Promotion of self care

OSTOMY MANAGEMENT

AssessmentAssess for: Normal Abnormal

Color Healthy pink, red and slightly moist

Dusky pink / bluish (cyanosis) suggest inadequate circulation to the stoma

Size and shape

New stoma are swollen; swelling decreases in 2-3 weeks or as long as 6 weeks Protrude slightly from the abdomen

Failure to recede may indicate blockage

Position Must remain on the abdominal surface

If stoma retracts, feces may enter the abdominal cavity and cause peritonitis; Prolapse must be reported to the doctor

Stomal bleeding

Slight bleeding Report other bleeding

Complaints Burning sensation under the skin may indicate skin breakdownAbdominal discomfort / distention

OSTOMY CHANGE

• Can be applied for up to 7 days

• Twice a week

• Change whenever the stool leaks onto the peristomal skin

• Every 24 – 48 hrs if the skin is erythematous, eroded, denuded or ulcerated

• More frequent changes if client complains of pain or discomfort

• The pouch is emptied when it is one third to one half full

• If the pouch overfills, it can cause separation of the skin barrier and stool comes in contact with the skin

PURPOSE OF OSTOMY CHANGE

• To assess and care for peristomal skin

• To collect stool for assessment of the amount and type of output

• Minimize odors for the client’s comfort and self esteem

References

• Kozier & Erbs’ Fundamentals of Nursing . Eighth ed. 2008

• Potter Perry. Basic Nursing 6th ed..Mosby, Missouri, 2006.