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COLOSTOMY CARE

At the end of the lecture, the students will be able to:

Identify the indications for colostomy and the different types of colostomies.

Explain the importance of colostomy care and the steps in colostomy care.

Summarize the risks associated with a colostomy.

Explain the importance of improving care coordination among the inter-professional team to enhance the delivery of care for patients with a colostomy.

At the end of the lecture, the students will be able to:

Identify the indications for colostomy and the different types of colostomies.

Explain the importance of colostomy care and the steps in colostomy care.

Summarize the risks associated with a colostomy.

Explain the importance of improving care coordination among the inter-professional team to enhance the delivery of care for patients with a colostomy.

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COLOSTOMY CARE

  1. 1. COLOSTOMY CARE By Rommel Luis C. Israel III
  2. 2. LEARNING OBJECTIVE At the end of the lecture, the students will be able to: • Identify the indications for colostomy and the different types of colostomies. • Explain the importance of colostomy care and the steps in colostomy care. • Summarize the risks associated with a colostomy. • Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with a colostomy.
  3. 3. THE TAKE AWAY • Together your small and large intestines are about 15 feet or more in length. • According to a 2014 study Trusted Source, the total surface area of your intestines is about half the size of a badminton court. • Your intestines have the very important job of helping to break down and absorb nutrients from what you eat and drink. Once these nutrients are absorbed, they can be delivered via the bloodstream to the rest of your body. Source: Seladi-Schulman, J 2019, How Long Are Your Intestines? Length of Small and Large Intestines, Healthline, viewed 24 February 2022, https://www.healthline.com/health/digestive-health/how-long-are-your-intestines#large-intestines-length .
  4. 4. HOW THE DIGESTIVE SYSTEM WORKS Source: Bryce, E 2017, How your digestive system works - Emma Bryce, YouTube, viewed 24 February 2022, https://www.youtube.com/watch?v=Og5xAdC8EUI . Click the picture to watch the video Copy-paste the link below to watch the video online
  5. 5. ANATOMY OF THE SMALL AND LARGE INTESTINES Source: Organs of the Body. Image of the Small and Large Intestines, www.organsofthebody.com/small-intestine/ . Accessed 22 Feb. 2022.
  6. 6. 3 MAJOR PARTS OF SMALL INTESTINES 1. DUODENUM • the first and shortest segment of the small bowel • connects the stomach to the jejunum. • this C-shaped hollow tube measures around a foot or sometimes 15 inches in length. • it receives food from the stomach in the form of chyme and mixes it with bile juice and the pancreatic secretions. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ .
  7. 7. 3 MAJOR PARTS OF SMALL INTESTINES 1. DUODENUM • It neutralizes the partially digested food with the help of alkaline mucus containing a high concentration of bicarbonate ions. • The mucus is secreted by the Brunner’s glands present only in the duodenum. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ . Image: Cabrera, Carlos León. Brunner’s Gland, 29 Aug. 2017, twitter.com/ilovepathology1/status/902278556725731336. Accessed 22 Feb. 2022.
  8. 8. 3 MAJOR PARTS OF SMALL INTESTINES 1. DUODENUM • The enzymatic secretions help in the digestion of carbohydrates, proteins and fats. - the process of chemical digestion that started in mouth gets completed here. • It also prepares food for absorption in jejunum. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ . Image: Christiansen, Sherry. Duodenum, 19 Mar. 2020, www.verywellhealth.com/duodenum-anatomy-4780308 . Accessed 22 Feb. 2022.
  9. 9. 3 MAJOR PARTS OF SMALL INTESTINES 2. JEJUNUM • It is the second or middle part of the small intestine. • It is longer than duodenum and shorter than ileum. • Measuring around 8 feet, the duodenum is as many as 8 times longer than the duodenum. • While duodenum carries out and completes the chemical digestion, jejunum is the principle site for the absorption of nutrients from the digested food. This is the place where over 90% absorption of the foodstuffs takes place. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ .
  10. 10. 3 MAJOR PARTS OF SMALL INTESTINES 2. JEJUNUM • Nutrients move across the epithelium of jejunum and ileum. • It absorbs nutrients (vitamins, minerals, carbohydrates, fats, proteins) and water from food so they can be used by the body. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ . Image: Cleveland Clinic. 20 Mar. 2019, my.clevelandclinic.org/health/diseases/15850-small-bowel-obstruction. Accessed 22 Feb. 2022.
  11. 11. 3 MAJOR PARTS OF SMALL INTESTINES 3. ILEUM • It is the third and longest segment of small bowel. • It runs for the length of 12 feet, accounting for three-fifths the length of the small bowel. • Continuous with the jejunum, it ends at the ileocecal valve ( a sphincter muscle) which separates it from the cecum. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ . Image: Cleveland Clinic. 20 Mar. 2019, my.clevelandclinic.org/health/diseases/15850-small-bowel-obstruction. Accessed 22 Feb. 2022. Silva, Alvin, et al. Drawings Illustrate the Anatomic Structures of the Terminal Ileum, ICV, Cecum, and Appendix. M. = Muscle., 1 July 2007, pubs.rsna.org/doi/full/10.1148/rg.274065164. Accessed 22 Feb. 2022.
  12. 12. 3 MAJOR PARTS OF SMALL INTESTINES 3. ILEUM • It contains receptors for absorption of vitamin B12 and bile salts. • It reabsorbs about 95% of the conjugated bile salts (that act as detergents, emulsifying large fat droplets into small ones) and reused by the liver by the process of enterohepatic circulation. - Fat emulsification is the process of increasing the surface area of fats in the small intestine by grouping them into small clusters. This is the responsibility of bile, a liquid created by the liver and stored in the gallbladder. Actual digestion of the fats is then accomplished by lipase, an enzyme from the pancreas. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ . Kester, J. E. “Liver.” ScienceDirect, Academic Press, 1 Jan. 2014, www.sciencedirect.com/science/article/pii/B9780123864543006291 . Accessed 22 Feb. 2022.
  13. 13. 3 MAJOR PARTS OF SMALL INTESTINES 3. ILEUM • It has bundles or patches (around 30 to 40) of lymphatic cells called Peyer’s patches. - Peyer’s patches have B and T cells similar to those found in the peripheral lymph nodes. So, they are said to play a role in the generation of immunologic response in the body. Source: “Small Intestine Function, Location, Parts, Diseases & Facts.” Organsofthebody.com, 2011, www.organsofthebody.com/small-intestine/ .
  14. 14. LARGE INTESTINES Source: Phillips, Michael, et al. “Large Intestine (Colon): MedlinePlus Medical Encyclopedia Image.” Medlineplus.gov, 23 Apr. 2021, medlineplus.gov/ency/imagepages/19220.htm. Accessed 22 Feb. 2022. Image: Phillips, Michael, et al. Large Intestine, 23 Apr. 2021, medlineplus.gov/ency/imagepages/19220.htm. Accessed 22 Feb. 2022. • It is most responsible for the absorption of water from the indigestible residue of food. • The ileocecal valve of the ileum (small intestine) passes material into the large intestine at the cecum. • Material passes through the ascending, transverse, descending and sigmoid portions of the colon, and finally into the rectum. • From the rectum, the waste is expelled from the body.
  15. 15. LARGE INTESTINE • It is about 5 feet long • Most of the bacteria that live in your body—and there are billions of them—live inside your large intestine. • The good bacteria that live in your colon are called your normal flora. They help prevent bad bacteria from multiplying and causing problems. • Bacteria also help break down fiber. This is an important part of your diet that contributes to digestive health by preventing constipation. • Normal bacterial flora also secrete vitamin K and vitamin B that you can absorb. • The gas that you produce is the result of the hard-working normal flora in your colon. Source: “The Digestive Process: The Large Intestine | University Hospitals.” Www.uhhospitals.org, 2021, www.uhhospitals.org/health-information/health- and-wellness-library/article/adult-diseases-and-conditions-v1/the-digestive-process-the-large-intestine . Accessed 22 Feb. 2022.
  16. 16. 8 PARTS OF THE LARGE INTESTINE 1. Cecum - Digested food from the small intestine goes into this pouch. The appendix hangs off the end of the cecum. 2. Ascending colon - This segment extends along the right side of the abdomen. It's about 9 inches long. 3. Hepatic flexure - In the upper right part of the abdomen, under the liver, this part of the large intestine makes a turn to the left. Source: “The Digestive Process: The Large Intestine | University Hospitals.” Www.uhhospitals.org, 2021, www.uhhospitals.org/health-information/health- and-wellness-library/article/adult-diseases-and-conditions-v1/the-digestive-process-the-large-intestine . Accessed 22 Feb. 2022. Image: Kilgore, Lon. The Gastrointestinal System: The Large Intestine, 7 May 2021, www.crossfit.com/essentials/the-gastrointestinal-system-the-large- intestine . Accessed 22 Feb. 2022.
  17. 17. 8 PARTS OF THE LARGE INTESTINE 4. Transverse colon - It travels across the upper part of the abdomen, from right to left. 5. Splenic flexure - In the left upper side of the abdomen, the large intestine is located under the spleen. At this flexure, the large intestine turns downward. Source: “The Digestive Process: The Large Intestine | University Hospitals.” Www.uhhospitals.org, 2021, www.uhhospitals.org/health-information/health- and-wellness-library/article/adult-diseases-and-conditions-v1/the-digestive-process-the-large-intestine . Accessed 22 Feb. 2022. Image: Kilgore, Lon. The Gastrointestinal System: The Large Intestine, 7 May 2021, www.crossfit.com/essentials/the-gastrointestinal-system-the-large- intestine . Accessed 22 Feb. 2022.
  18. 18. 8 PARTS OF THE LARGE INTESTINE 6. Descending colon - In the left side of the abdomen, the large intestine descends for about 5 inches. 7. Recto-sigmoid colon - This part is about 5 inches long and leads into the rectum. Source: “The Digestive Process: The Large Intestine | University Hospitals.” Www.uhhospitals.org, 2021, www.uhhospitals.org/health-information/health- and-wellness-library/article/adult-diseases-and-conditions-v1/the-digestive-process-the-large-intestine . Accessed 22 Feb. 2022. Image: Kilgore, Lon. The Gastrointestinal System: The Large Intestine, 7 May 2021, www.crossfit.com/essentials/the-gastrointestinal-system-the-large- intestine . Accessed 22 Feb. 2022.
  19. 19. 8 PARTS OF THE LARGE INTESTINE 8. Rectum - This part of the large intestine stores stool. - It's about 6 to 8 inches long and leads to the anal canal. Source: “The Digestive Process: The Large Intestine | University Hospitals.” Www.uhhospitals.org, 2021, www.uhhospitals.org/health-information/health- and-wellness-library/article/adult-diseases-and-conditions-v1/the-digestive-process-the-large-intestine . Accessed 22 Feb. 2022. Image: Kilgore, Lon. The Gastrointestinal System: The Large Intestine, 7 May 2021, www.crossfit.com/essentials/the-gastrointestinal-system-the-large- intestine . Accessed 22 Feb. 2022.
  20. 20. WHAT IS AN OSTOMY? • Causes a change in the way urine or stool exits the body as a result of a surgical procedure. • Bodily waste is rerouted from its usual path because of malfunctioning parts of the urinary or digestive system. • An ostomy can be temporary or permanent. Source: “What Is an Ostomy? L United Ostomy Associations of America.” United Ostomy Associations of America, 2017, www.ostomy.org/what-is- an-ostomy/ . Accessed 22 Feb. 2022. Image: What Is Ostomy? www.ostomy.org/what-is-an-ostomy/ . Accessed 22 Feb. 2022.
  21. 21. WHAT IS A STOMA? • It is the opening created by ostomy surgery. • It is located on the abdomen. • It is dark pink in color. • For most ostomies, a pouch is worn over the stoma to collect stool or urine. Source: “What Is an Ostomy? L United Ostomy Associations of America.” United Ostomy Associations of America, 2017, www.ostomy.org/what-is- an-ostomy/ . Accessed 22 Feb. 2022. Image: What Is Ostomy? www.ostomy.org/what-is-an-ostomy/ . Accessed 22 Feb. 2022.
  22. 22. OSTOMY SURGERY OF THE BOWEL • It is an operation that changes the way intestinal contents leave the body when part or all of the bowel is diseased, injured, or missing. • The surgeons connect the large or small intestine to the skin on the outside of your abdomen. Source: “Ostomy Surgery of the Bowel | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, 10 May 2019, www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel . Accessed 22 Feb. 2022. Image: Healy, Marisa. Living with a Bowel Ostomy, 22 Oct. 2021, www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/living-with- a-bowel-ostomy . Accessed 22 Feb. 2022.
  23. 23. OSTOMY SURGERY OF THE BOWEL • When the connection is to the colon, it is called a colostomy. • When the connection is to the small bowel, it is called an ileostomy or a jejunostomy. Source: Healy, Marisa. “Living with a Bowel Ostomy | OncoLink.” Www.oncolink.org, 22 Oct. 2021, www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/living-with-a-bowel-ostomy. Accessed 22 Feb. 2022. Image: Healy, Marisa. Living with a Bowel Ostomy, 22 Oct. 2021, www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/living-with- a-bowel-ostomy . Accessed 22 Feb. 2022.
  24. 24. WHAT IS A COLOSTOMY? • It is a surgical procedure that brings one end of the large intestine out through the abdominal wall. • During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy .
  25. 25. PURPOSE: TEMPORARY • Colostomies are performed because of problems with the lower bowel. Some problems can be corrected by temporarily diverting stool away from the bowel-to keep stool out of the colon. Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy .
  26. 26. PURPOSE: PERMANENT • Birth defect, such as a blocked or missing anal opening, called an imperforate anus • an injury • Crohn’s disease, which is an autoimmune form of inflammatory bowel disease • colorectal cancer • colonic polyps, which is extra tissue growing inside the colon that may be cancer or may turn into cancer Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy . Colostomy n.d., www.hopkinsmedicine.org .
  27. 27. PURPOSE: PERMANENT • diverticulitis, which occurs when small pouches in your digestive system, called diverticula, become infected or inflamed • imperforate anus or other birth defects • irritable bowel syndrome, which is a condition affecting the colon that causes diarrhea, bloating, constipation, and pain in the abdominal area • ulcerative colitis, which is an inflammatory bowel disease that causes the long-term inflammation of the digestive tract Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy .
  28. 28. NURSING DIAGNOSIS • Risk for Impaired Skin Integrity • Disturbed Body Image • Acute Pain • Impaired Skin Integrity • Deficient Fluid Volume • Risk for Imbalanced Nutrition: Less Than Body Requirements • Risk for Sexual Dysfunction • Disturbed Sleep Pattern • Risk for Constipation or Diarrhea • Deficient Knowledge Source: Vera, M 2012, 10 Ileostomy and Colostomy Nursing Care Plans, Nurseslabs, viewed 24 February 2022, https://nurseslabs.com/10- ileostomy-colostomy-nursing-care-plans/?fbclid=IwAR0XWMqiJb5BKvJgAadv9cKOBnh8pJPEwEZqTkP5B0u6sZLAaXsRO7mNbBA
  29. 29. PLANNING PHYSIOLOGIC • Patient will achieve optimal bowel function without complications • . Patient's wound will heal with no sign of infection PSYCHOLOGIC • Patient will demonstrate a level of acceptance of modified lifestyle. COGNITIVE • Patient/primary care person will demonstrate Independence with ostomy care
  30. 30. RISK OF A COLOSTOMY • Allergic Reaction to anaesthesia • Excessive bleeding • a blockage of the colostomy • damage to other organs • a hernia, which occurs when an internal organ pushes through a weak area of muscle Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy .
  31. 31. RISK OF A COLOSTOMY • an infection • internal bleeding • problems from scar tissue • a prolapse of the colostomy • a wound breaking open Source: Krans, B 2012, Colostomy, Healthline, Healthline Media, viewed 24 February 2022, https://www.healthline.com/health/colostomy .
  32. 32. 4 TYPES OF COLOSTOMY 1. TRANSVERSE COLOSTOMY - it is located in the upper abdominal region, on the right side or the middle of the body - are usually performed on a temporary basis, but they may also be permanent: • Loop colostomy - results in two stomas, one that releases waste from the colon and another, called a mucus fistula, that releases mucus from the part of the colon that is still active. Source: Poruk, K 2021, Colostomy, Cancer Treatment Centers of America, COH HoldCo Inc, viewed 24 February 2022, https://www.cancercenter.com/cancer-types/colorectal- cancer/treatments/surgery/colostomy . Image: The StayWell Company, LLC 2020, What Is a Colostomy?, viewed 24 February 2022, https://www.fairview.org/patient-education/82952 .
  33. 33. 4 TYPES OF COLOSTOMY 1. TRANSVERSE COLOSTOMY Single-barrel colostomy – it is permanent, may involve the removal of the colon below the surgical site, as well as the rectum and anus. • Double-barrel colostomy - the bowel is usually divided into two parts, each with a separate opening. Similar to the loop colostomy, one releases waste and the other releases mucus. However, in some cases, only one stoma is created, and mucus leaves the body through the anus. Source: Poruk, K 2021, Colostomy, Cancer Treatment Centers of America, COH HoldCo Inc, viewed 24 February 2022, https://www.cancercenter.com/cancer-types/colorectal- cancer/treatments/surgery/colostomy . Image: Image: The StayWell Company, LLC 2020, What Is a Colostomy?, viewed 24 February 2022, https://www.fairview.org/patient-education/82952 .
  34. 34. 4 TYPES OF COLOSTOMY 2. DESCENDING COLOSTOMY - Located on the lower left side of your abdomen (or descending colon) - this stoma placement results in waste close to normal in firmness. - may be either single-barrel or double-barrel, but single-barrel is more common. Source: Poruk, K 2021, Colostomy, Cancer Treatment Centers of America, COH HoldCo Inc, viewed 24 February 2022, https://www.cancercenter.com/cancer-types/colorectal- cancer/treatments/surgery/colostomy . Image: Lualdi, SM 2021, Colostomy Diet: What Can I Eat Without Consequences, viewed 24 February 2022, https://farmoderm.it/en/colostomy-diet-guidelines/ .
  35. 35. 4 TYPES OF COLOSTOMY 3. ASCENDING COLOSTOMY - Located on the right side of the abdomen - this type of colostomy is rare. - most of the colon will likely be removed, so waste is liquid with this stoma. Source: Poruk, K 2021, Colostomy, Cancer Treatment Centers of America, COH HoldCo Inc, viewed 24 February 2022, https://www.cancercenter.com/cancer-types/colorectal- cancer/treatments/surgery/colostomy . Image: Lualdi, SM 2021, Colostomy Diet: What Can I Eat Without Consequences, viewed 24 February 2022, https://farmoderm.it/en/colostomy-diet-guidelines/ .
  36. 36. 4 TYPES OF COLOSTOMY 4. SIGMOID COLOCTOMY - Located at the bottom of the large intestine - are the most common - because of its location near the rectum, there is still some functioning colon, so the waste produced is firmer and more normal in consistency than with other colostomy types. - as with a descending colostomy, single-barrel is more common, though a double-barrel procedure is also a possibility. - a loop-sigmoid colostomy is also a possibility. Source: Poruk, K 2021, Colostomy, Cancer Treatment Centers of America, COH HoldCo Inc, viewed 24 February 2022, https://www.cancercenter.com/cancer-types/colorectal- cancer/treatments/surgery/colostomy . Image: Lualdi, SM 2021, Colostomy Diet: What Can I Eat Without Consequences, viewed 24 February 2022, https://farmoderm.it/en/colostomy-diet-guidelines/ .
  37. 37. COLOSTOMY BAG/POUCH Image: United Ostomy Associations of America n.d., COLOSTOMY AND ILEOSTOMY POUCHES, viewed 24 February 2022, https://www.ostomy.org/types-pouching- systems/ .
  38. 38. TYPES OF A COLOSTOMY POUCH (BAGS OR APPLIANCES) • The 2-piece system - consists of a base-plate attached to the skin with a removable ostomy bag. - although it is very durable and long-lasting, it requires an amount of skill to use and has a weaker adhesive and does not fit very well. On the left is a drainable pouch and on the right is a closed-end one. Pictured clockwise is a Convatec Sur-fit Natura drainable pouch with an Invisiclose tail, a closed-end pouch, and a Durahesive cut-to-fit wafer. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: ostomyoutdoors 2013, How to select ostomy pouch styles for the outdoors, viewed 24 February 2022, https://ostomyoutdoors.com/tag/two-piece-ostomy-pouch/ .
  39. 39. TYPES OF A COLOSTOMY POUCH (BAGS OR APPLIANCES) • The one-piece system - consists of a single unit wherein the skin barrier and the pouch are joined. - it is simpler to use but must be replaced every 1 to 3 days. • In a one-piece ostomy system, the wafer is permanently attached to the pouch. Because of this, swapping out different pouch styles on the same wafer is impossible. Pictured is a Coloplast SenSura X-Pro drainable one-piece appliance (open ended). Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: ostomyoutdoors 2013, How to select ostomy pouch styles for the outdoors, viewed 24 February 2022, https://ostomyoutdoors.com/tag/two-piece-ostomy-pouch/ .
  40. 40. TYPES OF A COLOSTOMY POUCH (BAGS OR APPLIANCES) • The closed pouch system - is generally used by patients who have a constant elimination pattern and have to be discarded after a single-use On the left is a drainable pouch and on the right is a closed-end one. Pictured clockwise is a Convatec Sur-fit Natura drainable pouch with an Invisiclose tail, a closed-end pouch, and a Durahesive cut-to-fit wafer. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: ostomyoutdoors 2013, How to select ostomy pouch styles for the outdoors, viewed 24 February 2022, https://ostomyoutdoors.com/tag/two-piece-ostomy-pouch/ .
  41. 41. TYPES OF A COLOSTOMY POUCH (BAGS OR APPLIANCES) • The open-ended pouches - are also commonly used and consist of a single piece attached to the skin around the stoma with a drainable pouch and can be left attached to the skin while removing stomal content. *Generally in a colostomy, as compared to an ileostomy, a closed bag must be required, unless the content is excessively fluid, when a drainable bag may also be used. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  42. 42. SIZES OF A COLOSTOMY POUCH (BAGS OR APPLIANCES) • Larger sized bag - may be used while sleeping at night • Smaller sized bag - may be used during sexual activity or while exercising • Pediatric sized stoma bags are also available. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: https://www.dreamstime.com/close-up-top-view-transparent-colostomy-pouch-attached-to-baby-patient-ostomy-bag-filter-medical-theme-close-up-top-view- image140073408
  43. 43. STOMA CAPS • They are like lids applied over the stoma. • They may be worn by certain people like those with continent ileostomies or those who require stomal irrigation for movement at their discretion, for short intervals during the day. • They are the smallest of all the stoma pouches, hence it is classified as a cap rather than a bag. Stoma caps are a tiny, closed pouch, which have capacity to hold a very small amount of stool so they can only be worn for a very short period of time. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Mini Pouches & Stoma Caps - what are they and what are they used for? 2021, Oakmed Healthcare, viewed 24 February 2022, https://www.oakmed.co.uk/help- advice/advice-articles/mini-pouches-stoma-caps-what-are-they-and-what-are-they-used-for/ .
  44. 44. WHO ARE SUITABLE FOR STOMA CAPS? • Often ostomates who are quite petite in stature, find the mini pouches fit the contours of their bodies better than the standard or larger pouches, which can be too long and can crease into the groin area, causing discomfort. • Stoma caps are most suited to people who have an end colostomy or those people with a relatively inactive mucus fistula. • But this is not to say if you have an ileostomy or urostomy you cannot use them, this is completely personal choice. If you are interesting it trialling one, try wearing it at home first, so any accidents can be dealt with swiftly! Source: Mini Pouches & Stoma Caps - what are they and what are they used for? 2021, Oakmed Healthcare, viewed 24 February 2022, https://www.oakmed.co.uk/help- advice/advice-articles/mini-pouches-stoma-caps-what-are-they-and-what-are-they-used-for/ .
  45. 45. WHO ARE SUITABLE FOR STOMA CAPS? • Stoma caps are most suited to people who have an end colostomy or those people with a relatively inactive mucus fistula. • But this is not to say if you have an ileostomy or urostomy you cannot use them, this is completely personal choice. If you are interesting it trialling one, try wearing it at home first, so any accidents can be dealt with swiftly! Source: Mini Pouches & Stoma Caps - what are they and what are they used for? 2021, Oakmed Healthcare, viewed 24 February 2022, https://www.oakmed.co.uk/help- advice/advice-articles/mini-pouches-stoma-caps-what-are-they-and-what-are-they-used-for/ .
  46. 46. WHAT ARE THE BENEFITS OF USING A MINI POUCH OR CAP? The main benefits are for discretion. • Swimming: a smaller pouch/cap is easily concealed beneath trunks or a swimming costume. • Intimate moments: The stoma cap is still visible but can be less obtrusive. • Exercising: Moving around during high impact sports can be easier whilst wearing a stoma cap or small pouch. Stoma caps can also be combined with a stoma protector to provide a barrier and prevent injury whilst playing contact sports. • Colostomy irrigation: A stoma cap should only be worn full time if colostomy irrigation is successful and well established. Irrigation allows the bowels to be flushed and emptied via a strict irrigation regime set by the Stoma Care Nurse. This can have the advantage of enabling the person to control when their colon is emptying, meaning there is little or no need to wear a full-sized pouch. Source: Mini Pouches & Stoma Caps - what are they and what are they used for? 2021, Oakmed Healthcare, viewed 24 February 2022, https://www.oakmed.co.uk/help- advice/advice-articles/mini-pouches-stoma-caps-what-are-they-and-what-are-they-used-for/ .
  47. 47. STOMA CAPS Source: All About Stoma Caps! 2022, VeganOstomy, viewed 24 February 2022, https://www.veganostomy.ca/stoma-caps/ . A stoma cap (left) compared to a traditional “large” ostomy bag (right).
  48. 48. STOMA CARE • BEFORE THE ACTUAL SURGERY - It begins when the patient is diagnosed and informed about the possibility of stoma creation. - It requires mental health and guidance counselors to address any concerns the patient may have about their self-image and societal status. - It also requires an entero-stomal therapist to discuss with the surgeon the location of the possible creation of the stoma and to go on and mark the colostomy site in the preoperative period. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  49. 49. STOMA CARE • PREPARATION FOR SURGERY - Marking of the stoma preoperatively by an entero-stomal therapist helps to place the stoma in an appropriate location away from the beltline and away from folds of skin on the anterior abdominal wall to prevent repeated colostomy bag peel-off and leak. - A nasogastric tube may be placed in the pre or intraoperative period for bowel decompression - a Foley catheter must also be placed to keep the bladder empty to prevent intraoperative injury and also to monitor urine output, especially during emergency procedures. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  50. 50. STOMA CARE • PREPARATION FOR SURGERY - Antibiotics must be given just prior to the surgery. - For colostomy care preparation, a nurse or attendant is equipped with all the required equipment, including the appliance, the paste, and the scissors. A Macintosh sheet is placed under the patient, and gloves are worn. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  51. 51. STOMA CARE • POST-OPERATIVE - the colostomy may need dilatation and application of hyperosmotic agents like glycerine by the nursing staff so as to reduce stomal edema. - When the stoma becomes functional, generally between postoperative days 2 and 4, the colostomy will need a colostomy bag or appliance application. In the initial days, it is either done by the nursing staff or in larger hospitals, by an entero-stomal therapist. > This is done with a view to teaching patients or in case of children, their guardians, how to do it themselves at home. > They are informed about the various devices available, about the functioning of these devices, about their own colostomy and the kind of effluent that would be seen, about the complications of the stoma and the colostomy bags. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  52. 52. STOMA CARE • POST-OPERATIVE - the most important person involved in colostomy care is the patient himself. - once the patient is discharged from the hospital, they are in charge of their own colostomy care. - the patient must regularly change their colostomy bag as required and should visit the provider regularly to assess the stoma in the normal run, or in case of any complications. - as a rule, the stoma bag should be emptied when it is filled up to 1/3rd to prevent peeling off of the baseplate from the skin and leaks Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  53. 53. TECHNIQUE • The colostomy appliance should be changed every 5-7 days, depending on the appliance. - Patients generally do this themselves or with the help of the primary caregiver, or parent in case of children. - Any case of skin breakdown or skin irritation or difference in stomal appearance should be seen by a health worker. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  54. 54. TECHNIQUE Materials needed: • A new pouch (a 1-piece system, or 2-piece system that has a wafer) • A pouch clip • Scissors • A clean towel or paper towels • Stoma powder • Disposable pad (if necessary) • Skin Barrier If necessary) • Stoma paste or a ring seal • Skin wipes • A measuring card and a pen • Plastic Bag • Bed Pan • Water or special solution to clean pouch • Gauze Pad • Disposable Gloves • Deodorant for pouch (if necessary) Source: Phillips, M & Zieve, D 2020, Changing your ostomy pouch: MedlinePlus Medical Encyclopedia, medlineplus.gov, viewed 24 February 2022, https://medlineplus.gov/ency/patientinstructions/000204.htm .
  55. 55. TECHNIQUE • All supplies should be arranged • handwashing • donning of gloves • The used stoma bag should be first emptied of all content, and then the flange removed by gentle traction on the bag or flange towards the stoma with counter- traction on the skin. An adhesive remover may also be used. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  56. 56. TECHNIQUE • The stoma and parastomal area should be gently cleaned with water, dabbed rather than scrubbed, without using soap. • The stoma should be assessed and must be moist, above skin level, and pink to red in color, and the peristomal skin should be normal. Any deviation from this should be notified to the surgeon. • The stoma should be measured, or the previous measurement remembered and size should not be more than 1/16-1/8. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  57. 57. TECHNIQUE • The peristomal skin should be dried appropriately to allow good seal formation. Adhesive pastes or powders may also be applied peristomally. • The paper cover on the back of the flange is then removed with the border tape in place. It is then placed around the stoma and held in place for 1 to 2 minutes to create an adequate seal. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  58. 58. TECHNIQUE • If it is a 2-piece bag, the bag is then clipped on to the flange. A belt may be applied around the abdomen and clipped to the sides of the flange to hold it in place. • After this, safe disposal of the stoma bag. • Handwashing • Documentation of the procedure must be done. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  59. 59. TECHNIQUE • Another integral aspect of colostomy care is mental health support through a thorough assessment of the patients’ psychomotor status as to how they are coping and dealing with the stoma. • Poor body image perception, sexual dissatisfaction, and depression are common in patients with colostomies. • Reassurance, psychiatric, and behavioral counseling may be needed to alleviate these symptoms. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  60. 60. STOMA CARE- CHANGING A COLOSTOMY BAG (NURSING SKILLS) Source: Bryce, E 2017, How your digestive system works - Emma Bryce, YouTube, viewed 24 February 2022, https://www.youtube.com/watch?v=Og5xAdC8EUI . Click the picture to watch the video Copy-paste the link below to watch the video online
  61. 61. CHANGING YOUR TWO-PIECE POUCHING SYSTEM Image: Types of Pouching Systems l United Ostomy Association Of America 2021, United Ostomy Associations of America, viewed 24 February 2022, https://www.ostomy.org/types-pouching-systems/ .
  62. 62. CHANGING YOUR TWO-PIECE POUCHING SYSTEM Image: Types of Pouching Systems l United Ostomy Association Of America 2021, United Ostomy Associations of America, viewed 24 February 2022, https://www.ostomy.org/types-pouching-systems/ .
  63. 63. CHANGING TWO PIECE STOMA BAG Source: Bryce, E 2017, How your digestive system works - Emma Bryce, YouTube, viewed 24 February 2022, https://www.youtube.com/watch?v=Og5xAdC8EUI . Click the picture to watch the video Copy-paste the link below to watch the video online
  64. 64. CHANGING ONE PIECE STOMA BAG Image: Pamela & Squire, S n.d., Changing A One Piece Stoma Bag, viewed 24 February 2022, https://www.clinimed.co.uk/stoma-care/stoma-bag- changing/changing-a-one-piece-bag .
  65. 65. CHANGING ONE PIECE STOMA BAG Image: Pamela & Squire, S n.d., Changing A One Piece Stoma Bag, viewed 24 February 2022, https://www.clinimed.co.uk/stoma-care/stoma-bag- changing/changing-a-one-piece-bag .
  66. 66. CHANGING ONE PIECE STOMA BAG Image: Pamela & Squire, S n.d., Changing A One Piece Stoma Bag, viewed 24 February 2022, https://www.clinimed.co.uk/stoma-care/stoma-bag- changing/changing-a-one-piece-bag .
  67. 67. CHANGING ONE PIECE STOMA BAG Source: Bryce, E 2017, How your digestive system works - Emma Bryce, YouTube, viewed 24 February 2022, https://www.youtube.com/watch?v=Og5xAdC8EUI . Click the picture to watch the video Copy-paste the link below to watch the video online
  68. 68. HOW TO APPLY A ONE-PIECE DRAINABLE POUCHING SYSTEM Source: Bryce, E 2017, How your digestive system works - Emma Bryce, YouTube, viewed 24 February 2022, https://www.youtube.com/watch?v=Og5xAdC8EUI . Click the picture to watch the video Copy-paste the link below to watch the video online
  69. 69. COMPLICATIONS • Minor troublesome complaints of the patient include offensive smell, the repeated requirement of draining the colostomy appliance, or repeated colostomy bag leakage. • Offensive smells can be managed by stomal deodorants or deodorized colostomy bags or avoidance of food like fish, eggs, or onions that release such odors. • Repeated bag leakage can be prevented by preoperative stoma site marking and reassurance and counseling in the postoperative period. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  70. 70. COMPLICATIONS • Moderately severe complaints include pain and skin excoriation around the stomal site, stomal diarrhea, or constipation or requirement for colostomy irrigation or enemas. - Cutting pouch appliances too large exposes the peristomal skin to ileostomy output, which is rich in enzymes. The exposed stratum corneum becomes or excoriated. Excoriated skin is defined as that which has been traumatized, worn away, or abraded, often in the presence of maceration due to incontinence. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: Hollister Incorporated n.d., https://www.hollister.com/en/ostomycare/importanceofhealthyskin, viewed 24 February 2022, https://www.hollister.com/en/ostomycare/importanceofhealthyskin .
  71. 71. COMPLICATIONS • Pain and skin excoriation may be managed by application of creams around the stomal site, with the application of the right size of the cut end on the back of the baseplate to be not more than 1/16 to 1/8 larger than the diameter of the stoma to prevent contact of fecal matter with the peri-stomal skin. • Regular change of stomal appliances should be done, with the removal of the older bag with gentle pressure on the skin towards the abdomen and not with the severe force pulling the colostomy bag. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  72. 72. COMPLICATIONS • Colostomy diarrhea may be complained by the patient in case of ascending or transverse colostomies in case they are not fully explained about the nature of content expected, but stomal diarrhea may be the result of extensive resection with failure of bowel adaptation or if associated with short bowel syndrome. • It may also be due to infectious causes like bacterial overgrowth or Clostridium difficile enteritis or secretory tumors like VIPoma, carcinoid, gastrinoma or radiation enteritis or due to medical disorders like hyperthyroidism or adrenal insufficiency in which case the fluid and electrolyte balance of the patient should be restored, with the possible use of anti-diarrhoeal agents and the underlying disorder treated appropriately. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  73. 73. COMPLICATIONS • In the case of stomal constipation: - the stomal obstruction should be ruled out by checking for absent or greatly increased bowel sounds, - doing an X-ray abdomen in the anteroposterior view with the patient in the erect posture to rule out proximal obstruction or ileus. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  74. 74. COMPLICATIONS • Postoperative ileus may be present in the first few days after surgery - the colostomy should be expected to be functional within 2 to 4 days after surgery - the period of ileus may be reduced by early patient mobilization and following the ERAS (Enhanced Recovery After Surgery) protocol. * Ileus - functional obstruction of the gastrointestinal tract and especially the small intestine that is marked by the absence of peristalsis, is usually accompanied by abdominal pain, bloating, and sometimes nausea and vomiting, and typically occurs following abdominal surgery. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  75. 75. COMPLICATIONS • Inter bowel adhesions - may be a cause of obstruction in the late postoperative period. - Adhesions occur after abdominal surgery and can cause your tissues to stick together, when normally they would just move around freely. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Abdominal Adhesions: What Are They, Symptoms, Treatment 2020, Cleveland Clinic, viewed 24 February 2022, https://my.clevelandclinic.org/health/diseases/15254-abdominal-adhesions . Image: Bowel Adhesions - Clinical Features - Management 2020, TeachMeSurgery, viewed 24 February 2022, https://teachmesurgery.com/perioperative/gastrointestinal/bowel-adhesions/ .
  76. 76. COMPLICATIONS • Severe colostomy related complications include stomal gangrene - Stoma necrosis occurs when the blood flow to or from the stoma is impaired or interrupted, resulting in a change in the stoma viability or tissue death. Ischemia is most often noticed within 24 hours postoperatively. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Part 1: Assessment and Management of Stomal Complications: A Framework for Clinical Decision Making 2022, Hmpgloballearningnetwork.com, viewed 24 February 2022, https://www.hmpgloballearningnetwork.com/site/wmp/article/part-1-assessment-and-management-stomal-complications-framework-clinical-decision-making . Image: https://quizlet.com/270619321/ostomies-rectal-tubes-rectal-medications-and-enemas-flash-cards
  77. 77. COMPLICATIONS • Colostomy gangrene may be due to the disease process, if due to ischemia, involving the stoma or due to technical errors like tying the mesentery or making too narrow a defect in the rectus fascia, causing obstruction of the blood supply to the stoma. - This should be managed by re-exploration and new stoma creation after resection of the diseased bowel. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  78. 78. COMPLICATIONS • Stomal retraction - is generally detected when the stoma bag is being changed and refers to the condition when the stoma passes below the level of the skin. - It may recede inside the peritoneum, which leads to the discharge of fecal content inside the abdomen leading to peritonitis, which is an emergency. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  79. 79. COMPLICATIONS • Stomal Retraction - Depending on the degree of retraction, it may be managed locally by pull up of the stoma and re-fixation to the surrounding skin or may require laparotomy and re-creation of the stoma Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  80. 80. COMPLICATIONS • Colostomy prolapse - is commonly seen in transverse colostomies - is generally managed conservatively, however laparotomy with stomal revision may be required, especially in case of large prolapses with irreducibility. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ . Image: https://quizlet.com/270619321/ostomies-rectal- tubes-rectal-medications-and-enemas-flash-cards/
  81. 81. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM INTERVENTIONS • The nursing staff and enterostomal therapists - help in deciding and marking the stoma site in the preoperative period. - In the postoperative period, they teach patients how to manage and change their colostomy appliances as well as how to look out for complications. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  82. 82. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM INTERVENTIONS • Dieticians - help patients in the postoperative period by preparing a diet chart individualized for the patient, based on his weight and the amount of bowel resected and the amount of functioning bowel. They also help to reduce and manage postoperative ileus. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  83. 83. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM INTERVENTIONS • Psychologists - help manage the psychosocial aspect of colostomy creation and conduct counseling sessions and send patients to colostomy support groups. • Physical health therapists - help in early patient ambulation in accordance with the ERAS protocol to decrease postoperative ileus and decrease the chances of developing DVT Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  84. 84. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM MONITORING • Purpose: - to assess for complications - to plan for colostomy closure. * It is generally done in hospitals by a team of allied health workers and the nursing staff. • In the hospital setup, in the early postoperative period, the nursing staff must check for viability and full functioning of the stoma and also look for complications like stoma gangrene. Also, general surgical complications like post-op DVT, atelectasis, and UTI must be looked for. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  85. 85. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM MONITORING • After discharge: - The patients’ weight and body mass index (BMI) should be calculated at regular intervals by a dietician and be advised appropriate dietary and fluid management advice as well as vitamin and mineral supplementation to compensate for the reduced bowel length and reduced absorption. • The mental status of the patient should also be assessed at regular intervals, before and after stoma creation, by a psychologist. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  86. 86. NURSING, ALLIED HEALTH, AND INTERPROFESSIONAL TEAM MONITORING • After discharge: - the patients must be followed every couple of weeks to look for complications like stomal prolapse, retraction, and parastomal herniation. This is generally done by the nursing staff and, in case of complications, must be communicated to the treating surgeon for appropriate action. • The patients’ weight and body mass index (BMI) should be calculated at regular intervals by a dietician and be advised appropriate dietary and fluid management advice as well as vitamin and mineral supplementation to compensate for the reduced bowel length and reduced absorption. • The mental status of the patient should also be assessed at regular intervals, before and after stoma creation, by a psychologist. Source: Maria, A & Lieske, B 2021, Colostomy Care, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 24 February 2022, https://www.ncbi.nlm.nih.gov/books/NBK560503/ .
  87. 87. HOW TO EMPTY COLOSTOMY POUCH PURPOSE • You need to empty a drainable pouch when it gets to be about one-third full. This keeps the pouch from bulging under your clothes. • It also helps prevent leaking and odor. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  88. 88. HOW TO EMPTY COLOSTOMY POUCH EMPTY THE POUCH • Sit on or next to the toilet. Or stand in front of the toilet. Put a layer of toilet paper in the toilet bowl to keep stool from splashing. • Pull your clothes away from the pouch. • Hold the bottom of the pouch up. Open the Velcro closures or remove the clamp and set it aside. • Slowly unroll the tail, or spout, over the toilet. • Bend over the toilet to help prevent splashing • Slide your fingers down the pouch to push out all the stool. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  89. 89. HOW TO EMPTY COLOSTOMY POUCH CLEAN THE POUCH • Wipe the inside and outside of the tail with toilet paper. This helps prevent any odor. • Check both sides of the pouch for tears or holes. If you find any, put on a new pouch. • If the pouch closes with a clamp, rinse the clamp if there is stool on it. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  90. 90. HOW TO EMPTY COLOSTOMY POUCH CLOSE THE POUCH • Close the pouch • If the pouch has Velcro closures: • Properly fasten the Velcro closures to close the pouch. • If the pouch has a clamp: - Hold the clamp open with the curved side, or hinge, toward your body. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  91. 91. HOW TO EMPTY COLOSTOMY POUCH CLOSE THE POUCH • Lay the bar, or “knife,” of the clamp flat on the tail of the pouch, about 1 inch from the bottom of the tail. • Fold the tail up over the bar. Make sure the tail lies flat against the bar. Also make sure the whole width of the tail is held within the bar. If it isn’t, the pouch may leak or smell. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  92. 92. HOW TO EMPTY COLOSTOMY POUCH CLOSE THE POUCH • Hold the tail of the pouch firmly against the bar. Then close the clamp by bringing the hinge up to the bar. Press the two parts together until they lock. • Wash your hands with clean, warm or cold water for at least 20 seconds when you are done. (Hum Happy Birthday twice if you need a timer.) Or use a hand sanitizer that is 60% alcohol. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  93. 93. HOW TO EMPTY COLOSTOMY POUCH RELEASING GAS • Gas can collect in the pouch even if there is no stool. Never puncture the pouch to release gas. If you do, you’ll break the odor-proof seal. Stool can also leak if the pouch is punctured. To release gas, follow these steps: • Hold the tail of the pouch up slightly and open the Velcro closures or remove the clamp. • Hold the top of the pouch with one hand. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  94. 94. HOW TO EMPTY COLOSTOMY POUCH RELEASING GAS • With the other hand, push the gas out by sliding your thumb and index finger from the top to the bottom of the pouch. • Secure the Velcro closures or reclamp the pouch as described above. • Wash your hands when you are done. Source: Ostomy Care: Emptying Your Pouch 2019, www.fairview.org, Fairview Health Services, viewed 24 February 2022, https://www.fairview.org/Patient- Education/Articles/English/o/s/t/o/m/Ostomy_Care_Emptying_Your_Pouch_82173#:~:text=You%20need%20to%20empty%20a .
  95. 95. HOW TO EMPTY COLOSTOMY POUCH Source: Colwell, J 2015, How to Empty an Ostomy Pouch, www.youtube.com, University of Chicago Medicine Digestive Diseases Center, viewed 24 February 2022, https://youtu.be/NVrO-jITUTQ . Click the picture to watch the video Copy-paste the link below to watch the video online
  96. 96. DOCUMENTATION
  97. 97. DESCRIBE THE TYPE OF OSTOMY • colostomy (colon)—sigmoid or descending colostomy, transverse colostomy, loop colostomy, ascending colostomy • ileostomy (small bowel)—ileoanal reservoir (J-pouch), continent ileostomy (Kock pouch) • Document the presence and location of bowel sounds. • Stoma information Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  98. 98. DESCRIBE THE TYPE OF OSTOMY Note the type: • loop (two openings through one stoma) • end (one stoma) • double barrel (two distinct stomas). • Document the overall appearance (shiny, taut, edematous, dry, moist, pale, textured, smooth, and bloody) and the presence of stents, rods, drains (include type and location). Describe the color (red, beefy red, pink, pale pink, purple, blue, black) and shape (round, oval, budded). Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  99. 99. DESCRIBE THE TYPE OF OSTOMY Note the height: • flush—at skin level • prolapsed—telescoped out from the abdominal surface. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  100. 100. DOCUMENT THE SIZE IN MILLIMETERS • Round stomas are measured by diameter. • Oval stomas are measured by widest length and width. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  101. 101. DESCRIBE THE LUMEN • location—straight up, side, level with skin, or centrally located • the number of lumens, stenosis, or stricture. Note: Document the location of the lumen by using the clock system, with the patient’s head at 12:00. Describe the odor—presence or absence of odor, strong, foul, pungent, fecal, musty, sweet. Note whether the stoma and peristomal skin junction is intact or separated. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  102. 102. EFFLUENT • For a fecal stoma, describe the amount, consistency, and overall appearance of effluent • — thick, viscous, liquid, pasty, oily, formed, soft, thin, tarry. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  103. 103. PERISTOMAL SKIN • Describe the characteristics of peristomal skin— color, edema, firmness, intactness, induration, pallor, lesions, texture, scar, incision, rash, staining, moisture. • Assess a minimum of 2 inches out from around the stoma. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  104. 104. APPLIANCE AND ACCESSORIES • Document the type of ostomy appliance and accessories. Include the pouching system product, size, and product number. Note the presence of a spout, the convexity, and whether it’s a one-piece or two-piece system, • Observe and document proper function and adhesion, and complications experienced with appliance systems. Document any modifications to the care plan, implementation of new orders, and referrals. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .
  105. 105. OTHER IMPORTANT INFORMATION • Document the type of ostomy appliance and accessories. Include the pouching system product, size, and product number. Note the presence of a spout, the convexity, and whether it’s a one-piece or two-piece system, • Observe and document proper function and adhesion, and complications experienced with appliance systems. Document any modifications to the care plan, implementation of new orders, and referrals. Source: Medical Billers and Coders 2019, Ostomy Documentation Tips for Medicare Payment, Leading Medical Billing Services - USA, viewed 24 February 2022, https://www.medicalbillersandcoders.com/blog/ostomy-documentation-tips/ .

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