An ostomy is a stent diversion for urine or feces after removing part or all of the intestinal wall or bladder. According to the United Ostomy Associations of America (UOAA), approximately 750,000 Americans have an ostomy, and 130,000 new ostomy surgeries are performed annually.
Due to ostomy management’s complexities and labor requirements, numerous hospitals employ certified wound, ostomy, and bladder control nurses (CWOCN) to manage resources. They have an elite degree in these specialties and are known as WOC nurses. Even if one hospital has a patient care ostomy specialist (particularly if it does not), you must be able to care for ostomy patients. This article will give you the nuts and bolts to do just that.
Concerning ostomy nursing care
An Ostomy care plan may be created for various reasons, including cancer, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), trauma, constipation, and a bowel perforation. Ileostomy, ileostomy, and ileal conduit are examples of common diversions. The diversion could be incontinent or continental; this article only covers incontinent diversions. Preoperative planning and postoperative care are critical in helping patients with the new ostomy to adjust to this major life event.
Ostomy surgery in nursing
Preparation for surgery
Before the surgery, the patient care ostomy expert or another nurse needs to meet with the patient and household care provider to provide support and information and determine the best injection site for stoma creation. This important session allows patients to express emotions about the initial appointment and ostomy.
Following-up care
Following surgery, you must determine the type of ostomy the patient has, whether it’s a clue, temporary, or permanent. This data assists you in determining the patient’s overall health status, guiding interventions, and determining educational needs. You may need to consult some other source, such as the intelligence officer’s notes, to get answers to these questions. You must also be familiar with various ostomy devices and accessories, how to evaluate the patient, and the principles of emptying and changing the pouch.
Ostomy care procedure
After measuring the stoma, the nurse ostomy specialist selects the preliminary appliance (pouching system). It would be best to quantify the stoma after each appliance change because swelling can change size or placement. Swelling usually goes away within 6 weeks of surgery.
Wear time varies; for a colostomy, it is usually 5 to 7 days, and for an ileostomy or ileal conduit, it is 3 to 4 days. After the first six weeks, the patient may switch to a different appliance under professional supervision.
The ostomy appliance comprises a skin barrier and a pouch holding fecal matter or urine effluent. The appliance is disposable and waterproof, with either a drained clamp, Velcro closing, or a non-drainable shuttered pouch.
Some appliances are transparent, while others are opaque. Because the appliance is opaque, it may not be easy to center this same pouch straight over the stoma. Because all pouching processes are equally effective, patient preference largely determines the choice.
The ostomy appliance could be made up of one or two pieces.
- A single seal is used in a one-piece system, with the skin barrier firmly affixed to the pouch. It is appropriate for patients with a flat stomal profile and requires one fewer application step than a two-piece system.
- With a two-piece system, the bag can be detached from the skin and discarded rather than emptied. However, it necessitates an additional step: reattaching the pouch to a skin barrier.
Ostomy nursing care accessories
Various ostomy accessories improve comfort, adherence, and peristomal skin health. Adhesive pectin is used to make skin barrier paste and granules, as well as barrier rings, wafers, and strips. Sprays, wipes, and “lollipop” sticks are available for skin barrier preparation and powder. They protect the skin by trying to prevent effluent from leaking and trying to touch the skin under the appliance when applied directly to the skin around the stoma before the barrier or pouch application.
Before using these products, clinicians should read all manufacturer instructions. If the peristomal skin is despoiled (a condition known as epidermal skin stripping), the powder could be sprinkled directly on it and sealed by gently rubbing it with the edge of skin-barrier film prep—a process known as crusting.
Other ostomy supplies include:
- Ostomy belts that help secure the appliance
- Binders that help support a peristomal hernia
- Wraps that can provide a relatively flat body contour
- Special swimwear and women’s clothing allows for privacy.
Patient evaluation
When evaluating a patient with such a new ostomy:
- Inspect the appliance to ensure it is secure and functional
- Check for effluent leakage
- Record the date of the last pouch change
- Evaluate production character and volume
- Check for flatus.
Inspect the stoma when emptying and changing the pouch, noting its osseous location and nearness to drains or the surgery incision, as well as ileostomy character traits and stomal skin condition. The stoma is normally red, moist, and firm, protruding 2.5 cm (1 inch) above the skin’s surface. The opening should face directly up.
Stoma shape and size are determined by how the stoma was created and where it is located in the GI tract. Stomal discoloration, insufficient output, absent or reduced bowel sounds, and abdominal discomfort or tenderness can all be symptoms of the stomal disorder, poor perfusion, or both. Surgical consultation may be required if any of these signs and symptoms appear. Stomal mucosal tissue has a dense blood vessel supply; minor bleeding occurs with gentle cleansing.
Changing and emptying the pouch
When the pouch is one-third to one-half full, it should be emptied. In a high-volume scheme, such as a new ileostomy or ileal conduit, a device with a production spout may be connected to a urinary leg-bag drainage system via a conduit connection, enabling a larger storage tank and less frequent changes.
Patients should ideally empty their pockets while standing or sitting on the toilet with their legs open. Patients with limited mobility can lie on their side, drain the pouch into a urinal or rinse basin, and then flush the waste.
Basic pouches should be replaced at least once weekly or whenever a leak occurs. Large power systems require more frequent replacement, including such ileostomies and ileal conduits.
Changing the ostomy nursing care device
- Gather all necessary supplies.
- Practice hand hygiene.
- Gather and open supplies near the patient on a clean surface.
- To remove, stretch back the epidermis opening or cut an opening on a starter tunnel and peel it back. Join the skin barrier and the pouch.
- To prevent soiling, tuck an overactive bladder pad inside the patient’s clothing.
- Place a mirror on the night table so the patient can watch the procedure.
- Put on gloves.
- Remove the old appliance by pulling back the skin with one hand while holding the skin taut with the other (push-pull technique).
- Remove the old pouching system.
- Use moistened paper towels to clean these same stomal and peristomal areas. Soap and baby wipes should be avoided because they may leave a residue that will interfere with the appliance seal.
Patient and home caregiver education
Patients and caregivers may feel overwhelmed during the initial stages of a new ostomy. Work closely with them, conveying faith and patience to build their confidence. The ostomy type, anticipated output, a need to alert nurses of leakage or seal make concessions, and the importance of discharging the pouch when it’s one-third to one-half full are all topics to cover. Also, teach patients and families about a healthy diet.
Determine whether the patient is prepared to learn about the ostomy. Use a gradual, caring, step-by-step approach with patients refusing to look at or touch the pouch. Explain the function of each ostomy item and encourage the patient to touch and practice with these items for those who appear receptive can see, touching, and having to learn about the pouch. Demonstrate a pouch change once the patient is comfortable with the pouch; if the patient expresses preparedness, he or she could participate.
Encourage the client to perform a shows that holden with coaching at the next pouch change. Open and close a specimen pouch, attach a pouch to the skin barrier, and have the patient practice emptying his or her pouch. Assure patients that one’s appliance will adhere successfully, even if there are difficulties initially.
Many patients and their caregivers are much less concerned following the return demonstration. Supervise or assist the patient or caregiver with subsequent pouch changes.
At the time of discharge, the patient should be able to empty the pouch on his or her own. Otherwise, look into other options, such as a member of the family or caregiver who can assist the patient. The UOAA, Wound Ostomy and Bladder control Nurses Society, and Ostomy Secrets have written components, relevant data, and peer-support referrals. Arrange for a home health nursing referral as needed for additional assistance. Ostomy clinics and certificated ostomy nurses who practice in the community are also useful resources; for more data on the latter, contact the WOCN Society.
Bottom line
Patients with new ostomies must go through a period of difficult social and psychological adjustments. Concerns include a change in self-image, apprehension of rejection, changes in intimacy, and the fear that the ostomy device will lose adhesion in a public or social setting.
Offer emotional support and encourage patients to express their anxiety and fear. Teach them to take charge of their circumstances to improve their quality of life. Ostomy patients can feel powerful and achieve positive outcomes with comfort, support, information, and practice.
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