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26 Cards in this Set
- Front
- Back
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5 conditions that may be indicators of ostomies
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Crohn’s Disease,Ulcerative Colitis, Polyps, Cancer of Bowel,Diverticulosis
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Role of the ET Nurse
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• To assist in the rehabilitation of patients after ostomy surgery
• To act as a resource person for nursing staff Role of the ET Nurse Pre-operatively – counseling (procedures and routines) – family support – stoma site selection and marking |
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Role of the ET Nurse Post-operatively
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– assess stoma viability
– assess ostomy management – fitting of equipment – patient education – prepare for discharge – prepare for follow-up |
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Role of the ET Nurse Resource person
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– in-servicing
– orientation – clinical teaching |
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An OSTOMY is . . .
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“a surgical opening often exteriorized for the
elimination of body waste.” |
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Reasons for Ostomy Surgery
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• Cancer
– colon – rectum – bladder • Trauma – motor vehicle accident – stabbing – radiation enteritis and cystitis • Inflammatory Bowel Disease – ulcerative colitis – Crohn’s disease – diverticulitis – familial adenomal polyposis • Congenital Anomalies – meconium ileus – Hirschsprung’s disease – necrotizing enterocolitis – anorectal malformations – volvulus (a twisting of the intestine causing obstruction) |
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Ulcerative Colitis
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• Inflammation and ulceration of the colon and
rectum • young to middle age • 15 to 25 years, equal sex distribution • cause unknown • curative with surgery • dentate line of anal canal to ileocecal junction • Mucosa and submucosa • continuous distribution • nonadematous pseudopolyps common with increased risk of cancer after 10 years • medical management is primary treatment • surgical treatment is considered curative |
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Ulcerative Colitis ostomy
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• Ileoanal anastomosis
• Ileorectal anastomosis • Total proctocolectomy with end ileostomy • Total proctocolectomy with continent ileostomy (Kock Pouch) • Total proctocolectomy and ilealanal reservoir (Pelvic Pouch) • Subtotal colectomy |
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Crohn’s Disease
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• Non-specific inflammatory bowel disorder
• 20 to 35 years; 55 to 70 years • equal sex distribution • cause unknown • no cure • any part of the alimentary tract from the mouth to the anus • Transmural (full-thickness) • segmental distribution producing “skip” lesions • malignancy is rare • medical management is primary treatment • surgical management most likely required and is non-curative |
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Crohn’s Disease ostomy
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• Surgical management relieves distressing symptoms and improves quality of life
• Ileorectal anastomosis with healthy rectum • Total proctocolectomy with end ileostomy • Subtotal colectomy |
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Diverticular Disease
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• Diverticulosis
• Diverticular Disease • Diverticulitis |
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Complications of Diverticulitis
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• Perforations
• Hemorrhage • Pericolic abscess • Vesicocolic fistula • Muscular hypertrophy and obstruction |
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Types of Ostomies
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• Any part of the anatomy
• Usually of the digestive and urinary tracts • Temporary versus permanent |
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The 3 most common ostomies
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• Colostomy
• Ileostomy • Urostomy |
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Anatomic Location of Colostomies
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• Ileostomy
• Cecostomy • Ascending colostomy • Transverse colostomy • Descending colostomy • Sigmoid colostomy |
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Stomal construction
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• Brooke ostomy
• End ostomy • Double-barrel • Mucus fistula • Loop ostomy • Vent “blow-hole” |
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Ostomy Surgeries
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• Hartman’s procedure
• Abdominal perineal resection • Ileal conduit • Urostomy • Total pelvic exenteration • Anterior pelvic exenteration • Posterior pelvic exenteration • Pelvic pouch procedure |
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Urostomy
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• Any form of diversion of the urinary tract
• Nephrostomy • Pyelostomy • Ureterostomy • Transurethral Cutaneous Ureterostomy • Vesicostomy • Appendicovesicostomy |
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Pelvic Pouch Procedure
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• Ileoanal, S-, J-pouch or reservoir
• Internal reservoir constructed of ileum and sewn to the anal canal • can be a one-, two-, or three-stage procedure |
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Orthotopic Neobladder
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• Orthotopic neobladder (Studor Procedure)
• internal reservoir for urine collection • segments of small bowel used to create reservoir • eliminating the need for an external stoma and collection system |
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Stomal Assessment
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• Location on the body
• Viability • Construction • Height • Size • Shape • Color |
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Stomal Assessment
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• Location of the lumen
• Mucocutaneous junction • Peristomal skin • Function • Appliance |
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Stomal Complications
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• Necrosis
• Melanosis coli • Mucocutaneous separation • Prolapse • Retraction • Stenosis • Laceration • Malignancy |
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Peristomal Complications
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• Allergic dermatitis
• Irritant or contact dermatitis • Folliculitis • Hernia • Candida • Malignancy • Radiation injury • Urinary crystal formation |
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Ostomy Equipment
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• Sealants
• Skin barriers • Pouching systems • Belts • Convex inserts/ built-in • Pouch covers |
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Ostomy Equipment
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• Bedside drainage system
• Clamp • Solvents • Deodorants |
