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30 Cards in this Set
- Front
- Back
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"Ideal" Stoma (proper location, color, height, shape and location of opening)
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Location: smooth surface, through rectus muscle, where the patient can see it
Color: red color indicates healthy blood supply Height (protrusion) - approximately 1" is preferred Shape: round Location of opening - opening in center of stoma |
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GI Stomas - Ileostomy (opening location and output)
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Opening into the ileum
Output: Liquid to mushy Digestive enzymes (mucus like) Gas may or may not be an issue Usually little odor |
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GI Stomas - Colostomy (opening location and output)
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Opening into the colon
Most common type Output: varies liquid --> formed Gas common Odor (strong) |
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Urostomy or Uninary Diversion (opening and output)
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Opening into urinary system
Output: urine May contain mucus |
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Peristomal Assessment
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Skin integrity - intactness, rash
Skin plane - folds, dips, protuberances, angles Skin turgor - firm, soft, hard or "elasticity" |
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Pouching System Components: Skin Barrier (Function and Features)
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Function: protects skin and attaches pouching system
Skin barrier features: -cut to fit -flat or convex -standard or extended wear |
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Pouching System Components: Skin Barrier (the "Science")
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Adhere best to dry surfaces
Adhesive bond improves over time Warmth and pressure improve initial tack Usually should hug base of stoma |
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Pouching System Components: Cut to fit Skin Barriers
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Opening can be customized
Best for post-op stomas, stomas that are not round and decrease inventory |
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Pouching System Components: Pre-sized Skin Barrier
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Best after stoma size has stabilized
Usually for stomas that are round Opening should hug base of the stoma |
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Pouching System Components: Standard vs Extended Skin Barrier
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Standard wear: erodes when it comes in contact with liquid
Extended wear: Formulated to be most resistant to liquid discharge |
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Factors that Impact Skin Barrier Wear Time
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-Type of discharge
-Skin condition -Moisture - humidity, perspiration, water -Frequency of emptying -Pouching system |
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Pharmacist's Role for Patients Needing Ostomy
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-Understand insurance issues
-Recognize problems -Identify solutions -Know specialists -Make referrals |
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Pouching System Components: Tape (Function)
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Frames skin barrier
Helps secure pouching system |
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Definition of Wear time
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Length of time the pouch can be worn before it fails
Typical pouch change frequency is twice a week Maximum wear time is usually 7 days |
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Pouching System Components: Pouch (Function and Features)
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Function: collects discharge, contains odor and impacts body image
Features: one piece or two piece, drainable, closed, or urostomy, closure options and filters |
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Pouching System Components: Two-Piece Pouching Systems
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Must have both pieces
Flange type and size must match! Flange size NOT EQUAL to stoma size |
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Pouching System Components: One-Piece Pouching Systems
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Skin barrier and pouch are attached
May be easier to use Most flexible pouching option |
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Pouching System Components: Drainable Pouch
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A pouch with an opening at the bottom
Used for colostomy and ileostomy Empty when 1/3 to 1/2 full Closure options: clamp and integrated closure |
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Pouching System Components: Closed Pouches
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A pouch without a clamp
Used in colostomy, short-term use for ileostomy and limited dexerity Remove when 1/3 to 1/2 full |
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Pouching System Components: Pouch Filter
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Vents and deodorizes gas from the pouch
Option in closed and drainable pouches Best for: colostomy, ileostomy with thick discharge but NEVER for urostomy |
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Pouching System Components: Urostomy Pouch
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A pouch with a spout
Used for urinary diversions Empty when 1/3 to 1/2 full Other features: anti-reflux and may be connected to bedside collector |
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Accessories: Skin Barrier Paste
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Use as a caulk to prevent leakage to prevent leakage under the skin barrier
Help fill in uneven areas Tips: -Paste is NOT an adhesive -Too much paste will decrease wear time so more is not better -Replace cap after use |
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Accessories: Barrier Rings
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Prevent leakage under barrier
Protect skin Alternative to paste Create oval and customized openings Tips: -Easier to apply ring to back of skin barrier (rather than when on the pt) -Can be stretched to different sizes -Can easily broken and reformed |
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Accessories: Skin Sealant as Skin Wipes
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Makes the removal of adhesives easier
Helps to avoid skin stripping Tips: -Must dry completely before applying product -Use on intact skin |
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Accessories: Adhesive remover as Skin Wipes
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Makes the removal of adhesives easier
May help prevent skin stripping Removes adhesive and barrier residue Tips: -Must wash off skin with soap and water after use -Not usually needed with each pouch change |
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Accessories: Skin Barrier Powder
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Helps dry up moist peristomal skin so a skin barrier can adhere.
Tips: -Only use when skin is wet and weepy -Brush off excess powder -Only use a little bit! -Discontinue use when skin has healed |
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Accessories: Lubricating Deodorant
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Eliminate odor when emptying
Easier to empty pouch Pouch "cleaner" Tips: -Need to use at least 1 teaspoon - do no use less -Must rub around to coat inside of pouch -Reinsert after each pouch emptying -Safer alternative than rinsing pouch out or using cooking oil in pouch |
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Ghost Tablets
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May or may not be absorbed
Look on Medline for absorption data on patient with 6 ft vs 18 gt of intestine removed. Are there suitable alternatives? e.g. liquid form, alternative medications with better bioavailability, etc. If not working, can the dose be adjusted? |
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Ostomies and diarrhea - Treatment
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1. Bulk formers
2. Anti-diarrhea meds (loperamide, diphenoxylate/atropine (lomotil) - can be used consistently if needed 3. Cholestyramine (avoid bile acids because it can contribute to diarrhea) |
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Ostomies and Constipation - Treatment
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Treat as a medical emergency
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