Phar 462 - Ostomy Care

Front 1

What is an Ostomy?

Back 1

A surgically created opening from the inside of the organ to to the outside

Front 2

"Ostomy's can be temporary or permanent" True or False?

Back 2

TRUE

Front 3

What are the three types of Ostomy's?

Back 3

1) Ileostomy (ileum)

2) Colostomy (Colon)

3) Urostomy (ureter)

Front 4

What is Stoma?

Back 4

An opening site on the surface of the abdomen

(2-3cm protrusion above the abdomen)

Front 5

What are the two types of Stoma?

Back 5

1) End stoma (one sided)

2) Loop Stoma (both sides)

Front 6

What is an Ileostomy?

Back 6

The ileum of the small intestine is brought to the abdomen surface

Front 7

What is an Colostomy?

Back 7

The colon is brought to the abdominal surface

Front 8

What is an Urostomy?

Back 8

Ureter is brought to the abdomen surface and to other organs

Front 9

What conditions are associated with Ileostomy?

Back 9

1) Chron's Disease

2) Ulcerative Colitis

3) Familiar Polyposis

4) Cancer

Front 10

What conditions are associated with Colostomy?

Back 10

1) Colorectal Cancer

2) Diverticulitis

3) Obstructions

4) Physical Trauma

5) Loss Anal muscle control

Front 11

What conditions are associated with Urostomy?

Back 11

1) Bladder Cancer

2) Birth Defects (e.g. Spina Bifida)

3) Spinal Cord Injuries

Front 12

What types of surgeries are considered Ileostomies?

Back 12

i) Protocolectomy/Colectomy

ii) Low anterior resection

iii) Pelvic pouch/S or J pouch

Front 13

What types of surgeries are considered Colostomies?

Back 13

i) Abdominal Perineal Resection

ii) Hartmann's procedure

iii) Diverting Colostomy

Front 14

What types of surgeries are considered Urostomies?

Back 14

i) Uterostomy

ii) Nephrostomy

iii) Cystotomy

iv) Ileal & Colonic conduit

(ureters--> Intestine-->colon stoma)

Front 15

What is the regular output of Illeostomy?

Back 15

Contents from the small intestine:

1) Active digestive enzymes

2) Bile acids

3) Stomach acid.

The stool is liquid and smushy

Front 16

What is the regular output of Colostomy?

Back 16

If from the Ascending Colon:

Liquid or Semi-solid + Malodorous

If from the Descending/Sigmoid Colon:

Pasty and formed stool

Front 17

What is the regular output of Urostomy?

Back 17

Urine (with a presence of mucus shreds) and Hematuria

Front 18

What are the roles of Appliances for Ostomies?

Back 18

Is to collect drainage from the stoma site

Front 19

What are the three components of Appliances?

Back 19

1) Pouch

2) Flange

3) Skin Barrier

Front 20

What is the role of the Pouch?

Back 20

Collects the waste

Front 21

What is the role of the Flange?

Back 21

Connects the skin barrier and pouch together

Front 22

What is the role of the Skin Barrier?

Back 22

Attaches appliances to the Stoma

Front 23

What are the two types of Pouches?

Back 23

1) Closed Ended: Discarded after use

2) Open Ended & Clamped: Empty's contents without changing pouch

Front 24

What factors influence the selection of Pouches?

Back 24

i) Patient: Visual acuity, manual dexterity, wear time, preference

ii) Stoma: Type, location, Size, Shape, Skin integrity

Front 25

What are the different types of Flanges?

Back 25

Flat (Flexible for flat pouching surface) and Convex (Firm support for flush/retracted Stoma & Concave abdominal plane)

Front 26

What is the Skin Barrier composed of?

Back 26

Composed of Pectin, Gelatin and Cellulose

Front 27

What is the difference between one-piece and two piece systems?

Back 27

One Piece System: Barrier ring fused to pouch,

Two Piece System: Barrier ring with Flange or Adhesive landing zone to which the pouch is attached

Front 28

What are the benefits of one piece system?

Back 28

1) Simple and Flexible (useful for stoma located in deep creases)

2) Used once and discarded

3) Useful in patients with limited dexterity/eye sight

Front 29

What are the benefits of two piece system?

Back 29

1) Pouch is removed without removing Flange

--> Clean/Replace pouch is re-attached

2) Avoid frequent removal & Replacement (which can initiate skin, pouch can be cleaned/reused)

Front 30

What is the indication of the Barrier paste/ring/strip for Ostomy management?

Back 30

Fills gaps creases or add an extra seal between flange barrier & stoma

Front 31

What is the indication of the Barrier powder for Ostomy management?

Back 31

For weeping, excoriated skin to absorb exudate & protect the skin

Front 32

What is the indication of the Skin sealent for Ostomy management?

Back 32

For fragile or denuded skin to protect from adhesives

Front 33

What is the indication of the Adhesive remover for Ostomy management?

Back 33

Painful Ostomy pouch removal & to prevent skin stripping (contains acetone and alcohol which are irritating to skin)

Front 34

What is the indication of the Odor eliminator drops for Ostomy management?

Back 34

Used with appliance changes or instilled into pouch

Front 35

What is the indication of the Belts for Ostomy management?

Back 35

Provides support at 3 or 9 o'clock

Front 36

"None of the accessories used in Ostomy management should be used on a chronic basis" True or False?

Back 36

TRUE

Front 37

What are the principal DO's for Ostomy Management?

Back 37

1) Wash hands/clean gloves

2) Empty/Remove current pouching system

3) Clean the stoma & Peristomal skin with warm water & cleaning cloth

4) Assess Stoma/Peristomal skin

5) Ensure skin is dry; apply Flange

6) Hold palm of hand over system for 1-2min

Front 38

What are the principal DON'Ts for Ostomy Management?

Back 38

1) DO NOT reinforce leaking flange with tape

2) DO NOT use alcohol to clean stoma/peristomal area

Front 39

What are the complications of Stoma's?

Back 39

1) Retraction

2) Mucocutaneous Separation

3) Necrosis

4) Hernia

5) Prolapse

Front 40

What are the Peristomal Skin Complications?

Back 40

i) Peristomal Irritant Dermatitis: Irritant/Contact Dermatitis or Allergic Dermatitis

ii) Peristomal Skin Infections

iii) Folliculitis

iv) Drug Absorption Issues

v) Output Complications: Diarrhea/Constipation

vi) Quality of Life concerns

Front 41

What is the most common complication of Ostomies?

Back 41

Peristomal Irritant Dermatitis

Front 42

What are the causes of Irritant/Contact Dermatitis?

Back 42

1) Skin exposure to fecal, urinary drainage or chemical preparations

2) Repeated removal of adhesive products/overly aggressive cleansing techniques

3) Poorly fitted appliance or tight clothing

Front 43

What are the treatment options of Irritant/Contact Dermatitis?

Back 43

1) Assess for leakage (re-evaluate flange choice, consider pastes)

2) If excoriated skin (use skin barrier powder, barrier film, paste) AVOID CREAMS/OINTMENTS

Front 44

When would you refer Irritant/Contact Dermatitis?

Back 44

i) Painful skin (there are no nerve endings in stoma)

ii) Persistent despite pouch change

iii) Bleeding

Front 45

What is the cause of Allergic Dermatitis?

Back 45

Hypersensitivity to any elements in contact with peristomal skin

Front 46

What is the onset of Allergic Dermatitis?

Back 46

~48 hours

Front 47

What are the treatment options of Allergic Dermatitis?

Back 47

Change the product/brand

Front 48

When would you refer Allergic Dermatitis?

Back 48

1) Painful Skin/Bleeding

2) Persistent despite appliance change

Front 49

What are the causes of Peristomal Skin Infections?

Back 49

Fungal or Bacterial

Front 50

What is the most common Fungal peristomal skin infection?

Back 50

Candidia

Front 51

What is the appearance of Peristomal Skin Infections?

Back 51

Foul odor, purulent discharge, Satellite Rash with lesions (if Fungal) and possibly systemic signs of infection (fever, chills)

Front 52

When would you refer Peristomal Skin Infections?

Back 52

ANY of the signs and symptoms

Front 53

What are the treatment options of Peristomal Skin Infections?

Back 53

Anti-fungal powder (Nystatin) applied for Candida infections.

[Applied BID-TID to skin under/around appliance and crusted in skin prep keep applying until resolution of symptoms, often for 1 week AFTER clearance of symptoms]

Front 54

What is the cause of Folliculitis?

Back 54

Irritation to hair follicles around peristomal skin due to appliance or aggressive application/removal

Front 55

What is the appearance of Folliculitis?

Back 55

Pustule around Follicles

Front 56

When would you refer Folliculitis?

Back 56

ANY signs of infection

Front 57

What is the treatment option for Folliculitis?

Back 57

Hair removal with Ostomy powder & disposable razor recommended

Front 58

What affects the impacts of Drug Absorption Issues with Ostomy?

Back 58

Impact is dependent on proportion & location of intestine removed

Front 59

Which of the types of Ostomy affected drug absorption the most?

Back 59

Ileostomy

Front 60

Which of the types of Ostomy affected drug absorption the least?

Back 60

Sigmoidostomy

Front 61

Which types of drugs should you avoid if you have an Ostomy?

Back 61

Enteric Coated Tablets, Time released products, Pro-drugs

(conversion in ileum & ascending colon)

Front 62

Which types of drugs are preferred if you have an Ostomy?

Back 62

Solutions, Suspensions, Gelatin Capsules, Uncoated Tablets

Front 63

Which medications are of particular concern in ileostomy patients?

Back 63

1) Oral Contraceptives or Hormone Replacement Therapy in ileostomy patients

[Switch to injection, implant or topical patch due to poor absorption]

2) Vitamins A, D, E, K (fat soluble) B12 (water soluble)

[Switch to Alternative forms]

Front 64

Which medications are of particular concern in Urostomy patients?

Back 64

Sulfa Antibiotics in Urostomy patients

[counsel to drink plenty of fluids to dilute urine due to increased risk of crystallization]

Front 65

Which of the types of Output complications associated with Ostomys is more common with Colostomy patients?

Back 65

Low Stoma Output (Constipation/Obstruction)

Front 66

What are the concerns with High Stoma Output (Diarrhea)?

Back 66

Increased risk of dehydration & electrolyte imbalance

Front 67

What are the Signs and Symptoms of High Stoma Output (Diarrhea)?

Back 67

Dry mouth, Reduced Urine Output, Dark Concentrated Urine, Dizzy of Standing, Fatigue, Abdominal Cramping

Front 68

What are the Treatment options of High Stoma Output (Diarrhea)?

Back 68

1) Gut slowing medications

2) Oral Rehydration Therapy

3) Avoid Diarrhea causing agents when possible

Front 69

What gut slowing medications can be used for the treatment of High Stoma Output (Diarrhea)?

Back 69

1) Loperamide

2) Lomotil

3) Codeine

4) Octreotide

5) Proton Pump Inhibitors

6) Bulk forming agents (e.g. Psyllium)

Front 70

What are examples of diarrhea causing agents?

Back 70

Sorbitol, Harsh Laxatives/Stimulants, Magnesium Based Antacids

Front 71

How do Electrolyte imbalances occur with Ostomys?

Back 71

Extensive small intestine resection decreases adequate nutrition & hydration maintenance

(water, electrolytes, bile salts, vitamin B12 absorption)

Front 72

What are the signs and symptoms of Hyponatremia?

Back 72

Nausea, Malaise, Lethargy, Headache, Confusion

Front 73

What are the signs and symptoms of Hypokalemia?

Back 73

Muscle, Weakness, SOB, Fatigue, Decreased Sensation in limbs

Front 74

What are the signs and symptoms of Vitamin and Mineral Deficiencies?

Back 74

Parasthesias, Ataxic Gait, Visual Disturbances, Dyspnea & Lethargy

Front 75

What are the treatment options for Electrolyte imbalances?

Back 75

1) Resolve underlying cause

2) Supplementation as needed

3) Oral rehydration salts

4) Be consciousness of medications that also affects electrolyte balance (i.e. diuretics) or are affected by electrolyte balance (Digoxin, Lithium)

Front 76

What are the foods associated with Stoma Obstructions?

Back 76

Apple peels, Celery, Dried Fruits, Nuts, Oranges, Pineapples, Popcorn, Raw Cabbage, Seeds, Whole Kernal Corn, Chinese Vegetables

Front 77

What are the treatment options for Stoma Obstructions?

Back 77

1) Avoid associated foods

2) Fluid, fibre exercise

3) Avoid aluminum based antacids in Colostomy patients

4) Stool Softeners used (Avoid Laxatives/Stimulants)

5) Irrigation techniques for Colostomy patients

Front 78

What are the Quality of Life Concerns with Ostomy's?

Back 78

i) Odour

ii) GAS

iii) Output Colour

iv) Diet

v) Activities of Daily Living

Front 79

What foods are more likely to cause Odour with Ostomy's?

Back 79

Asparagus, Beans, Broccoli, Brussel Sprouts, Cabbage, Cauliflower, Cheese, Eggs, Fish , Garlic, Onion

Front 80

What are the treatment/preventative options for Odour with Ostomys?

Back 80

1) Identify and avoid odor producing foods

2) Assess pouch for Malfunctions (leakage in seal, pinholes, need for more frequent emptiying/cleaning)

3) Empty pouch when 1/3 full

4) Change the pouch 1-2 times weekly as needed

5) Odour controlling agents

6) Odour controlling foods

Front 81

What are the odour controlling agents used for Odour with Ostomy's?

Back 81

1) Deodorant Drops

(placed in pouch after emptying)

2) Oral Therapy

(Bismuth, Chlorophyll copper complex, activated charcoal tablets)

3) Room Spray

(To minimize odour when emptying)

Front 82

What are examples of Odour controlling foods?

Back 82

Buttermilk, Cranberry Juice, Orange Juice, Parsely, Tomato Juice, Yoghurt

Front 83

What are the causes of Intestinal GAS with Ostomy's?

Back 83

Alcohol, Broccoli, Brussel Sprouts, Cabbage, Carbonated drinks, Cucumbers, Dairy products, Eggs, Fish, Garlic, Legumes, Nuts, Onions, Radishes, Soy

Front 84

Which foods produce BOTH Gas and Odour?

Back 84

Broccoli, Brussel Sprouts, Cabbage, Eggs, Fish, Garlic, Onions

Front 85

What are the treatment options for GAS produced with Ostomy's?

Back 85

1) Identify the source of the Gas

2) Gas reducing agents (e.g. Simethicone)

3) Avoid drinking through straws, chewing gums, Smoking

4) "Burp the bag"

Front 86

Which drugs can produce Black coloured Output from Ostomy's?

Back 86

Bismuth containing products, Charcoal, Ferrous Salts

Front 87

Which drugs can produce Whitish coloured Output from Ostomy's?

Back 87

Antacids (Aluminum Hydroxide)

Front 88

Which drugs can produce Greenish/Gray coloured Output from Ostomy's?

Back 88

Antibiotics

Front 89

Which drugs can produce Pink/Red coloured Output from Ostomy's?

Back 89

Anticoagulants, Salicylates

Front 90

Which drugs can produce Red coloured Output from Ostomy's?

Back 90

Phenylbutazone

Front 91

Which drugs can produce Green coloured Output from Ostomy's?

Back 91

Indomethican

Front 92

Which drugs can produce Orange/Red coloured Output from Ostomy's?

Back 92

Phenazopyridine

Front 93

Which drugs can produce Yellow coloured Output from Ostomy's?

Back 93

Senna

Front 94

What is the appropriate diet for Ileostomy patients?

Back 94

Adequate fluid intake (~500-750ml/day),

Eat in small amounts, Chew throughly

Front 95

What is the appropriate diet for Colostomy patients?

Back 95

NO ABSOLUTE DIETARY RESTRICTIONS. Sufficient fiber & fluids to prevent constipation, while avoiding gas producing foods

Front 96

What is the appropriate diet for Urostomy patients?

Back 96

Adequate fluid intake in order to prevent kidney stones and UTIs

Front 97

How should patients with an Ostomy perform showering/bathing?

Back 97

Performed with a pouch on or off

Front 98

How should patients with an Ostomy perform Exercise?

Back 98

Resumed with minimal modifications (exception of extreme contact sports)

Front 99

How should patients with an Ostomy perform Intimacy?

Back 99

No affect on organic sexual function (exception of men with Urostomies who many have reduced sexual function).

No effect on pregnancies

Front 100

How should patients with an Ostomy patient Travel?

Back 100

No limitations on Travelling:

1) Take extra ostomy supplies

2) Avoid exposure of pouches/adhesive adjuncts to extreme temperatures

3) Drink bottled water only when safety of tap water is unknown

Front 101

What are the complications of Urostomy's?

Back 101

1) Increased risk of Pyelonephritis

2) Crystalline Phosphate Deposits

Front 102

When would you refer Urostomy complications?

Back 102

1) Blood in Urostomy

2) Ammonia

Front 103

What are the treatment options for Urostomy complications?

Back 103

1) Vinegar + 2/3 of Water

2) Dabbed on Stoma when cleaning

3) Cranberry Juice (Acidifies Urine)