enterostomal care

8/3/2019 Enterostomal Care

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ENTEROSOMAL CARE


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ENTEROSTOMAL CARE

Ostomy an opening for the GI, urinary, or

respiratory tract on the skin

Gastrostomy opening through the abdominal wall

into the stomachJejunustomy opens through the abdominal wall

into jejunum

Ileostomy opens into the ileum ( small bowel )

Colostomy opens into the colon ( large bowel )


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GASTROSTOMIES/JEJUNOSTOMIES

- Generally performed to provide an alternate

feeding route


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B.O. OFTEN CLASSIFIED ACCORDING TO

1. Their status as permanent or temporary

2. Their anatomic location

3. The construction of stoma

- single

- loop

- divided or double barrel


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DOUBLE BARREL


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TYPES OF COLOSTOMIES

a. Ascending colostomy

- the stoma is on the right side of the abdomen

- fecal drainage is watery

b. Transverse (double-barreled) colostomy

- two stomas

- R (proximal stoma) drains semi-formed feces

- L (distal stoma) drains mucus feces


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c. Descending and sigmoid colostomy

- stoma is on the left side of the abdomen

- fecal is well formed


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STOMAMONITORING

Stoma red with slight edema for 5-7 days, then

it becomes pinkish or pinkish red and moist

Dark, dusky, or brown-black indicates ischemia

and necrosis Notify the physician

Stoma should protrude by to inch over

abdomen, if prolapsed or retracted, notify the

physician


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Flatus and fecal drainage begin in 4-7 days,

indicate return of peristalsis

Empty pouch when it is 1/3 to full of stool, to

prevent leakage


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COLOSTOMYIRRIGATION

Enema is given through stoma to stimulate

peristalsis then to promote evacuation at regular

and convenient time ( for sigmoid colostomy

because fecal is hard

Done in semi-Fowlers position ( bedrest)

Position in sitting (ambulatory)

Hang the irrigation bag 12-18 inches

Use 500-1000 ml of warm normal saline orlukewarm water (avoid frequent irrigation with

water to prevent loss of fluids and electrolytes)


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Lubricate catheter

Dilate stoma with lubricated gloved pinky finger

before insertion

Insert 2-4 inches of the catheter If cramps occur during irrigation, clamp tubing;

release if cramps subside

Allow catheter remain for 5-10 minutes and

massage abdomen for better cleansing effect;remove catheter to drain for 15-20 minutes


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Clean stoma and apply new pouch

Perform irrigation around the same time each

day to promote regular pattern of stoma

emptying Irrigation preferably 1 hour after meal


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MANAGING ODOR

Avoid gas-forming and foul odor foods

y Dairy product, highly seasoned foods, fish, cabbage,

celery, cauliflower, eggs, carbonated drinks, nuts,

yogurt, parsley, buttermilk, green beets

Rinse the pouch with tepid water or weak vinegar

solution

Place deodorant, mouthwash, charcoal

Avoid use of ASA


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TEACHING FOR SELF-CARE OF STOMA

Ask the client to look the stoma

Encourage to verbalize feelings

Inform that the stoma has no touch or pain

sensation Instruct to report any purple-black discoloration

Cleanse stoma sterile saline or antiseptic solution

until healed


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SUPPORT APOSITIVE SELF-CONCEPT

Encourage to verbalize feelings

Encourage to participate in colostomy care


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RESOLVING GRIEF

Encourage to express feelings of loss

Explore clients usual coping strategies


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PREVENTING SEXUAL DYSFUNCTION

Advise couple on the following

- explore position that minimizes stress and

pressure on the pouch

- empty and clean pouch before sexual activity- use small-sized pouch or cover during sexual

activity

- use binder or special underwear to hold the

pouch

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