GIT - Stomas

Question 1

Ostomy Surgery

Answer 1

• procedure where a permanent opening through to the surface of the abdomen is made
• bowel is brought to the opening onto the surface, faecal matter emptied into collection bag
• colostomy - colon
• ilestomy - ileum

Question 2

Types of Surgery

Answer 2

• end stoma
• loop stoma
• double barrell stoma
• kock pouch
• ileoanal reservior

Question 3

Bowel Diversion - Stools

Answer 3

• ilesotomy
  
  • formed from ileum in small intestine, discharge from stoma is usually liquid or pasty in consistency and occurs several times a day, usually after meals, not physically able to be controlled
• colostomy
  
  • ascending colostomy - right side of abdomen, stool is liquid - semi-liquid, rich in digestive enzymes & discharge is irritating to skin around stoma
  • transverse colostomy - middle of abdomen, stool is liquid - semi-formed, usually less irritating to surrounding skin
  • descending colostomy - left side of abdomen, stool is semi-formed - formed as most of the water has been absorbed as it moves through ascending & transverse sections of the colon
  • sigmoid colostomy - lower left side of the abdomen, stool has a normal, formed consistency

Question 4

Pre-Operative care

Answer 4

• education
• siting of colostomy
• stomal therapy nurse involvement
• expected pain relief measures
• bowel preparation measures & oral / parenteral antibiotics to reduce risk of peritoneal confamination

Question 5

Nursing Management

Answer 5

• knowledge defecit - educate about what’s happening, what they can excpect, when to change bag, what they can / can’t eat, referral to stomal nurse, family & partner education, correct sizing of bags
• body image - body image disturbance, altered sexuality patterns due to stoma, anticipatory grieving due to loss of bowel / cancer, impaired social interactions due to fear of odour & seepage
• anxiety
• skin problems
• nutritional problems
• fluid and electrolyte imbalance
• sexuality dysfunction

Question 6

Post-Operative Care

Answer 6

• nil orally till bowel sounds evident
• IV fluids
• NG tube for gastric decompression
• physical discomfort - surgeical opening, specific examples?
• psychological implications