Ostomy Care

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What is an ostomy?

An ostomy is a surgical creation of an opening in the intestinal wall to the outside of the body. There are a few different types of ostomies and their names depend on the anatomical placement. 

Photo cred to Intermountain Healthcare

Usually, the name coincides with the part of the intestine being surgically placed. For example, and ileostomy is created in the ileum part of the intestine.

Who needs an ostomy?

Different types of disorders may call for the placement of an ostomy. Some ostomies are going to be permanent, others may only be temporary. This is usually determined by the provider and severity of the cause. Obstructive disorders such as intestinal tumors may require an ostomy. Diverticulitis, Ulcerative Colitis, and intestinal perforations may also require an ostomy. Most  are elective, however in some emergencies, an ostomy may be required. 

Pre/Post-Op Nursing

-Obviously for an ostomy procedure, we are going to need informed consent. It is the surgeon’s duty to explain thoroughly to the patient what the procedure is, including risks and benefits. The nurse’s position is to clarify only. The nurse also will help with a bowel prep, if needed, before surgery. So why are we doing a bowel prep? Before most procedures, the patient is given an enema or laxative to clear the bowels. This is to help decrease intestinal bacteria and therefore decreasing the risk of post-op infection. The patient will likely be NPO the night before surgery. Also, they most likely will have IV or oral antibiotics prescribed. If the patient is scheduled to have an NGT insertion, they need to be educated that after the surgery, a tube will be in their nose!!! They WILL try to pull it out if not!

-The patient may have an IV patient-controlled analgesia pump for 24-36 hours after the surgery. Their diet is going to be liquid to solid and advance as tolerated BY the patient. You need to make sure that before they are given ANYTHING, the gag reflex needs to be present. You need to monitor the stoma to make sure it is function and place a pouch as soon as possible.

Stoma Care

So what does a stoma look like? Stomas typically are going to be reddish-pink and moist. If they are dark red, purple, or black, this indicates ischemia and needs to be reported to the provider. 

The stoma should start working 2-4 days post-operatively. First there will be a passage of flatus, usually.  
Depending on the placement of the stoma will also depend on the type of stool you’ll typically see. 

Ascending Colon- liquid stools

Transverse Colon- pasty stools

Descending Colon- solid stools

If patients have a stoma in the lower vicinity, they should be informed that some sexual dysfunction may occur.

They should use mild soap to clean the stoma. 

Nutrition

Okay, guys! Just a couple notes on nutrition then ostomy care is finito!

So stomas can be stinky. 🙂 No big deal, as a nurse you can tell your patient a couple tips! For example, buttermilk, cranberry juice, and yogurt can reduce odor in a stoma. 
If the patients are having a lot of gas, you can recommend crackers, toast, and yogurt!!!