1.Colostomy ileostomy care Anuradha .Y

2. Colostomy: A surgically created opening between the colon and the abdominal wall to allow fecal elimination. It may be a temporary or permanent diversion Ileostomy : A surgically created opening between the ileum of the small intestine and the abdominal wall to allow elimination of small bowel effluent. 3. With Colostomy 4. Ostomy care (colostomy, ileostomy) described as care of the stoma and skin to prevent irritation and skin breakdown and immediate treatment. 5. To assess and care for the peristomal skin To collect stool for assessment of the amount and type of output To minimize odors for the clients comfort and self-esteem 6. The indications for a descending or sigmoid colostomy include the following Diverticulitis Trauma Inflammatory bowel disease Bowel obstruction Birth defects(imperforated anus) Paralysis Cancer of the sigmoid colon or rectum 7. A- Two- piece ostomy pouching system B- One piece ostomy pouches Pouches can be closed or drainable 8. Pouch should be changed according to manufacturers guidelines every week or twice in a week. If peristomal skin is erythematous ,eroded or ulcerated pouch should be changed every 24 to 48hrs. Pouch is emptied when it is one third to one half full. 9. Determine *The type of ostomy and its placement, and confirm which is the functioning stoma. *Type and size of appliance currently used Assess for: *Stoma color, stoma size, Stoma bleeding, status of peristomal skin *Amount and type of feces, color, odor and consistency. Inspect for abnormalities such as pus or blood *Assess for any complaint for burning sensation under skin. *Assess the clients and family members learning needs regarding the ostomy and self care and clients emotional status. 10. -clean gloves -Bedpan -Mackintosh -Moisture proof bag -Warm water, mild soap, - Towel. -washcloth OR 4X4Tissue or gauze pad -skin barrier OR Wafer -Stoma measuring guide -Pen or pencil and scissors - New ostomy pouch with optional belt -tail closure clamp -Deodorant for pouch(optional) 11. Review features of the appliance to ensure that all parts are present and function properly. 12. Introduce yourself and verify the client's identity. Explain to the client what you are going to do why it is necessary, and how the client can co-operate Provide client privacy Perform hand hygiene Apply clean gloves Assist client to a comfortable sitting or lying position Unfasten the belt if client is wearing one Empty the contents of a drainable pouch through bottom opening into a bedpan or toilet If the pouch uses a clamp do not throw it away it can be reused 13. Assess the consistency, color and amount of stool. Peel the skin barrier off slowly, beginning at the top and working downward, while holding the skin taut. Discard the pouch in moisture proof bag. Clean and dry the peristomal skin and stoma Use toilet tissue to remove excess stool. use warm water, mild soap and a wash cloth to clean the skin and stoma. 14. Dry the area thoroughly by patting with a towel. Assess the stoma for color size, shape, ulceration, irritation and bleeding. Place a piece of tissue or gauze over stoma and then prepare and apply skin barrier. Use the guide to measure stoma size, mark with pen/pencil cut according to stoma pattern to make an opening in skin barrier Remove the adhesive of skin barrier and center the one piece skin barrier and pouch over the stoma and gently press for 30 seconds. Snap the pouch onto the flange or skin barrier wafer. For drainable pouch close the pouch according to the manufactures directions or with a clamp. 15. Document the procedure type of ostomy pouch applied in the client's record Report any increase in stoma size, change in color, discoloration of stoma, appearance of stoma skin and the amount and type of drainage, clients reaction to the procedure, skills learned by the client. 16. -Relate findings to previous data if available. -Adjust the teaching plan and reinforce the teaching each time the care performed -Encourage and support self care as soon as possible as client should be able to perform. -Perform follow-up