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STOMA CARE BY SIS. RAMA.pptx

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STOMA CARE BY SIS. RAMA.pptx

  1. 1. SIS. RAMA INCHARGE SURGICAL ONCOLOGY WARD
  2. 2. INTRODUCTION • The word ostomy means an opening which is made during surgery that brings a piece of the bowel (intestines) to the outside of the abdomen, i.e. on the belly ( Certified wound, Ostomy, Continence Nurses, 2012).
  3. 3. •A Colostomy may be temporary or permanent. •Most permanent colostomies are “ end colostomies. •While many temporary colostomie bring the side of the colon up to an opening in the abdomen (Johns Hopkins Medicine, 2012).
  4. 4. INDICATIONS • Birth defect eg: an imperforate anus • Serious infection, such as diverticulitis • Inflammatory bowel disease • Injury to the colon or rectum • Partial or complete intestinal or bowel blockage • Rectal or colon cancer • Wounds or fistulas in the perineum.
  5. 5. NORMAL INTESTINES
  6. 6. ABNORMAL INTESTINES
  7. 7. LOCATION • The most common placement is on the lower left side near the SIGMOID where a majority of colon cancers occur.
  8. 8. SITES OF STOMA
  9. 9. TYPES OF COLOSTOMY
  10. 10. TYPES OF COLOSTOMY • Loop colostomy • End colostomy • Double barrel colostomy
  11. 11. LOOP COLOSTOMY • a loop of colon is pulled through a small incision in your abdomen. • The loop is opened up and both pieces are stitched to the surrounding skin. • This is done so both pieces are close together. • The end still attached to your small intestine will discharge food waste from your body and the end still attached to the bottom end of your colon will discharge mucous. • A loop colostomy is usually done for temporary colostomies.
  12. 12. LOOP COLOSTOMY
  13. 13. END COLOSTOMY • The end of the colon still attached to the upper part of the gastrointestinal tract is pulled through a small incision in your abdomen. • It is stitched to the surrounding skin. • The other end of the colon is sealed and left inside your body. • End colostomies are usually permanent
  14. 14. END COLOSTOMY
  15. 15. DOUBLE BARREL COLOSTOMY • This colostomy involves the creation of two separate stomas on the abdominal wall. • The proximal (nearest) stoma is the functional end that is connected to the upper gastrointestinal tract and will drain stool
  16. 16. DOUBLE BARREL COLOSTOMY
  17. 17. ACCORDING TO DURATION • Permanant • Tempaorary
  18. 18. • There are also three types of colostomy. Which one you have will depend on which part of the colon is used to create the stoma. The types are: • Ascending colostomy - created using the ascending colon and usually located on right side of abdomen. The stool will be liquid or semi-liquid • Descending colostomy - created using the ascending colon and usually located on the right side of the abdomen. Stool will be soft • Sigmoid colostomy - created using the last part of the colon known as the sigmoid colon and is usually located on the left side of the abdomen. Stool can be soft or firm.
  19. 19. MANAGEMENT OF COLOSTOMY
  20. 20. PRE OPERATIVE CARE • Psychological preparation : Assure the patient that 'Ostomy' can be care for without it interfering with daily activities and social life (HELLINGER, 2011). • Nutrition : Alow residue diet is given for at least 1 - 2 days prior to the surgery. • Care of bowel : “Sterilization” of the bowel prior to surgery to reduce bacterial flora can achieved through administration of poorly absorbed antiboitics such as neomycin 1gm 4 hourly for 1 - 3 days ; laxatives and enema may be done ( Lyerly, 2013).
  21. 21. POST OPERATIVE CARE • Skin care : Assess the skin for sign of irritation, or breakdown ; apply skin barrier paste. • Psychosocial Adaptation : The nurse should help the patient to accept the colostomy and teach the neccesary care and it's management. • Nutrition : The colostomatew is started on a light, low residue diet (Patel, 2012). • Patient Health Education : Provide written, verbal and psychomotor instruction on colostomy care , pouch management, skin care and irrigation for the client.
  22. 22. Cont... • Medications : Some medications or nutritional supplements may change the colour, odor or consistency of stool just like before surgery. • Patient education and post medication observation are therefore necessary. • Control of Odor : Control odor by a clean odor free, well - fitting appliance ; regular change of bag, cleaning and use of deodoant. • Applying an ostomy appliance : The stoma must be measured so that the right size appliance can be chosen. The pouch attaches over the stoma sand is fastened unto the faceplate.
  23. 23. PURPOSE OF STOMA CARE • Skin protection and care • Receptacle for drainage • Patient acceptance and self care • For cleanliness and control odour • Empty fecal contents • Prepare bowel for surgery or diagnostic procedures • Regular cycle of stool examination • Prevents accidental emptying of bowel
  24. 24. ARTICLES REQUIRED • A clean tray containing : • Makintosh • Kidney tray or paper bag • Pair of clean gloves • Bed pan • NS or Basin with warm water • Dressing swab • Gauze pad • Pen or Pencil • Colostomy bag • Stoma measuring guide • Skin barrier paste • Scissors
  25. 25. PROCEDURE • Gather equipment. • Encourage the client to look at the stoma. • Explain the procedure to the patient. • Provide privacy. • perform hand hygiene and wear gloves. • Spread makintosh and draw sheet. • Remove clamp and empty the content into bed pan. • Rinse the pouch with tepid water or NS. • Discard the disposable pouch in paper bag.
  26. 26. Cont... • Assess the stoma for colour, swelling, trauma, and healing. Stoma should be moist and pink. • Cover the stoma with a gauze piece. • Clean peristomal region gently with warm tap water using gauze pad. dry by patting the skin. • DON'T SCRUB THE SKIN. • Remove gauze and clean stoma with dressing swab.
  27. 27. PROCEDURE
  28. 28. COMPLICATIONS • Problems breathing • Reactions to medications • Bleeding inside your belly • Damage to nearby organs • Development of hernia at the site of the surgical cut • falling of the stoma (prolaps of the colostomy) • Infecion, especially in the lungs, urinary tract or belly • Narrowing or blockage of the colostomy opening (stoma) • Skin irritation • Wound breaking open ( Johns Hopkins Medicin, 2012)
  29. 29. DOCUMENTATION • Record the procedure with following details : • Date & Time • Amount • Colour • Coonsistency of faecal matter • Sign of any infection
  30. 30. Summery • A colostomy is a lifesaving surgery that nables a person to enjoy a full range of activities, including travelling, sports, family life and work. • Colostomy is performed for many different diseases and conditions and therefore can be temporary or permanent. • Proper education pre and post surgery, help improves clients quality of life.
  31. 31. ANY QUESTIONS ?

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