ostomies review and affects on medications
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| from stomach to anus | stomach, duodenum, jejunum, lleum, cecum, ascending colon, transverse, descending colon, rectum
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| what do the small n large intestine do | large is 5 to 6 feet long, small is 20 feet long, the function of the large is to absorb water and elctrolytes,
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| stoma | openign the end of the ureter, ileum, or colon which may be seen coming throug the skin
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| ileostomy | an opening in which the end of th small intestines is brought out surgically through an opening in the abdome
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| ostomy | opening or outlet through the abdominal wall created surgically for the purpose eliminating waste
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| ileostomy | which is the opening of the ileum
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| stoma | usually red or pink in color
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| urinary diversion | any one of the several surgical prodecures to divert urine away from diseased or defective kidneys, ureters, bladder or urethra
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| colostomy | surgical opening of the large intesting brought to the abdominal surface
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| stoma | contains no nerve endings therefore is not a source of pain
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| urostomy or urinary diversion | a new passageway for urine thorugh the abdominal wall to outside the body
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| WOCN | wound, ostomy and continence nurse or aka et nurse=enterostomal therapy nurse
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| reasons for ostomies ileostomy | inflammatory bowel disease IBD (crohn's disease or ulcerative colitis), traumatic injury cancer, familiar polyposis (ususally cancer), necrotizing enterocolities
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| reasons for ostomies colostomy | cancer colon or recturm , diverticulitis, trauma, obstruction, genetic malformation, temporary colostomy; protect areas that have been surgicall repaired
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| what are some standard ileostomy | more prevalent, colon removed, terminal ileum pulled through abdominal wall and a segment is turned back and sutured to form stoma, discharge: liquid or paste, unpredictable drainage, contains digestive ezymes, requires collection pouch, skin protection
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| continent ileostomy | colon is removed and a reservoir is created by looping the ileum back on itself, a valve is created with part of the ileum, discarge: liquid or pasted, management: drain periodically (a few tiems/day with a catheter) requires a stoma covering
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| ileoanal reservoir | j or s pouch, colon removed and an internal pouch is made out of the ileum and placed in the pelvis, anus must be intact, discharge soft, formed stool, management is natural evacuation but may need perianal skin protection
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| transverse colostomy | two stoma, proximal and distal, proximal:expels stool. distal expels mucus (some mucus may be passed through the rectum) discharge: semi-solid, unpredictable, may contain digestive enzymes. management: skin protection, collection pouch
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| descentding or sigmoid colostomy | most common colostomy, discharge is firmer, resembles normal bowl movements, no caustic enzyme content. management: natural evacuation or irrigation, with protective cover or closed end pouch. if not regulated, used openended, drainable pouch
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| kidneys | process an excreted urine and maintain the fluid, electrolye, and acid base balances of the body
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| ureters | tubes (approx 10-12 in legth that collect urine as it is excreted from the
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| bladder | reservoir for urine
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| urethra | tube from the bladder to the outsdie of the body
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| what are some reason for urostomies | correct bladder loss or dysfunction, caused by: cancer neurogenic bladder, genetic malformation interstitial cystitis
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| what is a comventional urostomy | an ileal conduit is crdeated by excising a segment of the ileum (6-8inches). ureter are detached from teh bladder then implanted into the ileal segment. (bladder amy or may not be removed) distal end forms stoma and proximal end is sutured shut...page 11
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| ostomy pouches | come as two pieces plate and bag. one piece, reusable or disposable, drainable or close, transparent or opaque, pouch opening pre-sized or cut to fit
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| how to choose an ostomy pouch | should be based on needs, cost and abilits. Whould like it to be lead proof seak, odor resistance, skin protection, be inconspiuous and unnoticeable, easy to apply an remove
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| what are the pros and cons of 1 pieces vs 2 pieces | one piece is easy to apply, especially for patients with impaired manual dexterity, two piece is generally more pliable and adaptable to different adominal contours, and not have to remove flange from the skin
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| how should the pouch fit | should fit nug, stoma could be oval or round, can be swollen form 6-8 weeks
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| drainable bag | might want to be used for someone who is not regular
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| closed ended bags are better | ideally for regulated colostomies that are routinely irrigated, not output between irrigations
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| when should the pouches be emptied | when 1/3 to 1/2 full to prevent leaks
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| why might a belt be used | active in kids, poor connect, be careful with latex allergy made out of this,
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| need skin barrier such as powders and pastes andgel packets | to absorb for smell, help with skin
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| how to prevent odor | regular changes and emptying, clean, put charcol tabs or come in already
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| irrigating sets | need to be flushed like a enema, use lukwarm tape water
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| odor and intestinal gas | odor is only normal when changing. If odor any other time could be problem. Sweating odor from bag
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| what food can they eat to thicken the stool | applesauce, bread, yogurt. caution with high fiber foods and blockage see table 22-7, pasta, toast
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| what foods will loosen stools | chocolate, leafy green vegetables, raw fruits/vegetables, alcohol, prune juice, greezy
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| what foods will control odor | cranberry, orange, or tomato juice parsley and yogurt
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| what will provide constipation relief | hot veverages, cooked fruits/vegetables, fresh fruit
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| what food will control diarrhea | applesauce, peanut butter toast se table 22-2
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| what are some local complication | skin irritation, excoriation due to enxymes, contact dermatitis change back Latex allergy, hyperplasia, pouch may be too large rubbing, make sure properly fit an use seal, hyperplasia means excess growth and in this cause excess growth of the skin
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| more complication | mechanical irritation, skin stripping from adhesive, adhesive remove, stenosis-scar tissure around stoma resolve by dialtion of stoma surgical, excessive sweating can resul in infection and can resolve by wearing barrier, Folliculitis can happen which is
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| local complication 3 | infection fungal, peristomal hernia, fistula like new tunnel, prolapse when you loose muscle contraction and stoma falls out, retraction goes into abdominal tract
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| what are some precautions for medication use | coated or sustained release medication may pass through into pouch withou being absorbed leading to subtherapeutic dose because not enough small intestine to break down. all osmotic release capsule concerta. waxy matrix good to have clear bag
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| liquid or tablets that can be crushed are | prefered
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| potential effects of medication in patients with ostomies antibiotics diuretics laxatives antidiarrheals | antibiotics diarrhea, diurectics electrolye balance laxative diarrhea, antidiarrheals laxatives, contraceptive tablets are not as effective especial if done in ileostomy
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| drugs tHAT CAn discolor feces and urine | feces: asa, warfarin, or nsaids (bleeding), bismuth ferrous salts and senna are all benign bismuth black iron green senna-darker urine red iron urine red
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| what is the role of the pharmacist | finding products, counsel on pouch components, paste to keep and main job is to know the effect on ostomies with medication and food
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| what we need to know | ostomy terminology, reasons for ostomies, which types require collection pouches, types of ostomy pouches basics of how to fit, osotmy accessories, compication, effects of medications/food
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| types | urin-drainable- colostomy can be drainable but urin almost always
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| nice to know and where to go | types of ostomy procedures, details of pouch application/drainage, managment of food blockage
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| websites | united ostomy associations of america uoaa. coloplast group coloplast.com and wound ostomy ?something
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