Ostomy Care Overview

Ostomy Care

• Ileal Conduit Care: Clients with ileal conduits might have drains still intact. Teach them to use a 4x4 inch dressing to absorb leakage around the drain.

• Follow-up Care: Regular follow-up with surgeons and wound/ostomy/continence nurses is crucial. Discuss resuming activities after adequate stoma healing. Provide specific information about exercise and sexual activity guidelines from the provider.

• Exercise: Ostomy clients should stay hydrated during strenuous activity and engage in regular cardiovascular and musculoskeletal exercises.

• Sexuality: Address clients' concerns about body image changes. Encourage open communication with partners. Suggest emptying pouches, using smaller pouches, or pouch covers before sexual activity.

• Urostomy Management: Teach clients and families about stoma/diversion care, odor management, skin care, hydration, pouch application, leakage prevention and signs of urinary infection or obstruction.

  • Important: Evaluate urine color and character and skin alterations.

• Urostomy Dietary Information: No dietary restrictions. However, some foods cause odor (e.g., alcohol, asparagus, beans, broccoli, cheese, eggs, fish, onions). Encourage adequate hydration (unless restricted) to maintain urinary function. Ileal conduits have a higher risk of electrolyte imbalances and metabolic acidosis.

• Ostomy Management: Teach clients and families about stoma & diversion care including odor, skin care, hydration, pouch application & leakage prevention, self-catheterization (for continent reservoirs), and infection/obstruction signs.

• Ileostomy: The stoma is typically located in the right lower quadrant. A restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) may be done.

  • Initially, clients may follow a low-residue diet to prevent blockage and avoid high-fiber foods for 6-8 weeks.
  • Use caution with enteric-coated pills/tablets. Monitor for undissolved meds in the pouch.
  • Output is typically dark green, loose, and odorless. Empty pouch when 1/3 - 1/2 full.
  • Use skin barriers and monitor for leakage.
  • Recognize signs of food blockage (abdominal cramping, nausea, vomiting, stoma swelling, lack of output for 6 hours or more). Lie down in knee-chest position, massage abdomen to promote peristalsis, and consider changing to a pouch with a larger opening if stoma is swollen.
  • High-volume ileostomy output puts clients at risk for fluid/electrolyte imbalances. Recognize the signs of dehydration/electrolyte imbalance.

• Dietary Adjustments for Ileostomy and Colostomy: Clients may need to gradually resume a regular, balanced diet including fresh fruit, vegetables, proteins and whole grains.

  • Avoid foods that cause gas/odor (e.g., alcohol, beans, broccoli, cabbage, chocolate, fried foods, fish, garlic, onions, highly spiced foods, raw fruits, stringy veggies).
  • Avoid foods that cause blockage (strings veggies, coconuts).
  • If client is experiencing large amounts of effluent, limit insoluble fiber to decrease digestion time.
  • Some clients may require foods that thicken stools (e.g., applesauce, bananas, cheese, pasta, rice).

• Colostomy: Depending on the area of the colon involved, stomas can be located in the ascending, transverse, descending, or sigmoid colon. Output varies based on location (liquid to semi-formed).

  • Potential dietary adjustments for diarrhea, constipation, or medications such as antibiotics.
  • Discuss usage of laxatives and enemas with provider/surgeon.
  • Use caution with enteric-coated and sustained-release medications.
  • Management options include drainable or closed-end pouches, irrigation and dietary management.
  • Temporary diverting colostomy clients will have rectal urges/drainage.
  • Clients with double-barrel/loop colostomies the distal section carries no feces.

• Colostomy Location:

  • Ascending colon (right abdomen): Liquid to semi-liquid output, very irritating to skin.
  • Transverse colon (mid-abdomen): Temporary ostomy, output is pasty.
  • Descending colon (left upper abdomen): Semi-formed output due to increased water absorption.
  • Sigmoid colon (left lower abdomen): Formed output, commonly used for permanent colostomies.

Enteral Tube Feeding

• Tube Insertion Preparation: Prepare the tube tip with water-based lubricant. Facility policies for numbing agents (lidocaine spray/gel) apply.
• Client Positioning: Client tips head back, breathes through mouth, tube inserted through the naris to the posterior nasopharynx.
• Tube Advancement: Have client flex head toward chest/swallow and advance tube on each swallow to predetermined length.
• Tube Placement Verification: Use a penlight and tongue blade to visualize tube, assess for breathing/coughing/gagging, and client comfort. Verify placement by checking gastric aspirate pH or bilirubin/CO2 levels.
• Fluid Analysis:
  • Gastric fluid (fasted for 4+ hrs): pH 1-4, grassy green, off-white, or tan, consistency of water.
  • Intestinal fluid: pH 7+, light to golden/brownish green, syrupy.
  • Continuous tube feeding: pH 5+.
  • Respiratory fluid: clear, pH > 6.
• Client Risks: Decreased consciousness, poor cough/gag reflexes, recent intubation/extubation, inability to cooperate, restlessness/agitation increase risk for improper placement.
• Tube Security: Secure tube at insertion point. Mark the tube.
• Post-Insertion Client Care: Comfort, dispose of supplies, clean gloves, mouth care, documentation.
• X-ray Confirmation: X-ray is needed.
• Guidewire Removal: If using guidewire, remove it after placement confirmation to avoid tissue damage.
• Assessment Prior to Insertion: Check client's nares and gag reflex, auscultate the abdomen. Determine the length of the tube necessary for insertion. Consult with appropriate clinical staff based on facility guidelines.