Seminar 9: Customized Patient - Ostomy Focus

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Questions and Answers

What does the term 'ostomy' specifically refer to in medical terminology?

  • A surgical procedure creating an artificial opening (correct)
  • A method of organ transplantation
  • A diagnostic imaging technique
  • A type of surgical incision

Which ostomy is classified under digestive procedures specifically aimed at the ileum?

  • Urostomy
  • Colostomy
  • Ileostomy (correct)
  • Gastrostomy

What distinguishes a temporary ostomy from a permanent one?

  • Permanent ones allow total recovery of the organ
  • Permanent ones require lifelong care
  • Temporary ones are always performed in children
  • Temporary ones allow the organ to heal (correct)

Which of the following conditions is a pathological cause for an ostomy?

<p>Obstructive lithiasis (C)</p> Signup and view all the answers

What main function is NOT associated with the large intestine (colon)?

<p>Filtration of blood (C)</p> Signup and view all the answers

Which type of ostomy is specifically indicated for direct feeding into the stomach?

<p>Gastrostomy (A)</p> Signup and view all the answers

What alteration is commonly observed in patients with digestive ostomies?

<p>Loss of control over defecation (B)</p> Signup and view all the answers

Which type of colostomy is classified as descending?

<p>Descending colostomy (B)</p> Signup and view all the answers

What is a key function of urine elimination in the body?

<p>Acid-base balance (C)</p> Signup and view all the answers

What is typically true about the volume of urine produced at night compared to the day?

<p>It is about half of that formed during the day (B)</p> Signup and view all the answers

Which of the following suggests a problem in patients with urostomy?

<p>Loss of control over urination (D)</p> Signup and view all the answers

What should a doctor advise a patient with urostomy to ensure proper hydration?

<p>Drink plenty of fluids (A)</p> Signup and view all the answers

Which statement regarding stoma hygiene is true?

<p>Warm water and gentle soap should be used (C)</p> Signup and view all the answers

What is one of the common fears associated with ostomy patients?

<p>Losing health (A)</p> Signup and view all the answers

What is the recommended action if the ostomy device is half full?

<p>Replace the device (A)</p> Signup and view all the answers

Which of the following is NOT mentioned as a key function of urine?

<p>Detoxification of heavy metals (B)</p> Signup and view all the answers

What is the primary purpose of maintaining the health of the peristomal skin?

<p>To ensure the good sealing of adhesives and avoid leaks. (D)</p> Signup and view all the answers

Which of the following is not recommended to maintain skin health around the stoma?

<p>Use harsh detergents for cleaning. (D)</p> Signup and view all the answers

What is a significant disadvantage of using 1-piece ostomy systems?

<p>Reduced flexibility requiring complete system change. (A)</p> Signup and view all the answers

Which characteristic is essential for ostomy devices to ensure patient comfort?

<p>They should be lightweight and not noticeable. (B)</p> Signup and view all the answers

What distinguishes 2-piece ostomy systems from 1-piece systems?

<p>They allow for pouch replacement without changing the barrier. (D)</p> Signup and view all the answers

What is a common misconception regarding the adaptation of ostomy devices?

<p>All patients should use the same size device. (C)</p> Signup and view all the answers

Which of the following describes a key feature of ostomy devices that contributes to discretion?

<p>Devices should not be noticeable or produce odor. (B)</p> Signup and view all the answers

In ostomy care, what is emphasized as a balance that must be maintained?

<p>Adhesion and skin protection. (B)</p> Signup and view all the answers

Flashcards

Urinary Elimination

The elimination of waste products from the body through urine.

Acid-Base Balance

The process of maintaining the balance between acids and bases in the body.

Blood Pressure Regulation

The process of regulating the pressure of blood flowing through blood vessels.

Red Blood Cell Production

The process of producing red blood cells in the bone marrow.

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Regulation of Phosphocalcium Metabolism

The process of maintaining the proper levels of calcium and phosphorus in the body.

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Urostomy

A surgical procedure where a portion of the bladder is brought to the surface of the abdomen to create an opening (stoma) for urine to drain.

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Control Over Urination

The ability to control the elimination of urine.

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Urinary Tract Infections (UTIs)

Infection of the urinary tract, which includes the bladder, kidneys, and ureters.

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1-Piece Ostomy Device

A type of ostomy device with an integrated pouch and skin barrier, offering a slimmer profile and easier application but limited flexibility and wear time.

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2-Piece Ostomy Device

A type of ostomy device with a separate pouch that can be changed independently from the reusable skin barrier. Offers flexibility, longer wear time, and reduced skin irritation but may have a bulkier profile.

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Skin Barrier

The protective barrier attached to the skin around the stoma to seal the ostomy device and prevent leaks.

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Ostomy Pouch

The part of the ostomy device that collects waste.

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Flexibility

The ability of an ostomy device to conform to the body's natural movements and curves for a comfortable and secure fit.

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Comfort

The level of comfort an ostomy device provides to the patient, minimizing irritation or discomfort.

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Discretion

The ability of an ostomy device to be hidden from view, allowing the patient to live a normal life without drawing attention to their condition.

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Range of Devices

The range of sizes and shapes offered by an ostomy device to ensure the best match based on individual needs and body types.

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What is an ostomy?

An artificial opening created in a bodily organ to communicate with the exterior. The prefix specifies the organ while the suffix is '-ostomy.'

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What is an ileostomy?

Ileostomy is a type of ostomy specifically created in the ileum, the final part of the small intestine. It allows for waste removal from the body through the opening.

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What is a colostomy?

A colostomy is a surgical procedure creating an opening in the colon (large intestine) that communicates with the exterior. Used when the colon cannot function properly.

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What is a urostomy?

A urostomy, also called ureterostomy, is a surgical procedure involving the creation of an opening in the urinary tract (specifically the ureter) to divert urine to the outside of the body, bypassing the bladder. Usually created for patients with bladder dysfunction or cancer.

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What is the difference between temporary and permanent ostomies?

Temporary ostomies are created for a short period, usually until the original organ heals. Permanent ostomies are done when the organ's function can not be retrieved.

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What are some causes of ostomies?

Inflammatory bowel diseases like Crohn's disease or ulcerative colitis, intestinal occlusions, diverticulitis, and neurogenic bladder, bladder exstrophy, and obstructive lithiasis are some pathologies that can lead to the creation of an ostomy.

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What are the main functions of the digestive system?

The primary functions of the digestive system are the absorption of nutrients and the elimination of waste. The small intestine absorbs nutrients, while the large intestine absorbs water and controls bowel movements.

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What are the common alterations in patients with digestive ostomies?

Patients with digestive ostomies might experience a loss of bowel control as the digestive process is altered. The inability to absorb water and electrolytes properly can lead to dehydration.

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Study Notes

Seminar 9: Customized Patient

  • Focuses on ostomized patients
  • Covers academic year 2024/25
  • Presented by Professor Vittoria Carrabs PhD

Ostomy

  • Derived from the ancient Greek word "stoma" meaning "mouth" or "opening"
  • Medical term for a surgical procedure creating an artificial opening in the body
  • Surgical opening connecting an organ or duct to the exterior
  • Organ name prefixed, "-ostomy" suffix

Types of Ostomies

  • Classification by organ:

    • Digestive: Colostomy, Ileostomy
    • Urinary: Urostomy (Ureterostomy)
    • Gastrostomy: Feeding directly to the stomach
    • Tracheostomy: Opening in the trachea for breathing

  • Classification by temporality:

    • Temporary/palliative: Allows healing, used for short-term operations
    • Permanent: When organ function cannot be restored (e.g., complete resections)

Causes of Ostomies

  • Pathological: Inflammatory bowel diseases, Intestinal Occlusion, Diverticulitis, Neurogenic bladder, Bladder exstrophy, Obstructive lithiasis
  • Tumor
  • Traumatic
  • Congenital

Main Functions of the Digestive System

  • Nutrition: Ingestion, digestion, and absorption of nutrients
  • Elimination: Removal of waste products
  • Small Intestine: Nutrient absorption
  • Large Intestine (Colon): Nutrient absorption, water absorption, ion absorption, and bowel control

Alterations in Patients with Digestive Ostomies

  • Loss of control over defecation
  • Absorption issues
  • Hydroelectrolyte imbalance leading to dehydration

Types of Digestive Ostomies by Location

  • Ileostomy (lleum)
  • Transverse Colostomy (Transverse Colon)
  • Descending Colostomy (Descending Colon)
  • Cecostomy (Ciego)
  • Ascending Colostomy (Ascending Colon)
  • Sigmoid Colostomy (Sigmoid)

Main Functions of the Urinary System

  • Filtration
  • Maintenance of homeostasis
  • Elimination
  • Acid-base balance
  • Blood pressure regulation
  • Red blood cell production
  • Regulation of phosphocalcium metabolism

Urine

  • Adults typically eliminate 1.5 liters of urine daily, depending on fluid and food intake
  • Nighttime urine volume is roughly half of daytime volume
  • Healthy urine is sterile, containing liquids, salts, and waste products without bacteria, viruses, or fungi
  • Bladder tissues are isolated from urine and toxic substances by a barrier preventing bacterial growth.

Alterations in Patients with Urostomy

  • Loss of control over urination
  • Recurrent Urinary Tract Infections (UTIs)
  • Increased risk of leakage and peristomal irritation due to highly irritating and liquid content

Care of Ostomy Patients

  • Stress: Fears related to loss of health, rejection from family and social environment, changes in habits and customs, inability to adapt to the situation, loss of independence
  • Anxiety: Related to the underlying pathology
  • Medical Considerations -Guidance on appropriate device. -Device accessories for special situations -Importance of device usage.
    • Continuous advice on proper device maintenance

Stoma Hygiene

  • Stoma is not a wound
  • Wash with warm water and soap/washcloth
  • Dry thoroughly with cellulose paper or cotton towel
  • Perform gentle hygiene without rubbing
  • Slight bleeding is normal
  • Replace device when half full, leaking, or causing discomfort
  • Avoid changing directly after eating due to peristaltic movements

Peristomal Skin Care

  • Maintaining peristomal skin health is crucial for device sealing and leak prevention
  • Proper hygiene is critical
  • Avoid physical trauma to the skin
    • Gently peel off adhesives
    • Cutting hair instead of shaving
  • Avoid chemical irritants:
    • Harsh detergents, disinfectants, and alcohol
    • Contact with feces
  • Use specific products for skin irritation
  • Adapt devices to patient needs

What is Required of Ostomy Devices

  • Adhesion
  • Skin Protection
  • Flexibility
  • Comfort
  • Discretion
  • Range width: balance between skin protection and adhesion, flexibility, and fit to the patient's needs

Ostomy Devices

  • 1-piece systems: Integrated pouch and skin barrier
    • Advantages: Slimmer profile, easier application, lightweight, lower cost
    • Disadvantages: Less flexibility, shorter wear time, risk of skin irritation due to frequent changes
  • 2-piece systems: Separate pouch and skin barrier through a coupling system
    • Advantages: Reusable skin barrier, customizable, longer wear time, easier pouch changes
    • Disadvantages: Bulkier, higher cost, requires dexterity

Clinical Case 1

  • Maria, 45, with permanent ileostomy due to ulcerative colitis
  • Problems: leakage of intestinal contents, redness and dermatitis around the stoma, increased stool output, difficulty maintaining hydration

Clinical Case 2

  • Luigi, 60, with temporary colostomy following rectal cancer resection
  • Problems: Stoma swelling, difficulty fitting the flange, reduced stool output, occasional prolapse beyond the skin

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