Seminar 9 Ostomy PDF

SEMINAR 9 OSTOMIZED PATIENT 3° MEDICINE Academic year: 2024/25 Professor: Vittoria Carrabs PhD  OSTOMY From the ancient Greek "stoma" (στόμα), meaning "mouth" or "opening’’. This is used in medical terminology to describe a sur...

SEMINAR 9 OSTOMIZED PATIENT 3° MEDICINE Academic year: 2024/25 Professor: Vittoria Carrabs PhD  OSTOMY From the ancient Greek "stoma" (στόμα), meaning "mouth" or "opening’’. This is used in medical terminology to describe a surgical procedure that creates an artificial opening in the body. OSTOMY: The surgical opening that communicates an organ or duct with the exterior. This opening is prefixed with the name of the organ to be exteriorised and suffixed with the ending -ostomy.  TYPES OF OSTOMIES Classification by the organ: COLOSTOMY Digestive ILEOSTOMY ILEOSTOMY Urinary UROSTOMY (URETEROSTOMY) Gastrostomy: Feeding directly into the stomach. COLOSTOMY Tracheostomia:Opening in the trachea for breathing. 3  TYPES OF OSTOMIES Classification by TEMPORALITY Temporary/palliative ✓ Allows the organ to heal. ✓ Often used for short-term operations. Permanent: ✓ When the function of the organ cannot be restored (e.g. complete resections).  CAUSES OF OSTOMIES PATHOLOGICAL Inflammatory bowel diseases Intestinal Occlusion DIGESTIVE Diverticulitis …. Neurogenic bladder UROLOGICAL Bladder exstrophy Obstructive lithiasis …. TUMOR TRAUMATIC CONGENITAL  MAIN FUNCTIONS OF THE DIGESTIVE SYSTEM NUTRITION ELIMINATION SMALL INTESTINE Nutrient Absorption  MAIN FUNCTIONS OF THE DIGESTIVE SYSTEM LARGE INTESTINE (COLON) Nutrient Absorption Water Absorption Ion absorption Bowel control ALTERATIONS IN PATIENTS WITH DIGESTIVE OSTOMIES LOSS OF CONTROL OVER DEFECATION ABSORPTION HYDROELECTROLYTE BALANCE DEHYDRATION TYPES OF DIGESTIVE OSTOMY BY LOCATION ILEOSTOMY TRANSVERSE COLOSTOMY (Ileum) (Transverse Colon) DESCENDING CECOSTOMY COLOSTOMY (Ciego) (Descending Colon) ASCENDING COLOSTOMY SIGMOID COLOSTOMY (Ascending Colon) (Sigmoid) https://youtu.be/weBLgOW8UTA?si=FyMg_-BHQpnDueXu  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 eliminate about one and a half liters of urine each day, depending on their fluid and food intake. ✓ The volume of urine formed at night is about half that formed during the day. ✓ Normal urine is sterile. It contains liquids, salts, and waste products, but it is free of bacteria, viruses, and fungi. ✓ The tissues of the bladder are isolated from urine and toxic substances by a layer that does not allow bacteria to stick and grow on the bladder wall.  ALTERATIONS IN PATIENTS WITH UROSTOMY LOSS OF CONTROL OVER URINATION RECURRENT URINARY TRACT INFECTIONS VERY IRRITATING AND LIQUID CONTENT INCREASED RISK OF LEAKS AND PERISTOMAL IRRITATION CONSEJOS PARA PACIENTES CON UROSTOMÍA DRINK PLENTY OF FLUIDS VERY WELL HYDRATED EAT FOODS RICH IN VITAMIN C  CARE OF OSTOMY PATIENTS The following patients are under big stress: Fears as a response to a situation experienced as a threat: – Loss of health – Fear of rejection from the closest family and social environment – Changes in your habits and customs – Not being able to successfully overcome the situation, losing their independence and control over their life Anxiety The stress of the pathology that is the cause of ostomy  CARE OF OSTOMY PATIENTS There are a lot of ostomy care devices and materials A doctor should: ▪ Provide guidance on the right device ▪ Report the existence of accessories ▪ Use of devices for special situations ▪ Give information on the significance of the measure ▪ Continuous advice Provide patient safety and avoid complications so that after the adaptation period PATIENT LIVE A COMPLETELY NORMAL LIFE  STOMA HYGIENE ▪ The stoma is not a wound. ▪ Washing your stoma with warm water and soap or washcloth ▪ Dry very well with cellulose paper or cotton towel. ▪ Perform hygiene gently without rubbing. ▪ Slight bleeding may be normal ▪ Replace the device when it is half full, leaking, or causing discomfort. ▪ After ingestion, peristaltic movements increase, therefore, it is not the most ideal time for change  PERISTOMAL SKIN CARE How to prevent skin problems? The health of the peristomal skin is very important to ensure the good sealing of the adhesives and thus avoid possible leaks. Maintain proper hygiene. Do not physically traumatize the skin: > Peel off the adhesives gently > Do not shave the hair, but cut Nor chemically: >Do not use harsh detergents, disinfectants, or alcohol >Avoid contact with feces >Use of specific products for the treatment of irritation and the best adaptation of the devices  What is required of ostomy devices? Adhesion Skin protection Flexibility Safety Solutions Comfort Discretion Breadth of Range Balance between SKIN PROTECTION and ADHESION FLEXIBILITY: it is basic for a perfect fit COMFORT: If a device is comfortable, not even the patient should feel it DISCRETION: No one has to know that an ostomy patient is a carrier of a device. It should not be noticed, it should not smell... RANGE WIDTH: A device must be chosen carefully and adapted to each patient and need. "We are not all the same."  https://youtu.be/uIFVJJ6O OSTOMY DEVICES X2I?si=gCY2BUeayEDPDJvy Ostomy devices are essential for stoma care, allowing patients to manage waste effectively. Two main types: 1-piece systems 2-piece systems 1-PIECE SYSTEMS The pouch and the skin barrier (or flange) are a single, integrated unit. Advantages: Slimmer profile: Less bulky, more discreet under clothing. Easier application Lightweight: Comfortable for active individuals. Lower cost: Often less expensive than 2-piece systems. Disadvantages: Less flexibility: Must change the entire system when replacing. Shorter wear time: Frequent changes may be required. Skin irritation risk: Removal and replacement can stress the skin. https://youtu.be/dZigixuwkhA?si=-bpZETkY95PIfjo6  OSTOMY DEVICES 2-PIECE SYSTEMS The pouch and skin barrier are separate and attach via a coupling system (mechanical or adhesive). Advantages: Reusable skin barrier: Only the pouch needs changing, reducing skin irritation. Customizable Longer wear time Convenient pouch changes: Simple and quick to replace the pouch without removing the barrier. Disadvantages: Bulkier: May be more noticeable under clothing. Higher cost: Typically more expensive due to separate components. Requires dexterity: May be challenging for individuals with limited mobility or strength. https://youtu.be/feY3idewAc8?si=wOIz-cJXSqbK_04I  OSTOMY DEVICES 1-PIECE vs 2-PIECES SYSTEM  Clinical case 1 Maria, 45 years old, underwent a permanent ileostomy following surgery for severe ulcerative colitis unresponsive to medical treatment. Reported Problems: The patient experiences leakage of intestinal contents from the collection device, especially at night. The skin around the stoma shows redness and signs of contact dermatitis. Maria reports increased stool output and struggles to maintain proper hydration. Clinical case 2 Luigi, 60 years old, underwent a low anterior resection for rectal cancer and has a temporary colostomy to protect the anastomosis. Reported Problems: Swelling around the stoma, causing difficulties in fitting the device’s flange properly. Episodes of partial bowel obstruction, with intermittent abdominal pain and reduced stool output. Occasional prolapse of the stoma beyond the skin level.