NCLEX Review: GI Ostomies - Colostomies and Ileostomies

Introduction

• Presenter: Sarah from RegisteredNurseAriene.com
• Focus on colostomies and ileostomies.
• NCLEX review with a free quiz available online.

What are Colostomies and Ileostomies?

• Definition: Surgical opening on the abdomen surface for stool exit.
• Stoma: The visible part of the ostomy on the abdomen.
  • Should appear red, shiny, and moist.

Reasons for Ostomies

• GI diseases: Crohn's, ulcerative colitis, diverticulosis.
• Infections, cancer (colon/rectal), injuries, congenital defects.
• Can be permanent or temporary.

Anatomy and Physiology of the GI Tract

• Digestive Process:
  • Starts in the mouth, food mixed with saliva.
  • Esophagus: Transports food to the stomach.
  • Stomach: Mixes food with gastric acid to form chyme.
  • Small Intestine: Absorbs nutrients (duodenum, jejunum, ileum).
  • Large Intestine (Colon): Absorbs water, forms stool (cecum, ascending, transverse, descending, sigmoid).

Types of Colostomies

• Ascending Colostomy: Right side of abdomen, liquid stool.
• Transverse Colostomy: Mid-abdomen, semi-formed stool.
• Descending Colostomy: Left upper abdomen, more formed stool.
• Sigmoid Colostomy: Lower left abdomen, near-normal stool consistency.
• Double Barrel Ostomy: Two stomas, proximal (stool) and distal (mucus).

Ileostomy

• Location: Right lower quadrant.
• Stool: Liquid, rich in electrolytes and enzymes.
• Risks: Dehydration, skin irritation.

Pre-op and Post-op Nursing Care

Pre-op Care

• Education: Inform patient about ostomy appearance, location, and care.
• Diet and Preparation:
  • Soft/semi-liquid diet prior to surgery.
  • Possible cleansing solutions for the colon.
  • Oral antibiotics to reduce infection risk.

Post-op Care

• Monitoring: Electrolytes, dehydration signs, stoma appearance.
• Stoma Appearance: Should be red and moist.
  • Abnormal: Black/dark red (compromised circulation), light pink (low hemoglobin/hematocrit).

Expected Drainage

• Ileostomy: Dark green initially, turns yellow as diet normalizes.
• Colostomy: Mucus initially, becomes more solid as diet normalizes.

Skin Care and Pouching System

• Pouching: Change every 3-5 days, empty when 1/3-1/2 full.
• Time for Change: Morning, when gut is least active.
• Skin Barrier: Cut to fit stoma, prevent skin contact with stool.

Medications and Diet

Medications

• Avoid enteric-coated or sustained-release meds for ileostomy patients.

Diet

• Start with low-fiber diet post-surgery.
• Small, frequent meals, thorough chewing.
• Avoid foods causing blockages or excessive gas.

Foods to Avoid

• Blockage Risk: Corn, seeds, nuts, raw mushrooms.
• Gas Producing: Beans, onions, broccoli.

Conclusion

• Ensure proper stoma care and patient education.
• Encourage use of resources like quizzes and videos for further learning.