Understanding Colostomies and Ileostomies

Hey everyone, it's Sarah with RegisteredNurseAriene.com and in this video I'm going to be doing an NCLEX review over GI ostomies specifically colostomies and ileostomies and as always in the YouTube description below or at the end of this YouTube video you can Access the free quiz that will test you on GI ostomies. So let's get started So what is a colostomy or an ileostomy? It is a surgical opening created on the surface of the abdomen to allow stool to exit the body rather than through the rectum. And here is what a basic GI ostomy looks like on the surface of the abdomen. And notice that you have the stoma and the stoma is setting right on the surface of the abdomen. And in the middle, this is where the stool will be excreted. You always want your stoma to look nice and red like this. It'll have a shiny look to it and be moist. So what are some reasons why a person may have an ostomy? One thing is they may have GI disease like Crohn's, ulcerative colitis, or diverticulosis, or an infection or cancer like colon or rectal cancer, or maybe an injury or congenital defects like an obstruction. And a colostomy or an ileostomy may be permanent or reversible depending on what's going on with the patient and their treatment plan. Now before we dive into our lecture about colostomies, ileostomies, and the nursing care, let's go back to the basics. Let's look at the anatomy and physiology of the GI tract and how food flows through the system. And as I do this, be sure you pay attention to the small intestines, specifically the ileum and where it's located, and the parts of the large intestine, like the colon areas, because this is where your ostomies are going to be located and you need to be familiar with those locations. So whenever you eat food, digestion starts in the mouth. So you eat food, you chew it up, your saliva's mixing with it, it's breaking down the food a little bit, and then you're going to swallow it. And you're going to swallow it. down through a tube called the esophagus. And the esophagus is going to use peristalsis to get that food down into your stomach, which is like a pouch. and in that stomach is gastric acid. And it's gonna mix with your food and it's gonna break it down a little bit and it's gonna turn into a substance called chyme. Then it's going to go through the small intestine. And the small intestines are responsible for absorbing and digesting your food. That is its huge role. So the food's gonna enter into the first part of the small intestine, it's called the duodenum. Then it's gonna flow down. through through the jejunum and then it's going to go through the last part of the small intestines called the ileum and the ileum is where our ileostomy will be then the food will flow into the large intestine and colon is also called large intestine it's going to enter in through the cecum up through the ascending colon across the transverse colon down through the descending colon into the sigmoid colon and your large intestine the big role it does is it absorbs water and it helps get the food that your body didn't use the waste and forms it so you can pass it as stool through the rectum then to the anus and then out so that is how the basic setup of how food will flow through your GI tract first let's start out talking about colostomies okay we know that GI ostomy is where a surgical opening has been created to bring some part of the intestines to the abdominal surface so stool can be excreted rather than through the rectum well a colostomy is a surgical opening that brings the large intestine the colon to the surface of the abdomen now there are various locations for a colostomy so different types and I would remember these types because you need to know them for when you're assessing a patient with a colostomy. If you see it on the right side, the left side, mid-abdominal, you need to know what type of colostomy that is and what type of stool you would be expecting from that colostomy because depending on its location there's going to be different varieties of stool which we'll talk about a little bit later. So let's talk about the types. Okay to help you remember the different types, remember this mnemonic. That's for that's a colostomy. Glastamine. D is for descending. When you have a descending colostomy, it will be located in the left upper abdomen. So we have our left, we have our descending colon and you could expect one about right here. Then we have our ascending and you could expect an ascending colostomy to be on the right area of the abdomen. So over here on the right side where the ascending colon is, you would expect one about right here. Then we have a transverse colostomy and you will expect that about mid-abdominal so you have your transverse colon so about right here is where you would expect that and then we have a sigmoid colostomy and this can be found in the lower the less lower area of the abdomen so we have our sigmoid colon right here so about right there would be be a little bit lower than your descending colon so you could expect that right there now let me discuss this real fast with you it's called a double barrel ostomy and it's where it's part of the transverse colon so you would find one about up in this region and it is the creation of two stomas and let me show you what one looks like as you can see here we have two stomas and the stomas are nice and red they're moist they're shiny, which is how we want them to look. And I would remember this part. Okay, we have the proximal stoma and we have the distal stoma. And the proximal stoma is connected to the upper GI tract. So it's functional and it's going to be draining stool. So that's what we will expect out of here. But over here with our distal, it's connected to the rectum and it's not functional. Sometimes it's referred to as a mucus fistula. So what you will expect to come out of here would be mucus. So if you're ever asked on a test, a patient has a double barrel ostomy, what do you expect the proximal and the distal to drain? You will know that the proximal drains stool and the distal will drain mucus. And so that's what your classic double barrel ostomy will look like. Now let's talk about an ileostomy. Okay, an ileostomy is a surgical opening that has been created to bring the small intestines, specifically the ileum, to the surface. of the abdomen so stool can be excreted. and an ileostomy is going to be located in the right lower quadrant. So you can expect one to be about right here on the abdomen. Now let's look at the pre-op and the post-op nursing care that you will be providing to that patient who may be getting an ostomy. Okay, so the pre-op. Okay, what are you going to do as the nurse? Number one, your role is educating. You want to sit down with that patient. You want to talk to them about how the ostomy is going to be is going to look you don't want them the first time they see an ostomy stoma is right after surgery that'll really scare them so they need to be familiar with what's going to happen where it's going to be located at on the abdomen diet what kind of diet they need to follow which we're going to cover in the post stop part of this lecture a little bit later and the pouching system of how it's going to work with placing the pouch on how to do that and because at first it can be really confusing and overwhelming for the patient. So if you introduce them to that a little bit in the pre-op part, when the post-op part comes in, they actually have to start participating and taking over care for that. It won't be so overwhelming. And I'm going to be making a video on how to place an ostomy pouch and how to provide care. So be sure to check out that video. Okay. Another thing, the MD may order oral antibiotics. Why? Because in your gut, are are all these bacteria that normally live there. But when you go in and you do surgery and you mess around with those, you can cause some problems. So the Anabox will help decrease the bacteria in the colon and decrease the chances of post-op infection. And also the physician may order the patient about two to three days prior to surgery to be on a soft or semi-liquid diet. Also may order cleansing solutions to cleanse the colon, get it all cleaned out before they go in. there and do surgery don't want any residue of food in there and they also may be on a clear liquid diet 24 hours before and then nothing by mouth and a lot of times patients are admitted to the hospital because they're gonna be on these cleansing solution which is going to cause profuse diarrhea and they're at risk for electrolyte imbalance and dehydration so they will probably be on an IV solution to help balance that out Now let's look at the post-op care. Okay, so your patient's back, they've had their ostomy placement. What is your role as the nurse? Okay, you're going to monitor their electrolytes, you're going to monitor them for signs of dehydration. So you're going to be looking at that urinary output, making sure that they're stable, they're doing good, and they're tolerating everything. Also, big thing what you want to do is you want to monitor that site, specifically that stoma. Okay. And what you're looking at is how does the stoma look? So how should it look? After surgery, the stoma is going to be large and swollen. And you need to let the patient know that as months go by, the stoma will shrink down to normal size. But at first it's okay, it's going to be large and swollen. Now the stoma should always look pink or red, like how I showed you in that example of red, and be moist and shiny, like the inside of your cheek. of your mouth. Abnormal! I would remember this. Test questions like to give you a scenario about how a stoma may look and what it shouldn't look like. So if the stoma appears to be black or dark red that could indicate, well it indicates compromised circulation to that stoma. Not good. You need to contact the doctor immediately. And let's look at a stoma that has compromised circulation versus a stoma that is nice and healthy. And I want you to see the difference. Over here we have an ostomy. This does not look good. This has compromised circulation. So if you ever see it's turning black or a dark red, not good at all. compared to how you want it to look. So just looking at the difference you can really tell that something just is not right over here compared to over here. Also, you want to make sure the stoma does not look light pink. That can indicate a low hemoglobin or hematocrit level. So anytime those types of stomas present you'll want to notify the doctor. Okay, so what kind of drainage do you expect your ostomy, depending on if it's an ileostomy or colostomy, to have after surgery? I'm going to show you how to do that. Okay, and ileostomy, remember it's going to be located in that right lower quadrant. It's going to drain dark green stool. And as the patient, whenever they start to eat and tolerate food, they'll start out slow, clear as fools, and that stool will start to turn like a yellowish color. Now, the colostomy, at first it may be like a mucousy, mucoid type drainage. And as time goes by, it's normal for it not to really produce anything until about day two. first it's probably going to be liquid then depending on where that colostomy is located it'll turn into the form that it's supposed to look like which we'll cover here in a second and over the site and you could expect a petroleum gauze to keep the site nice and moist and also later on there may be a sterile dry dressing until you get the pouching system in place to start draining the stool so remember if a test question asks you the dressing fell off what are you going to reapply or what type of dressing do you expect the patient to come back from surgery remember petroleum gauze dressing now let's look at the types of stool that you should expect after the post-op period has passed a little bit what that site should be putting out. Okay colostomies. Okay you have the ascending colostomy. Remember it's over here. So referring back to the beginning of the lecture when we talked about the food going through the system. Remember the food's going through the small intestines and it's liquid. Okay and once it hits the colon as it goes through the colon more and more water is going to be absorbed. So remember the big role of the large intestine was to absorb water. So you can expect if it starts out in the ascending colon, it's going to be liquid because it's just came from the small intestine. So that's how you can expect the stool to be when it comes out of the ascending colon as the ascending colostomy. Now transverse. Now as it travels up through the transverse and you have a transverse colostomy, more water is going to be absorbed. So it's not going to be totally form. So it's going to be loose to partly form, semi. Now as it travels down through the descending into the sigmoid, a lot more water is being absorbed and it's going to start looking similar to what the patient would expel normally through the rectum through the anus. So you can expect it to look like a similar consistency to what it should look like normally. Now keep this in mind. Remember this the descending and sigmoid colon colostomies the patient has a greater chance of developing bowel continence where they can learn to control their bowel movements and Why because look normally if stool was going to go in the rectum you control your bowel movements so the more distal the Colostomy is down in GI tract the greater chance of continence that patient has and they can learn to do this through Irrigation which is just an enema given through the stoma and I'll be making a video on how to do that So stay tuned for that now. Let's look at ileostomy. How do you expect the stool to be? Well as we learn the small intestine, it's rich in electrolytes. It's rich in water and digestive enzymes So, that stool is always going to be liquid. That's what we expect. And, like I said, it's rich in all those enzymes, electrolytes, and water. Now, if you have a patient with an ileostomy because of the substance in that being excreted through that, the patient has a higher risk of dehydration because it's going to go through the colon to be absorbed, so they're losing a lot of water and electrolyte imbalance as well. Another thing to keep in mind, there is a major risk for skin breakdown around that stoma. That's true for the colostomy as well because you don't want that nasty bacteria getting on that skin. It's going to cause issues, but especially with your ileostomy. If it gets on the stoma, it's fine because that's like the part of the GI tract just flipped out. It's normal. It lives in those conditions normally, but our skin doesn't. If you get that... stool from the ileostomy onto the skin with those digestive enzymes and all that, it's going to get on the skin. It's going to cause major irritation. Notice how around the stoma, the skin is very irritated. It's excoriated. And what you want to do is you always want to make sure that the side around the stoma is dry and clean and that stool is not getting on there. And what will really help prevent this is a good pouching system with a really good skin barrier, which we'll discuss in the next video on how to apply that. So always when you're inspecting and assessing as a nurse, always look around the skin and make sure it does not look like this. Okay, continuing with the post-op care that you'll be providing to the patient. One of the big things you need to know is about the pouching system. Here, we have an ostomy and it has a pouch over it. This pouch will collect the stool that will drain from it. So as the nurse, you need to be teaching the patient and you need to know how often you will empty this bag, when you will change the system out, and how to change it. So some highlights. Okay, you will empty the bag whenever it becomes about one-third to halfway full of stool. Every system is different, so always get familiar with what the patient has or what your employer has for the patient. This one one's a clamp, you would undo the clamp and empty it into the commode. Some of them are Velcroed, some of them you just take off and you have to get a whole new pouch because it snaps on there. The whole pouching system, you will change it about every three to five days. And around the system is some skin barrier that sets around the stoma to protect it from any drainage leaking onto the skin. and you will change that whole system out and in the next video i will show you how to do that and when is the best time to change the pouch on the patient the whole system about in the morning Whenever the gut is the least active, so before breakfast, they just got up, they haven't ate, and that's usually the best time to do it. And you'll want the patient to report if they feel any wetness around the stoma or if there's any burning. If that happens you'll want to completely replace the system because you don't want that stool to get onto the skin because it can cause a lot of problems. Now there's various types of pouching systems. The one I have here is called a one-piece system and it has the skin barrier attached to the bag. The two-piece systems will have the skin barrier separate in the bag and they'll just snap together. Now there's some things you want to keep in mind whenever you're replacing the skin barrier. The skin barrier is going to prevent stool from coming into contact with the skin. So what you'll do is you'll have to measure the stoma with a measuring card. a lot of Cosme kits come with them so you'll measure the stoma to whatever size it is and you will cut the opening of the barrier to be about one-eighth inch larger than the stoma. So you don't want the hole to be so small it's constricting the stoma and you don't want it to be too large that it allows stool to leak onto the skin underneath the skin barrier around it. So remember that. 1 8 inch is how much you want to cut it larger than the stoma now let's look at medications and diet for your patients with ostomies okay medications specifically the ileostomy you do not want to give them enteric coated or sustained release medications because, where the ileostomies add, that medication won't be able to work correctly because with enteric coated, these medications don't dissolve until they release a specific part in the small intestine. So like aspirin enteric coated, you wouldn't want to do. other drugs similar to that. Your sustained release are medications released over a certain period of time. Not a candidate for that. As a side note, you will never want to crush these medications because crushing it is messing up how it's supposed to work because it's made to work whenever it gets to a certain part in the body or released slowly over an amount of time. Now diet. Let's talk about that. Whenever you have a patient who just had an ostomy placed, generally they will start out slow with their food for about the first six weeks. Advanced things is tolerated. Get comfortable, get the gut readjusted to what's going on. They'll start out usually on a low fiber diet. They want to eat small meals throughout the day, not huge, large ones. That's a lot for the gut to handle. And they'll want to chew their food thoroughly because depending on where they have their ostomy at. The food's not getting broke down like it normally could, so they need to help with that process by breaking it down as much as they can in the mouth. And maintaining hydration, especially with your ileostomies, because remember, the drainage that they're draining is rich in water that your colon can absorb and electrolytes, so it's all going out. So they need to make sure that they drink Gatorade or some type of electrolyte solution to maintain that. And And they will eventually be able to follow a regular diet, but they'll probably want to avoid foods that caused them problems before they had the ostomy place because chances are they'll have problems with it again. And they'll want to use caution with the following foods, like hard to digest foods, because this could block the stoma. So they either need to avoid these foods altogether or eat them in very, very small amounts. And foods like this include corn, peas, coleslaw. popcorn nuts and seeds raisins skin of fruits and raw mushrooms or pineapple so just think common sense what is not normally digested very well what could get stuck in a little stoma hole that could cause a problem a patient issue so if you see a test question try to look for those options okay also gas a lot of times and with ostomies they can produce odorous gas so food to eat to avoid from having this gas would be beans, onions, eggs, broccoli, cabbage, garlic, alcoholic beverages, fish, or any types of foods that have high fiber in them. And one thing you'll need to be educating your patient about because gas is produced, the ostomy bag over time can inflate and they'll need to know how to release that gas from that bag. bag. And a lot of times they are making ostomy bags that have a filter on them which will help the gas to escape and it filters out so it doesn't have a smell. Or they can use pouch drops in the pouch to prevent the smell. Okay, so that wraps up this NCLEX review on GI ostomies. Thank you so much for watching. Don't forget to take the free quiz and to subscribe to our channel for more videos.

And in the middle, this is where the stool will be excreted. You always want your stoma to look nice and red like this. It'll have a shiny look to it and be moist. So what are some reasons why a person may have an ostomy?

One thing is they may have GI disease like Crohn's, ulcerative colitis, or diverticulosis, or an infection or cancer like colon or rectal cancer, or maybe an injury or congenital defects like an obstruction. And a colostomy or an ileostomy may be permanent or reversible depending on what's going on with the patient and their treatment plan. Now before we dive into our lecture about colostomies, ileostomies, and the nursing care, let's go back to the basics. Let's look at the anatomy and physiology of the GI tract and how food flows through the system.

And as I do this, be sure you pay attention to the small intestines, specifically the ileum and where it's located, and the parts of the large intestine, like the colon areas, because this is where your ostomies are going to be located and you need to be familiar with those locations. So whenever you eat food, digestion starts in the mouth. So you eat food, you chew it up, your saliva's mixing with it, it's breaking down the food a little bit, and then you're going to swallow it. And you're going to swallow it. down through a tube called the esophagus.

And the esophagus is going to use peristalsis to get that food down into your stomach, which is like a pouch. and in that stomach is gastric acid. And it's gonna mix with your food and it's gonna break it down a little bit and it's gonna turn into a substance called chyme. Then it's going to go through the small intestine.

And the small intestines are responsible for absorbing and digesting your food. That is its huge role. So the food's gonna enter into the first part of the small intestine, it's called the duodenum. Then it's gonna flow down.

through through the jejunum and then it's going to go through the last part of the small intestines called the ileum and the ileum is where our ileostomy will be then the food will flow into the large intestine and colon is also called large intestine it's going to enter in through the cecum up through the ascending colon across the transverse colon down through the descending colon into the sigmoid colon and your large intestine the big role it does is it absorbs water and it helps get the food that your body didn't use the waste and forms it so you can pass it as stool through the rectum then to the anus and then out so that is how the basic setup of how food will flow through your GI tract first let's start out talking about colostomies okay we know that GI ostomy is where a surgical opening has been created to bring some part of the intestines to the abdominal surface so stool can be excreted rather than through the rectum well a colostomy is a surgical opening that brings the large intestine the colon to the surface of the abdomen now there are various locations for a colostomy so different types and I would remember these types because you need to know them for when you're assessing a patient with a colostomy. If you see it on the right side, the left side, mid-abdominal, you need to know what type of colostomy that is and what type of stool you would be expecting from that colostomy because depending on its location there's going to be different varieties of stool which we'll talk about a little bit later. So let's talk about the types. Okay to help you remember the different types, remember this mnemonic.

That's for that's a colostomy. Glastamine. D is for descending. When you have a descending colostomy, it will be located in the left upper abdomen.

So we have our left, we have our descending colon and you could expect one about right here. Then we have our ascending and you could expect an ascending colostomy to be on the right area of the abdomen. So over here on the right side where the ascending colon is, you would expect one about right here. Then we have a transverse colostomy and you will expect that about mid-abdominal so you have your transverse colon so about right here is where you would expect that and then we have a sigmoid colostomy and this can be found in the lower the less lower area of the abdomen so we have our sigmoid colon right here so about right there would be be a little bit lower than your descending colon so you could expect that right there now let me discuss this real fast with you it's called a double barrel ostomy and it's where it's part of the transverse colon so you would find one about up in this region and it is the creation of two stomas and let me show you what one looks like as you can see here we have two stomas and the stomas are nice and red they're moist they're shiny, which is how we want them to look. And I would remember this part.

Okay, we have the proximal stoma and we have the distal stoma. And the proximal stoma is connected to the upper GI tract. So it's functional and it's going to be draining stool.

So that's what we will expect out of here. But over here with our distal, it's connected to the rectum and it's not functional. Sometimes it's referred to as a mucus fistula.

So what you will expect to come out of here would be mucus. So if you're ever asked on a test, a patient has a double barrel ostomy, what do you expect the proximal and the distal to drain? You will know that the proximal drains stool and the distal will drain mucus.

And so that's what your classic double barrel ostomy will look like. Now let's talk about an ileostomy. Okay, an ileostomy is a surgical opening that has been created to bring the small intestines, specifically the ileum, to the surface.

of the abdomen so stool can be excreted. and an ileostomy is going to be located in the right lower quadrant. So you can expect one to be about right here on the abdomen. Now let's look at the pre-op and the post-op nursing care that you will be providing to that patient who may be getting an ostomy.

Okay, so the pre-op. Okay, what are you going to do as the nurse? Number one, your role is educating. You want to sit down with that patient.

You want to talk to them about how the ostomy is going to be is going to look you don't want them the first time they see an ostomy stoma is right after surgery that'll really scare them so they need to be familiar with what's going to happen where it's going to be located at on the abdomen diet what kind of diet they need to follow which we're going to cover in the post stop part of this lecture a little bit later and the pouching system of how it's going to work with placing the pouch on how to do that and because at first it can be really confusing and overwhelming for the patient. So if you introduce them to that a little bit in the pre-op part, when the post-op part comes in, they actually have to start participating and taking over care for that. It won't be so overwhelming. And I'm going to be making a video on how to place an ostomy pouch and how to provide care. So be sure to check out that video.

Okay. Another thing, the MD may order oral antibiotics. Why?

Because in your gut, are are all these bacteria that normally live there. But when you go in and you do surgery and you mess around with those, you can cause some problems. So the Anabox will help decrease the bacteria in the colon and decrease the chances of post-op infection. And also the physician may order the patient about two to three days prior to surgery to be on a soft or semi-liquid diet.

Also may order cleansing solutions to cleanse the colon, get it all cleaned out before they go in. there and do surgery don't want any residue of food in there and they also may be on a clear liquid diet 24 hours before and then nothing by mouth and a lot of times patients are admitted to the hospital because they're gonna be on these cleansing solution which is going to cause profuse diarrhea and they're at risk for electrolyte imbalance and dehydration so they will probably be on an IV solution to help balance that out Now let's look at the post-op care. Okay, so your patient's back, they've had their ostomy placement. What is your role as the nurse?

Okay, you're going to monitor their electrolytes, you're going to monitor them for signs of dehydration. So you're going to be looking at that urinary output, making sure that they're stable, they're doing good, and they're tolerating everything. Also, big thing what you want to do is you want to monitor that site, specifically that stoma.

Okay. And what you're looking at is how does the stoma look? So how should it look? After surgery, the stoma is going to be large and swollen. And you need to let the patient know that as months go by, the stoma will shrink down to normal size.

But at first it's okay, it's going to be large and swollen. Now the stoma should always look pink or red, like how I showed you in that example of red, and be moist and shiny, like the inside of your cheek. of your mouth.

Abnormal! I would remember this. Test questions like to give you a scenario about how a stoma may look and what it shouldn't look like. So if the stoma appears to be black or dark red that could indicate, well it indicates compromised circulation to that stoma. Not good.

You need to contact the doctor immediately. And let's look at a stoma that has compromised circulation versus a stoma that is nice and healthy. And I want you to see the difference.

Over here we have an ostomy. This does not look good. This has compromised circulation.

So if you ever see it's turning black or a dark red, not good at all. compared to how you want it to look. So just looking at the difference you can really tell that something just is not right over here compared to over here.

Also, you want to make sure the stoma does not look light pink. That can indicate a low hemoglobin or hematocrit level. So anytime those types of stomas present you'll want to notify the doctor. Okay, so what kind of drainage do you expect your ostomy, depending on if it's an ileostomy or colostomy, to have after surgery? I'm going to show you how to do that.

Okay, and ileostomy, remember it's going to be located in that right lower quadrant. It's going to drain dark green stool. And as the patient, whenever they start to eat and tolerate food, they'll start out slow, clear as fools, and that stool will start to turn like a yellowish color.

Now, the colostomy, at first it may be like a mucousy, mucoid type drainage. And as time goes by, it's normal for it not to really produce anything until about day two. first it's probably going to be liquid then depending on where that colostomy is located it'll turn into the form that it's supposed to look like which we'll cover here in a second and over the site and you could expect a petroleum gauze to keep the site nice and moist and also later on there may be a sterile dry dressing until you get the pouching system in place to start draining the stool so remember if a test question asks you the dressing fell off what are you going to reapply or what type of dressing do you expect the patient to come back from surgery remember petroleum gauze dressing now let's look at the types of stool that you should expect after the post-op period has passed a little bit what that site should be putting out.

Okay colostomies. Okay you have the ascending colostomy. Remember it's over here. So referring back to the beginning of the lecture when we talked about the food going through the system. Remember the food's going through the small intestines and it's liquid.

Okay and once it hits the colon as it goes through the colon more and more water is going to be absorbed. So remember the big role of the large intestine was to absorb water. So you can expect if it starts out in the ascending colon, it's going to be liquid because it's just came from the small intestine.

So that's how you can expect the stool to be when it comes out of the ascending colon as the ascending colostomy. Now transverse. Now as it travels up through the transverse and you have a transverse colostomy, more water is going to be absorbed.

So it's not going to be totally form. So it's going to be loose to partly form, semi. Now as it travels down through the descending into the sigmoid, a lot more water is being absorbed and it's going to start looking similar to what the patient would expel normally through the rectum through the anus.

So you can expect it to look like a similar consistency to what it should look like normally. Now keep this in mind. Remember this the descending and sigmoid colon colostomies the patient has a greater chance of developing bowel continence where they can learn to control their bowel movements and Why because look normally if stool was going to go in the rectum you control your bowel movements so the more distal the Colostomy is down in GI tract the greater chance of continence that patient has and they can learn to do this through Irrigation which is just an enema given through the stoma and I'll be making a video on how to do that So stay tuned for that now. Let's look at ileostomy.

How do you expect the stool to be? Well as we learn the small intestine, it's rich in electrolytes. It's rich in water and digestive enzymes So, that stool is always going to be liquid. That's what we expect.

And, like I said, it's rich in all those enzymes, electrolytes, and water. Now, if you have a patient with an ileostomy because of the substance in that being excreted through that, the patient has a higher risk of dehydration because it's going to go through the colon to be absorbed, so they're losing a lot of water and electrolyte imbalance as well. Another thing to keep in mind, there is a major risk for skin breakdown around that stoma.

That's true for the colostomy as well because you don't want that nasty bacteria getting on that skin. It's going to cause issues, but especially with your ileostomy. If it gets on the stoma, it's fine because that's like the part of the GI tract just flipped out.

It's normal. It lives in those conditions normally, but our skin doesn't. If you get that... stool from the ileostomy onto the skin with those digestive enzymes and all that, it's going to get on the skin. It's going to cause major irritation.

Notice how around the stoma, the skin is very irritated. It's excoriated. And what you want to do is you always want to make sure that the side around the stoma is dry and clean and that stool is not getting on there. And what will really help prevent this is a good pouching system with a really good skin barrier, which we'll discuss in the next video on how to apply that. So always when you're inspecting and assessing as a nurse, always look around the skin and make sure it does not look like this.

Okay, continuing with the post-op care that you'll be providing to the patient. One of the big things you need to know is about the pouching system. Here, we have an ostomy and it has a pouch over it.

This pouch will collect the stool that will drain from it. So as the nurse, you need to be teaching the patient and you need to know how often you will empty this bag, when you will change the system out, and how to change it. So some highlights.

Okay, you will empty the bag whenever it becomes about one-third to halfway full of stool. Every system is different, so always get familiar with what the patient has or what your employer has for the patient. This one one's a clamp, you would undo the clamp and empty it into the commode. Some of them are Velcroed, some of them you just take off and you have to get a whole new pouch because it snaps on there. The whole pouching system, you will change it about every three to five days.

And around the system is some skin barrier that sets around the stoma to protect it from any drainage leaking onto the skin. and you will change that whole system out and in the next video i will show you how to do that and when is the best time to change the pouch on the patient the whole system about in the morning Whenever the gut is the least active, so before breakfast, they just got up, they haven't ate, and that's usually the best time to do it. And you'll want the patient to report if they feel any wetness around the stoma or if there's any burning.

If that happens you'll want to completely replace the system because you don't want that stool to get onto the skin because it can cause a lot of problems. Now there's various types of pouching systems. The one I have here is called a one-piece system and it has the skin barrier attached to the bag. The two-piece systems will have the skin barrier separate in the bag and they'll just snap together.

Now there's some things you want to keep in mind whenever you're replacing the skin barrier. The skin barrier is going to prevent stool from coming into contact with the skin. So what you'll do is you'll have to measure the stoma with a measuring card. a lot of Cosme kits come with them so you'll measure the stoma to whatever size it is and you will cut the opening of the barrier to be about one-eighth inch larger than the stoma. So you don't want the hole to be so small it's constricting the stoma and you don't want it to be too large that it allows stool to leak onto the skin underneath the skin barrier around it.

So remember that. 1 8 inch is how much you want to cut it larger than the stoma now let's look at medications and diet for your patients with ostomies okay medications specifically the ileostomy you do not want to give them enteric coated or sustained release medications because, where the ileostomies add, that medication won't be able to work correctly because with enteric coated, these medications don't dissolve until they release a specific part in the small intestine. So like aspirin enteric coated, you wouldn't want to do.

other drugs similar to that. Your sustained release are medications released over a certain period of time. Not a candidate for that.

As a side note, you will never want to crush these medications because crushing it is messing up how it's supposed to work because it's made to work whenever it gets to a certain part in the body or released slowly over an amount of time. Now diet. Let's talk about that.

Whenever you have a patient who just had an ostomy placed, generally they will start out slow with their food for about the first six weeks. Advanced things is tolerated. Get comfortable, get the gut readjusted to what's going on. They'll start out usually on a low fiber diet.

They want to eat small meals throughout the day, not huge, large ones. That's a lot for the gut to handle. And they'll want to chew their food thoroughly because depending on where they have their ostomy at. The food's not getting broke down like it normally could, so they need to help with that process by breaking it down as much as they can in the mouth.

And maintaining hydration, especially with your ileostomies, because remember, the drainage that they're draining is rich in water that your colon can absorb and electrolytes, so it's all going out. So they need to make sure that they drink Gatorade or some type of electrolyte solution to maintain that. And And they will eventually be able to follow a regular diet, but they'll probably want to avoid foods that caused them problems before they had the ostomy place because chances are they'll have problems with it again.

And they'll want to use caution with the following foods, like hard to digest foods, because this could block the stoma. So they either need to avoid these foods altogether or eat them in very, very small amounts. And foods like this include corn, peas, coleslaw.

popcorn nuts and seeds raisins skin of fruits and raw mushrooms or pineapple so just think common sense what is not normally digested very well what could get stuck in a little stoma hole that could cause a problem a patient issue so if you see a test question try to look for those options okay also gas a lot of times and with ostomies they can produce odorous gas so food to eat to avoid from having this gas would be beans, onions, eggs, broccoli, cabbage, garlic, alcoholic beverages, fish, or any types of foods that have high fiber in them. And one thing you'll need to be educating your patient about because gas is produced, the ostomy bag over time can inflate and they'll need to know how to release that gas from that bag. bag.

And a lot of times they are making ostomy bags that have a filter on them which will help the gas to escape and it filters out so it doesn't have a smell. Or they can use pouch drops in the pouch to prevent the smell. Okay, so that wraps up this NCLEX review on GI ostomies.

Thank you so much for watching. Don't forget to take the free quiz and to subscribe to our channel for more videos.

Transcript for:Understanding Colostomies and Ileostomies

Transcript for:
Understanding Colostomies and Ileostomies