Lecture Notes: GI Ostomies - Colostomies and Ileostomies

Introduction

• Speaker: Sarah from Registered Nurse RN
• Topic: GI Ostomies, specifically Colostomies and Ileostomies
• Resources: Free quiz available in the video description and at the end of the video

What is a Colostomy or Ostomy?

• Definition: A surgical opening on the abdomen surface to allow stool to exit the body
• Appearance: Ostomy should be red, shiny, and moist

Reasons for Colostomy/Ileostomy

• GI diseases: Crohn’s, ulcerative colitis, diverticulosis
• Infections, cancers (colon or rectal), injuries, congenital defects like obstruction
• Can be permanent or reversible

Anatomy and Physiology of the GI Tract

• Digestion Process:
  • Begins in the mouth, food mixed with saliva
  • Food travels down the esophagus to the stomach
  • In the stomach, gastric acids form a substance called chyme
  • Chyme moves to the small intestines: duodenum, jejunum, ileum
  • Ileum to large intestines: cecum, ascending colon, transverse colon, descending colon, sigmoid colon
  • Large intestine absorbs water, forms waste for excretion

Types of Colostomies

• Descending Colostomy: Located in the left upper abdomen
• Ascending Colostomy: Located in the right area of the abdomen
• Transverse Colostomy: Mid-abdominal
• Sigmoid Colostomy: Lower abdomen
• Double Barrel Ostomy: Two stomas (proximal drains stool, distal drains mucus)

Ileostomy

• Definition: Surgical opening to bring the ileum to the abdomen surface
• Location: Right lower quadrant

Preoperative and Postoperative Nursing Care

Preoperative Care

• Educate patient on appearance, location, and care of ostomy
• Discuss diet and pouching system
• Possible orders: antibiotics, dietary restrictions, cleansing solutions

Postoperative Care

• Monitor electrolytes, hydration, and urinary output
• Assess stoma appearance (healthy: pink/red, moist)
• Be alert for abnormal stoma appearance (black or dark red indicates compromised circulation)
• Manage different types of drainage

Types of Ostomy Drainage

• Ileostomy: Dark green to yellowish stool
• Colostomy:
  • Initial mucoid drainage, then liquid to formed stool over time
  • Ascending: liquid
  • Transverse: loose to semi-formed
  • Descending/Sigmoid: formed

Risks and Management

• Ileostomy: Higher risk of dehydration, skin breakdown
• Colostomy: Skin irritation management with a good pouching system

Pouching System and Skin Care

• Emptying Frequency: When 1/3 to halfway full
• Changing Frequency: Every 3-5 days
• Best Time to Change: In the morning
• Pouching Systems: One-piece and two-piece systems
• Skin Barrier: Cut 1/8 inch larger than the stoma

Medication and Diet Considerations

• Avoid: Enteric-coated or sustained-release medications
• Diet:
  • Start with low fiber, advance as tolerated
  • Small meals, thorough chewing, maintain hydration
  • Avoid hard-to-digest foods
  • Watch for gas-producing foods

Conclusion

• Wrap up of ostomy care
• Reminder to take the quiz and subscribe for more educational content