hey everyone it's Sarah with register nurse rn.com and in this video I'm going to be doing an inlex review over GI osm specifically colostomies and IL oomies 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 EMES so let's get started so what is a colostomy or an ostomy 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 ostomate looks like on the surface of the abdomen and notice that you have the stom and the stom is setting right on the surface of the abdomen and in the middle this is where the stool will be excreted and you always want your stom 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 osme 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 colomy or an iloom 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 osies and the nursing care let's go back to the basics let's look at the anatomy and physiology of the GI track and how food flows through the system and as I do this be sure you pay attention to the small intestines specifically the ilum and where it's located and the parts of the large intestine like the colon areas because this is where your Aames 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 Slava is 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 esoph esophagus is going to use parolis to get that food down into your stomach which is like a pouch and in that stomach is gastric acid and it's going to mix with your food and it's going to break it down a little bit and it's going to turn into a substance called Kim 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 going to enter into the first part of the small intestines called the doo denim then it's going to flow down through through the Juna and then it's going to go through the last part of the small intestines called the ilium and the ilium is where our ilos 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 seeum 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 waist 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 track first let's start out talking about colostomies okay we know that GI omey is where a surgical opening has been created to bring some part of the intestines to the abdominal surface so um 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 coloss me so different types and I would remember these types because you need to know them for when you're a assessing a patient with a colostomy if you see it on the right side the left side midabdominal you need to know what type of um colostomy that is and what type of stool you would be expecting from that colos 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 pneumonic that's for that a colostomy D is for descending so 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 colomy 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 L lower area of the abdomen so we have our sigmoid colon right here so about right there it would be a little bit lower than your descending colum so you could expect that right there now let me discuss this real fast with you it's called a double barrel osty and it's where it's part of the transverse colon so you would find one about up in this region and it is a 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 stom and we have the distal stom and the proximal stom 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 um 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 um test a patient has a double barrel omey 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 iloy okay an iloy is a surgical opening that has been created to bring the small intestines specifically the ilium to the surface of the abdomen so stool can be excreted and an iloom is going to be located in the right lower quadrant so you could expect one to be about right here on the abdomen now let's look at the preop and the post-op nursing care that you will be providing to that patient who may be getting an osty okay so the preall okay what are you going to do as a nurse number one Your Role is educating you to sit down with that patient you want to talk to them about how the ostomy is going to look you don't want them the first time they see an osty sto 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 posttop 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 um because at first it can um 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 and 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 omey pouch and how to provide care so be sure to check out that video okay another thing the MD May order or antibiotics why because in your gut 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 antio will help decrease the bacteria and the colon and decrease the chances of posttop infection and also the physician um May order the patient um about two to three days prior to surgery to be on a soft or semi- liquid diet um Also may order cleansing solutions to cleanse the coal and get it all cleaned out before they go in there and do surgery don't want any residue of food in there um 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 going to be on these cleansing solution which is going to cause profuse diarrhea and they're at risk for um electrolyte imbalance and dehydration so they um will probably be on um an IV solution to help um bance that out now let's look at the posttop care okay so your patients's back they've had their osty 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 um they're tolerating everything also big thing what you want to do is you want to monitor that sight specifically that sto and what you're looking at is um how does the stom look so how should it look after surgery the stom is going to be large and swollen and you need to let the patient know that as months go by the stom will shrink down to normal size but at first it's okay it's going to be large and swollen now the stom 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 stom may look and what should what it shouldn't look like so if the stom appears to be black or dark red that could indicate well it indicates compromise circulation to that stom not good you need to contact the doctor immediately and then and let's look at a stom that has compromised circulation versus a stom is nice and healthy and I want you to see the difference over here we have an OSI 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 stom does not look light pink that can indicate a low hemoglobin or hematocrit level so anytime those types of stas 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 IL ostomy or colostomy to have after surgery okay an IL ostomy 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 clears fulls and um that 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 um it's normal for it not to really produce anything until about day two but at 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 um you could expect a petroleum gauze uh to keep the site nice and moist um also uh 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 now let's look at the types of stool that you should expect after the postop period has passed a little bit what that site should be putting out okay colomes okay you have the ascending colomine 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 um 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 intestin 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 intestines 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 coloss more water is going to be absorb absorb so it's not going to be totally formed so it's going to be loose to partly formed semi now as it travels down through the descending into the sigmoid 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 um consistency to what it should look like normally now keep this in mind remember this the descending and sigmoid colon um colostomies the patient has a greater chance of developing bow continents where they can learn to control their valve movements and um why because look normally if stool was going to go in the rectum you control your bowel movement so the more distal the um colos is down in the 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 stom and I'll be making a video on how to do that so stay tuned for that now let's look at ilos how do you expect the stool to be well as we learned 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 ilos because of that the substance in that um being excreted through that the patient has a higher risk of dehydration because it's not going to go through the colon to be absorbed so they're losing a lot of water and um electrolyte imbalance as well and another thing to keep in mind there is a major risk for skin breakdown around that stom now 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 iloom if it gets on the stom it's fine because that's like the part of the GI um track just flipped out and it's normal it like it lives in those conditions normally but our skin doesn't so if you get the um stool from the ilos 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 stom the skin is very irritated it's excoriated and um what you want to do is you always want to make sure that the side around the stom 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 will discuss in the next video on how to apply that so always when you're inspecting assessing as a nurse always look around the skin and make sure it does not look like this okay continuing with the posttop care that you'll be Pro providing to the patient one of the big things you need to know is about the pouching system here we have an OSI and it has a pouch over it um 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 you need to know um 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 comes becomes about 1/3 to halfway full of stool um every system is different so always get familiar with what the patient has or what your employer has for the patient this one's a clamped um you would undo the clamp and empty it into the commode um 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 um 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 stom 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 um system about um in the morning whenever the gut is the least active so before breakfast they just SC up they haven't ate um 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 have here is called a one piece system and it has the Skin Barrier attached to the bag of the two piece systems will have the Skin Barrier separate in the bag and they'll just um snap together now there's some things you want to keep in mind whenever you're replacing this 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 stom with a measuring card a lot of omey kits come with them so you'll measure the stom to whatever size it is and you will cut the opening of the barrier to be about 1/8 in larger than the stom so you don't want the hole to be so small it's constricting the stom 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 in is how much you want to cut it larger than the stom now let's look at medications and diet for your patients with EMES okay medications specifically the ostomy um you do not want to give them inter coated or sustain relase medications because where the IL oomies add that medication won't be able to work correctly because with inter CED these medications don't dissolve until they release a specific part in the small intestine so like aspirin and Terra codage you wouldn't want to do or other drugs similar to that and your sustained release are medications released over a certain period of time so not a candidate for that and 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 release slowly over amount of time now diet let's talk about that okay whenever you have a patient who just had an omey Place generally they will start out slow with their food for about the first six weeks Advance things as tolerated get comfortable get the gut readjusted to what's going on um 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 to their food thoroughly because depending on where they have their Emy at you know 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 M and maintaining hydration especially with your ioses because remember that um 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 know drink Gatorade or some type of electrolyte solution to maintain that and um they will eventually be able to follow a regular diet but they'll probably want to avoid foods that cause them problems before they had the OSI 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 stonea so they either need to avoid these Foods all together or eat them in very very small amount and foods like this include corn peas cold saw popcorn nuts and seeds raisins skin of fruits and raw mushrooms or pineapples so just think Common Sense what is not normally digested very well what could get stuck in a little stom hole that could cause a problem a patient issue so if you see a test question try to look for those options okay also um gas a lot of times um with Aames they can produce odorous gas so um foods to eat to cons to avoid from having 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 omey bag over time can inflate and they'll need need to know how to release that gas from that bag and a lot of times and they are making omey 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 um pouch drops in the pouch to prevent the smell okay so that wraps up this inle review on GI Aames thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos