Question

• Illustrate how to assess a fecal ostomy postoperatively.
• Discuss the nursing management of ostomies and their complications, including patient education.

Answer 1

An ostomy is a procedure of creating artificial opening surgically in the abdomen to allow for the removal of waste materials and the stoma is an artificial opening made. Fecal and urinary stomas consist of mucous membranes or the lining of the intestine that is exposed to the surface. Fecal ostomies are related to parts of large intestine like colon , rectum, anus. Colostomy of the colon, ileostomy of ileum,urostomy to drain urine is the most common ostomies.

• How to assess a fecal ostomy postoperatively?

Ostomies are assessed by their stoma and peristomal skin.

Stoma assessment is performed by inspection (looking), palpation (touching), listening, and smell. Start in the center of a stoma and assess outward ending with the surrounding tissue.

• Ideal Stoma Characteristics:

  1. Check for color and shape: Moist, round, beefy red, budded shape

2. Appearance: Shiny, taut, edematous postoperatively

3. Protrusion: 2-3cm (20-30mm)  

4. Lumen in center of stoma

5. Bloody - superficial bleeding from the stoma during routine cleaning is normal. Stoma tissue is highly vascularized, fragile, and does bleed occasionally.

6.Periosteal skin tenderness, what provokes pain?

If you find any deviation in stoma other than the characteristics mentioned above, you should contact your doctor.

Patient education:

Teaching points to cover :

• the importance of emptying the pouch when it’s one-third to one-half full.
• Explain about ostomy type, expected output, leakage, or seal compromise issues.

Nursing care and complications of ostomies:

A stoma nurse is a specialized role and will look after and advise patients with a colostomy, ileostomy, or urostomy before and after surgery. She will check for the pouching system. It must be completely sealed to prevent leaking of the affluent and to protect the surrounding peristomal skin.

It should be changed every 4 to 7 days, depending on the patient and type of pouch.

COMPLICATIONS:

• Skin irritation. a common problem that's caused by the adhesive on your ostomy appliance. ...
• Dehydration
• Leakage.
• Bowel obstruction.
• Retraction.
• Parastomal hernia.
• Necrosis.

I hope our explanations are easy to clear your doubts. If you like our explanations, encourage us by giving thumbs up.