ostomy care, the management and support of a patient with a surgical opening created in the bladder, ileum, or colon for the temporary or permanent passage of urine or feces, necessitated by carcinoma, intestinal obstruction, trauma, or severe ulceration distal to the site of the incision. In most cases the opening is covered with a temporary disposable bag in the operating room. ▪ METHOD: The patient with a colostomy or an ileostomy is helped to accept the stoma and the change in body image that frequently causes grief or in some instances denial. Discussions of the person’s feelings are encouraged, and questions regarding the procedure and possible changes in the person’s lifestyle are answered in a positive manner. The disposable bag, called an appliance, is changed when necessary, and the character, color, and amount of odor and drainage are observed. Mucus secretion from the stoma usually begins within 48 hours after the surgery, fecal drainage within 72 hours. The stoma is inspected periodically for color, bleeding, stricture, retraction, and infection and is measured periodically to determine the size of the appliance that is to be used. There is mild to moderate swelling of the stoma the first 2 to 3 weeks postoperatively. Size of the stoma is determined with a stoma measuring card. Each time the temporary or permanent appliance is changed, the skin around the stoma is washed with soap and water, rinsed thoroughly, and patted dry with a clean towel. If the skin is irritated or excoriated, karaya powder, alone or mixed with an ointment, is spread over the area before the appliance is reinstalled. A pouch should never be placed directly on irritated skin without the use of a skin barrier. An adhesive substance may be used to maintain a tight seal with the appliance. Deodorant drops, aspirin, or various bismuth or chlorophyll preparations or mouthwash solutions are added to the ostomy bag to control odor. The diet is planned according to the kind of ostomy. Ileostomates require food high in sodium and potassium, such as bananas, citrus juices, molasses, and cola, and are advised to avoid fried, highly seasoned, and rich foods, nuts, raisins, raw fruits other than bananas, and anything that produces gas or causes diarrhea. Gas-producing foods such as cabbage, beans, broccoli, cauliflower, and corn; foods causing disturbing odors such as onions, eggs, and fish; and sharp condiments are contraindicated. A low-residue diet is ordered for most ostomates. The fluid intake is carefully maintained. ▪ INTERVENTIONS: Before discharge, each step in the care of the stoma and surrounding skin is rehearsed with the patient; the equipment that will be available at home is used during this rehearsal. The patient is urged to establish a regular pattern of evacuation and to report any signs of wound infection or obstruction, such as nausea, vomiting, decreased drainage from the stoma, abdominal distension, and cramps. Normal daily activity is encouraged. ▪ OUTCOME CRITERIA: Visiting nurse referrals may be indicated for client assessment and education. Referrals to support groups are also encouraged. Clients are encouraged to keep appointments with care providers. The ability of the patient to adjust to the ostomy procedures and equipment is greatly affected by the nursing care received in the days after surgery. A positive patient, matter-of-fact approach; sensitive emotional support; and thorough teaching of self-care measures are essential aspects of ostomy nursing care.
