When a patient has a diseased gastrointestinal system or dysfunctioning bladder, a surgical opening must be made so that waste products can exit the body. An ostomy defines the surgically created opening, while a stoma defines the actual protruding end in the abdominal wall. Types of ostomies vary depending on the diseased area to be bypassed, according to the United Ostomy Associations of America. Generally a colostomy indicates an opening in the colon or large intestine, an ileostomy indicates an opening in the small intestine and an urostomy indicates diverting the ureter to either the large or small intestine away from the bladder.
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Prior to caring for an ostomy, nurses need to recognize the normal appearance of a stoma. The protruding tissue, whether it be the large or small intestine, has high vascularity, or rich blood supply. This produces a pink to bright red and shiny appearance to the stoma. A pale pink stoma indicates low hemoglobin and hematocrit levels, while a purple to black stoma indicates compromised circulation requiring immediate notification to the doctor, according to the book "Medical-Surgical Nursing."
Additionally, note that the type of drainage exiting the ostomy depends on the area of surgery. For colostomies, expect liquid stool from the ascending colon, loose to semiformed stool from the transverse colon and normal stool from the descending colon, notes Drugs.com. Expect that liquid stool is normal from an ileostomy and clear yellow urine along with mucus created by the intestinal walls from a urostomy.
A new stoma must be kept moist to ensure tissue integrity, so the nurse should place a petrolatum gauze over the stoma. As soon as possible, a pouch system needs to be placed over the ostomy and monitored for proper fit and signs of leakage. Besides monitoring the stoma color, the nurse needs to continuously assess functioning of the stoma and notify the physician of complications such as stoma retraction, unusual bleeding or presence of necrotic tissue and compromised stoma vasculature. Waste matter should never be allowed to remain on the skin, so nurses should diligently empty an ostomy pouch when one-third full and perform skin care on the peristomal area. According to the National Kidney and Urologic Diseases Information Clearinghouse, urostomies can get infected, so nurses should monitor and teach the patient signs of symptoms of infection. These are dark urine with foul odor, increased mucus in urine, lower back pain, nausea and vomiting.
"Ostomy Wound Management" reports that educating the patient is the most significant step in preventing ostomy complications. During the hospitalized period and prior to discharge, nurses should educate the patient on different pouching systems, how to empty and change the pouch, self-irrigation of a colostomy if appropriate, as well as proper skin care around the stoma.
Besides physical aspects, nurses should identify psychosocial concerns the patient has regarding an ostomy. According to the UOAA, the patient may experience self-esteem issues due to a change in body image and worry about self-managing an ostomy. They may also develop an apprehension about the effects of the stoma on their sexuality and other social relationships. It is important for the nurse to let patients express their concerns, provide information and help as well as remember to let patients adjust in their own way and in their own time.
- United Ostomy Associations of America, Inc.: What is an Ostomy?
- "Medical-Surgical Nursing: Critical thinking for collaborative care"; D. Ignatavicius & M. Workman; 2006
- Drugs.com: Colostomy Care
- National Kidney and Urologic Diseases Information Clearinghouse: Urostomy and Continent Urinary Diversion
- "Ostomy Wound Management"; What is Preventive Ostomy Care?; Gwen B. Turnbull, R.N., B.S., E.T.; May 2005