DEFINITION OF TERMS:
1. OSTOMY- is surgery to create an opening (stoma) from an area inside the body to
the outside.
2. GASTROSTOMY- is a surgical procedure in which an opening is created into the
stomach for the purpose of administering foods and fluids via tube.
3. STOMA - the opening created in the abdominal wall by ostomy.
4. PERIOSTOMAL SKIN - the area of skin surrounding a stoma in the abdominal wall.
PURPOSE OF GASTROSTOMY
PURPOSE RATIONALE
1. provide route for feeding. - alternative method for feeding.
2. administer medications directly - Alternative method of feeding
GI tract.
3. to remove fluid and gas from GIT - Prevent bloating of the stomach
thus reducing pressure within
stomach.
4. to prevent nausea, vomiting and - It can drain gastric secretions.
gastric distention.
5. to restore or maintain nutritional
status. - It is another way of giving
correct nutrition.
INDICATIONS OF GASTROSTOMY
INDICATIONS RATIONALE
1. patient with head and neck - Prevention of further
trauma. complications.
2. patient with injuries in mouth and
throat. - unable to tolerate adequate oral
intake.
3. stroke patient
- neurological dysphagia occurs
4. patient with oral or esophageal
cancer. - since swallowing can’t be
tolerated.
5. Chronic unresolved
gastrointestinal stenosis or ileus. - to drain gastric secretions and
resolve persistent nausea and
vomiting
CONTRAINDICATIONS OF GASTROSTOMY
CONTRAINDICATIONS RATIONALE
1. obstruction of GIT -Cannot provide adequate
nutrition.
2. previous abdominal surgery - to prevent further injury
3. ascites - due to concerns regarding
ascitic fluid leakage.
4. pregnancy - potential risks of uterine and
fetal injury.
COMPLICATIONS OF GASTROSTOMY
wound infection periostomal leakage
aspiration peritonitis
septicemia cellulites
hemorrhage fluid and electrolyte imbalance
tube dislodgement cramping
GUIDELINES IN THE CARE MANAGEMENT OF PATIENTS WITH
GASTROSTOMY
1. Do medical hand washing.
2. Position patient in a semi-Fowlers.
3. Inspect the skin surrounding the insertion site for healing, redness, swelling and
the presence of any drainage.
4. Assess the abdomen for distention, bowel sounds and tenderness.
5. After the introduction of gastroscope into the oral cavity of the patient is asked to
do a swallowing movement that facilitates the promotion of the device into the
esophagus.
6. In order to suppress the gag reflex patient should be observed calm deep
breathing.
7. until the stoma is well healed, use sterile technique for dressing changes and site
care.
8. wearing clean gloves, remove old dressing. Cleanse the site with saline or soap
and water and rinse appropriate. Pat dry with 4x4 gauze pads and allow to air dry.
9. redress the wound using a stoma dressing or folded 4x4 gauze pads.
10. irrigate the tube with 30-60 ml water, and clean the tube
inside and out as indicated or ordered.
11. provide mouth care or remind patient to do so.
PRINCIPLES INVOVLED IN THE CARE MANAGEMENT OF PATIENTS WITH
GASTROTOMY
Anatomy and Physiology
it determines the involved human parts and their function and its passageway in
the procedure.
Chemistry
it involves in giving medication about the proper amount and mixing of the
medications given.
Microbiology
it involves in wearing gloves in the procedure and to show a clean technique to
avoid contamination of bacteria.
Body Mechanics
the nurse must observe the proper body mechanics to avoid musculoskeletal
strain.
Time and Energy
to conserve time and energy in the doing the procedure.
NURSING RESPONSIBILITIES IN GASTROSTOMY FEEDING
BEFORE:
check the patient’s chart
explain procedure to the patient
prepare all necessary equipment
wash hands
provide patient privacy
prepare warm food
check for residual gastric content
let patient taste, smell and chew food
place patient in an upright or semi-fowlers position
check for tube patency
DURING:
expose the insertion site
remove the small dressing attached to the tip of gastrostomy tube and kink tube
check the patency of the tube
attach syringe to the tube then kink again as you get the asepto bulb infuse
feeding.
hold the syringe 3-6 inches above the insertion site
fill syringe with feeding and allow to flow into gastrostomy tube
follow the medication, then water for flushing (30-60 ml water)
do not allow syringe to empty until feeding water infusion are completed
. clamp or put a small dressing secured with a rubber band in the gastrostomy
tube
remain patient in semi-Fowlers position
AFTER:
wash hands
do after care
documents all assessment and interventions
CARE MANAGEMENT OF PATIENTS WITH GASTROSTOMY
check the tube daily
keep the hub of the tube clean
routine skin care
wound care
nutritional support
clean the stoma site with sterile saline
dry the area with gauze
provide oral care
