ILEOSTOMY
- When the colon and rectum are removed, the surgeon performs an ileostomy to
attach the bottom of the small intestine to the stoma.
First pic- acystoma
3rd – need to eliminate
COLOSTOMY
- When the rectum are removed, the surgeon performs a colostomy to attach the
colon to the stoma.
Difference bet ileostomy and colostomy - location of the surgery/cutting
TOTAL PROCTOCOLECTOMY WITH PERMANENT ILEOSTOMY
Curative and involves the removal of the entire colon (colon, rectum, and anus
with anal closure).
The end of the terminal ileum forms the stoma, which is located in the right lower
quadrant.
KOCK ILEOSTOMY (Continent Ileostomy)
It is an intraabdominal pouch that stores the feces and is constructed from the
terminal ileum.
The pouch is connected to the stoma with a nipplelike valve constructed from a
portion of the ileum; the stoma is flush with the skin.
A catheter is used to empty the pouch, and a small dressing or adhesive
bandage is worn over the stoma between emptyings.
ILEOANAL RESERVOIR
A two-stage procedure that involves the excision of the rectal mucosa, an
abdominal colectomy, construction of a reservoir to the anal canal, and a
temporary loop ileostomy.
Ileostomy is closed in 3 to 4 months after the capacity of the reservoir is
increased.
ILEOANAL ANASTOMOSIS (Ileorectostomy)
It does not require ileostomy. A 12 to 15cm rectal stump is left after the colon is
removed, and the small intestine is inserted into this rectal sleeve and
anastomosed.
Ileorectostomy requires a large, compliant rectum.
Preoperative Colostomy/ Ileostomy Nursing Responsibilities
Consult with enterostomal therapist to assist in identifying optimal placement of
the ostomy.
Instruct the client to eat a low-residue diet for 1 to 2 days before surgery as
prescribed for easy cleansing of the bowel.
Administer intestinal antiseptics and antibiotics as prescribed to cleanse the
bowel and to decrease the bacterial content of the colon
Administer laxatives and enemas as prescribed to remove fecal material.
Postoperative Ileostomy Nursing Responsiblities
Note that normal stool is liquid since the ostomy is located in the ileum.
Monitor for dehydration and electrolyte (potassium, sodium, chloride) imbalance
to prevent complications
Do not give suppositories through an ileostomy to avoid contamination.
Postoperative Colostomy Nursing Responsibilities
Place a petroleum gauze over the stoma to keep it moist, followed by a dry sterile
dressing if a pouch (external) system is not in place.
Place a pouch system on the stoma ASAP for possible fecal drainage
Monitor the stoma for size, unusual bleeding or necrotic tissue to ensure
functioning and prevent complications.
Monitor for color changes in the stoma. Note that the normal stoma color is pink
to bright red and shiny, indicating high vascularity.
Note that a pale pink stoma indicates low hemoglobin and haematocrit levels and
a purple-black stoma indicates compromised circulation, requiring physician
notification.
Expect that the stool is liquid in the immediate postoperative period but becomes
more solid depending on the area of the colostomy: ascending colon- liquid;
transverse colon- loose to semiformed; and descending colon- close to
normal.
Monitor the pouch system for proper fit and signs and leakage.
Empty the pouch when it is one-third full to avoid messy disposal of fecal matter
Fecal matter should not be allowed to remain on the skin to prevent infection.
Administer analgesics and antibiotics as prescribed to prevent pain and infection,
respectively.
Irrigate the perineal wound (if present) as prescribed and monitor for signs of
infection to prevent complications.
Instruct the client to avoid foods that cause excess gas formation and odor as
this inflates the colostomy pouch.
Instruct the client about stoma care and irragations as prescribed to promote
independent care of the system.
Instruct the client that normal activities may be resumed when approved by the
physician so as to enhance personal well-being.
COLOSTOMY IRRIGATION
It is performed by instilling 500 to 1000mL of lukewarm tap water through the
stoma and allowing the water and stool to drain into a collection bag
An enema is given through the stoma to stimulate bowel emptying
Nursing Consideration
If ambulatory, position the client sitting on toilet.
If on bedrest, position the client on the side
Hang the irrigation bag so that the bottom of the bag is at the level of the client’s
shoulder or slightly higher.
Perform irrigation around the same time each day
Perform irrigation preferably 1 hour after meal.
To enhance effectiveness, massage the abdomen gently.
T-Tube
It is placed after surgical exploration of the common bile duct.
It preserves the patency of the duct and ensures drainage of bile until edema
resolves and bile is effectively draining into the duodenum
A gravity drainage bag is attached to the tube to collect the drainage.
Nursing Responsibilities
Position the client in semi Fowler’s position to facilitate drainage.
Monitor the amount, color, consistency, and odor of drainage. (Normal amount
drainage:500–100mL)
Report sudden increase in bile output to the physician
Monitor for inflammation and protect the skin form irritation.
Keep the drainage system below the level of the gallbladder.
Monitor for foul odor and purulent drainage and report to the physician.
Avoid irrigation, aspiration, or clamping of the T-tube without physician’s order.
Usually: Clamping – 1 bf meal and 1hr after meal
As prescribed, clamp the tube before meal, and observe for abdominal
discomfort and distention, nausea, chills, or fever; unclamp the tube if nausea or
vomiting occurs.
Can be removed 7 to 10 days
s/s of obstructive bld flow – chills, fever, tachycardia, nausae, RUQ fullness, jaundice,
pain, clay colored stool
