Set of activities performed by the nurse when faced with a patient with digestive ostomies.
Objectives:
– To maintain the patency of the digestive ostomy. – Prevent possible complications. – Maintain the integrity of the peristomal skin. – Educate the patient and family on digestive ostomy maintenance care.
Equipment:
– Trough. – Dressing trolley. – Towels. – Scissors.
Material:
– Ostomy drainage bag. – Waste bag. – Soaker. – Non-sterile gauze. – Non-sterile gloves. – Neutral soap. – Nursing records.
Procedure:
– Instruct the patient and family in the use of the ostomy equipment. – Help the patient and family to choose the ostomy equipment that best suits the characteristics of the type of ostomy that has been performed. Ileostomies and
right colostomies the stool is more liquid so an open system is more appropriate; left colostomies the stool is more solid so closed systems are more suitable. – Observe the healing of the incision or stoma. – Monitor possible postoperative complications such as abdominal obstruction, paralytic ileus, fissure of the anastomosis or separation of the cutaneous mucosa. – Change and empty the ostomy pouch, if necessary (see procedure for changing the colostomy collection device). – Help the patient and family practice self-care. – Encourage the patient and family to express feelings and concerns about the change in body image. – Teach the patient and family to watch for possible complications such as mechanical rupture, chemical rupture, rash, leaks, dehydration, infection, etc. – Instruct the patient and family about the mechanisms to reduce pain. – Instruct the patient and family about the proper diet depending on the type of ostomy. – Provide support and assistance while the patient develops the pouch changing technique. – Teach the patient to chew food well, to drink plenty of fluids, to add a new food each time to observe possible intolerances. – Teach the patient and family to periodically dilate the stoma with the index finger and petroleum jelly. – Discuss their concerns about sexual functioning. – Instruct the patient on the type of dressing: comfortable and not putting direct pressure on the stoma. – Encourage visits to the patient by people from support groups with the same condition. – Record in nursing documentation: procedure, reason, date and time, incidents and patient response.
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