The Pulse | Thursday, October 1, 2020
Ostomy Awareness: What the GI Nurse Should Know
By Gwen Spector, BSN RN COCN
Ostomy Awareness Day is celebrated on the first Saturday in October, and this year marks the 10-year anniversary for this national event. The theme of the awareness day is Ostomies are Life-savers; ostomies have a bad reputation — there is still plenty of stigma, fear and misinformation about them — but they can be lifesavers.
About Ostomies
An ostomy is a surgically created connection between an internal organ and the outside of the abdomen. The opening on the skin is called the stoma and the area around it is the peristomal skin. The function of an ostomy is to allow fluids in or out of the body. Most ostomies require either an appliance (a pouch) to capture exiting fluids or a tube for administering fluids and/or allowing fluid and air to exit.
Ostomies can be temporary or permanent, and patients can have more than one depending on their condition. They are created in people of all ages due to diseases like inflammatory bowel disease (IBD), colorectal and anal cancer, necrotizing enterocolitis (NEC), Hirschsprung’s disease and failure to thrive. There are many common traits of ostomies in general, each type having specific characteristics and care needs. An ostomy nurse may be a wound, ostomy and continence (WOC) nurse or an ostomy management specialist (OMS).
The GI Ostomies
The majority of ostomies are created in the digestive system. The name of the ostomy reflects its location.
Gastrostomy and jejunostomy are openings created through the skin into the stomach and jejunum. A tube is used to administer formula, water and medications for nutritional support or to decompress the stomach or intestines when there is an obstruction.
Ileostomies and colostomies are created by bringing part of the ileum or colon through the abdominal wall to the outside onto the skin. These are also known as fecal diversions because they are created to divert stool to bypass an obstruction or allow the anastomosis (surgical connection) to heal after surgery. Fecal stomas will take six to eight weeks to shrink. The stoma is usually dark pink to beefy red, moist and may bleed when touched. Output from an ileostomy will be higher volume and liquid or pasty. Colostomy output is thicker liquid to formed stool, depending on its location.
Cecostomy is an opening created through the skin into the cecum of children and some adults with severe chronic constipation or fecal incontinence due to conditions related to neuromuscular or motility problems. A (C-) tube is inserted for the administration of fluids or medicine for bowel management.
Potential Problems and Red Flags
Peristomal skin problems occur on the skin around the stoma. They are often caused by leakage of caustic digestive fluids onto the skin causing irritation. This commonly happens with fecal stomas when the pouch is not adhering well. Fungal infections, caused by chronic moisture around the stoma, bacterial infections and granulomas can also occur.
Other problems can be life threatening. Dehydration can occur with fluid and electrolyte loss from increased output especially from an ileostomy or jejunostomy. A bowel obstruction can develop after abdominal surgeries and from certain foods eaten by patients with an ileostomy. Peritonitis can develop if the enteral or fecal tube is not in the correct place or with perforation of the bowel. Aspiration and dumping syndrome can occur with enteral tube feedings as well.
Red flags requiring notification of the physician include: significant increased or decreased output from fecal stomas, signs of dehydration, abdominal distension/rigidness, stoma color changes, prolonged bleeding, respiratory problems after tube feedings, fever and severe cramping, and nausea or vomiting for more than two hours. Be aware that not all physicians are ostomy literate. An ostomy nurse should be notified for peristomal skin irritation and pouch adherence problems.
Nursing Implications
You do not need to be an ostomy nurse to take care of a patient with an ostomy, but you should be able to assess the ostomy, identify red flags and know where to refer patients. In addition, you should know your patient’s baseline so you can identify problems easier. Assess the stoma, peristomal skin and the output characteristics. Be aware that some foods, like beets, will change the color of the stool (see ostomy food chart). Monitor the output volume and hydration status.
Ostomy is a general term and it is important for you and your patient to know their specific type of ostomy. Look at the operative report if you’re not sure. Educate yourself about ostomies by reading patient literature and taking Hollister’s ostomy care online course.
You can also ask patients with older ostomies to educate you. Educate and inform your patients with newer ostomies using materials from your facility and the United Ostomy Association website and provide resources for further learning. Tell patients to bring extra supplies when coming for outpatient appointments and contact the ostomy nurse for more in-depth or additional teaching.
Getting an ostomy is a loss of a normal function and it affects body image. It is an emotional adjustment and many patients will grieve even when prepared. Most patients are also dealing with the disease or trauma that led them to needing the ostomy. Be careful of your reaction, as well — be patient, empathetic and supportive. Refer patients to support groups at your hospital or through the United Ostomy Association’s support group finder.
Ostomy Awareness
You can raise awareness for Ostomy Awareness day on your social media platforms by using the hashtag #OstomyDay2020. You can also get an ostomy awareness sticker from the healthcare company Hollister at www.hollister.com/en/ostomysticker.
Resources:
American Society of Colon and Rectal Surgeons https://fascrs.org/
Hollister Ostomy Care Online Course www.hollister.com/en/ostomycare/ostomycareprofessionalresources/elearning
Oley Foundation https://oley.org/page/HEN_LandingPage tube feeding troubleshooting
Ostomy Awareness: Navigating the Journey https://sarahcannon.com/blog/entry/ostomy-awareness-navigating-the-journey
OstomyLife www.shieldhealthcare.com/community/ostomylife/
United Ostomy Association of America www.ostomy.org; download or order free New Ostomy Patient Guides at www.ostomy.org/new-ostomy-patient-guide/