Ostomy Care
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Ostomy Care Marie Berry, BScPharm, BA, LLB Date of Revision: April 2013
Types of Ostomy
An ostomy is an artificial opening made surgically in the body. The opening itself is called a stoma, derived from the Greek word stoma, meaning mouth. A colostomy involves the colon, an ileostomy the ileum or small intestine and a urostomy the urinary tract. Ostomies may be permanent or temporary. The type of ostomy depends upon the condition being treated. Half a million North Americans have ostomies and over 90 000 ostomy operations are performed each year in the United States and Canada.1 No particular age or ethnic group has more ostomies, but in general more women than men have ostomies. Birth defects account for the majority of ostomies in children. The older the adult the more likely the ostomy surgery will be a colostomy because of cancer or obstruction related to disease. Ileostomies are more common in young women, especially those resulting from inflammatory bowel disease.
Ileostomy
To construct an ileostomy, the entire colon and possibly part of the ileum is removed or bypassed. Usually the ileum end is brought to the skin surface. For some persons, instead of an ileostomy, the surgeon creates a continent fecal diversion, such as an ileoanal reservoir (“S” or “J” pouch). In this procedure, the rectum is left intact, the ileum is refashioned into an internal pouch, and the end of the ileum may be pulled through the rectum. The internal pouch created from the ileum is emptied by the patient, thus keeping him or her continent. Crohn's disease and ulcerative colitis are the most common reasons for an ileostomy. An ileostomy may also be required because of trauma, cancer, familial polyp disease or necrotizing enterocolitis.
Colostomy
To construct a colostomy, part of the colon is removed and the GI tract ends with a portion of the colon. The different types of colostomy are illustrated in Figure 1. A colostomy may be required due to obstruction of the colon or rectum, genetic malformation, trauma, radiation colitis, loss of anal muscle control, diverticulitis, or cancer of the colon or rectum. Colorectal cancer is the most common indication for this procedure. Temporary ileostomies and colostomies are sometimes performed to allow a diseased or surgically repaired bowel to heal, and once the bowel has healed it is reversed. Colostomies and ileostomies show a characteristic drainage or effluent, as described in Table 1. Table 1: Description of Drainage from Different Colostomies and Ileostomies Ileostomy
Initially the drainage is liquid. With time, as the ileum becomes more absorptive, the drainage becomes semi-soft. The drainage is continuous and contains enzymes that may cause skin irritation but is less odourous than drainage from a colostomy. An appliance must be worn at all times.
Ascending colostomy (uncommon)
The drainage is liquid or semi-solid, malodourous and irritating. An appliance must be worn at all times.
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The drainage is semi-liquid, malodourous and irritating; an appliance must be worn at all times.
Descending and sigmoid colostomies (more common)
Drainage is pasty. Irrigation may be an option and an appliance may not be needed.
Figure 1: Types of Colostomies
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Urostomies
Urostomies (urinary diversions) are most common in infants and the elderly. They are performed to correct bladder loss or dysfunction resulting from genetic malformation, cancer or neurogenic bladder. These provide for elimination of urine through an opening in the abdominal wall. Because urine always remains liquid and is discharged continuously, urostomy surgery usually requires an appliance. There are many types of urostomies: Ileal and colonic conduits (more common): The ileum or colon is used to fashion the conduit into which the ureters are implanted (Figure 2). Mucus shreds may be seen in urine because the bowel has been used. Urine drainage from the stoma is continuous and an appliance is required at all times.
Ureterostomy (uncommon) (Figure 2): The ureters are brought to the skin surface; with time the ureters tend to narrow. Nephrostomy: A tube is placed into the renal pelvis of kidney to divert urine from the kidneys. It may be temporary in the case of reversible ureteral obstruction.
Cystotomy: A suprapubic cystostomy is a surgically created passage from the abdominal wall directly into the urinary bladder. A catheter tube is then inserted into the bladder to continuously drain urine.
Continent urinary diversion: a pouch is created using the small or large bowel and is emptied by intermittently inserting a catheter in the stoma. Some examples are the Kock, Indiana, Florida or Miami pouches. In the Mitrofanoff procedure the appendix is used to create the conduit and a stoma is constructed that can be intermittently catheterized. A passage is created with a reservoir valve to channel from the urinary bladder to the abdominal skin. No external collection pouch is required. Orthotopic neobladder, i.e., Studer pouch, is a new or neobladder constructed from intestine to replace a diseased or dysfunctional urinary bladder. The detubularized bowel segment is surgically attached to the urethra. No stoma is present and it is possible to void normally through the urethra but some persons may require urethral catheterization. Figure 2: Types of Urostomies
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Patient Assessment
A healthy stoma is shiny, moist and either dark pink or red (see Photo, Healthy Stoma). It has no pain sensation because it does not contain nerve fibres. The stoma size in adults usually ranges from 2–5 cm depending upon the portion of the bowel or urinary tract used. After surgery, it shrinks gradually over several months to its permanent size. A careful history and inspection of the ostomy site can help to determine if the patient is experiencing a problem. See Common Problems section for more information. Photo 1: Healthy Stoma
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Goals of Ostomy Care
Contain drainage or effluent
Prevent common problems such as skin irritation
Minimize the impact of the ostomy on the person's activities of daily living and optimize quality of life
Appliances and Accessories
For product selection, consult Compendium of Products for Minor Ailments. Ostomy Products: Adhesive Powders; Appliances, Adult; Appliances, Pediatric; Creams, Ointments and Cleansers.
Appliances
An appliance is used to collect the drainage from the stoma but not all stomas require appliances. The ideal ostomy appliance permits effective containment with no leakage, does not damage skin and is odour free. An ostomy appliance includes the pouch, which collects drainage, and the skin barrier with a flange. The flange is the plastic ring on the skin barrier to attach the pouch. The skin barrier attaches to the skin on the person's abdomen (Figure 3). Appliances are available in both pediatric and adult sizes. Figure 3: Placement of a Two-piece Ostomy Appliance
Pouch Pouches are available in different lengths and capacities to contain the varying amounts of drainage. Pouches may be open-ended (drainable) or close-ended (not drainable) (Figure 4). Whether a drainable or non-drainable pouch is selected depends upon the site of the stoma, the consistency of the drainage and whether the task or cost of emptying and cleaning the pouch is acceptable to the individual. Open-ended appliances afford frequent emptying and are more often used for ileostomies and when a colostomy is not regulated. It is usually recommended that pouches are emptied when they are half to a third full. If a drainable pouch is used, the drainage end needs to be kept clean. Pouches are selected based on the individual's choice and their ability to care for the ostomy. Pouches come in various lengths, can be clear or opaque and some may have a fabric backing for comfort or discretion. Most pouches are odour proof and some have an embedded charcoal filter to minimize odour while allowing gas to
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Flange The flange is the plastic ring on the skin barrier to attach the pouch. The selection of the flange size depends upon the size of the stoma. Skin barriers with flanges are also available in different sizes, shapes (e.g., round, oval) and convexities, and in rigid or flexible formats to accommodate different body contours and stoma sizes, shapes and locations.
One-piece vs Two-piece
Appliances are available as both one- and two-piece units (Figure 4). One-piece appliances combine a pouch/skin barrier and attach directly to the skin. They are usually used once then discarded. Two-piece appliances consist of a skin barrier with a flange, which is attached directly to the skin and separate pouches. The benefits of using a two-piece appliance include: pouch can be cleaned for reuse and avoiding frequent removal/replacement which can irritate the skin. While this ability to interchange appliance components exists within a manufacturer's line of products, it does not usually extend between various manufacturers. Of note, two-piece appliances can be difficult to use if a person has either diminished manual dexterity or eyesight. Figure 4: Ostomy Appliances
Accessories Skin Barriers Skin barriers help keep the skin surrounding a stoma intact, protecting it and keeping it dry. Skin barrier wafers are usually composed of pectin, gelatin and cellulose. The skin barrier wafer can be flat or convex, regular wear or long wear, rigid or flexible, to accommodate different body contours and stoma sizes, shapes and locations. Flanges are incorporated in skin barrier wafers and are an essential component of the ostomy appliance. If the person has a confirmed allergy to any of the components of the product it would be best to test the skin barrier before using it. Applying the product to an inconspicuous area of skin for 48 hours is usually sufficient to
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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/... determine if there is any sensitivity. Skin barrier powders are formulated of pectin, gelatin and cellulose and used to absorb moisture from the skin. Skin barrier pastes are also formulated of pectin, gelatin and cellulose and contain alcohol and preservatives. They are used like caulking, to improve the seal between the skin barrier wafer and the skin on the abdomen. Skin barrier paste is also available in strip format that is alcohol free.
Adhesives Although no longer in common use, adhesives are applied either as cement, which must be allowed to dry before the appliance is attached, or as a pad. Some adhesives include skin barriers in their formulations. Some ostomy pouches have adhesive integrated into the flange and/or skin barrier, making application simple. Adhesives are the most common cause of allergies. A patch test should be performed prior to use as described in Skin Barriers.
Other Accessories Sometimes adhesive tape is used to secure an appliance. If so, it should be hypoallergenic.
Belts are most often used by urostomy patients to reduce the strain on the skin barrier wafer from the weight of the urine in the pouch.
Solvents are available to remove adhesive residue, however they are drying and should be used sparingly and washed off thoroughly. Ostomy pouch covers prevent rustling, provide discretion during intimacy and may prevent skin irritation due to rubbing or perspiration.
Appliance Fit
Note: Measurement of the stoma and fitting an appliance are beyond the scope of this chapter and should only be performed by individuals with specialized training in this area. The correct appliance fit is paramount. A fitting guide is usually included with each box of appliances to help determine the correct size based on the stoma. An appliance with an opening smaller than the stoma may cause abrasion of the stoma and poor wearing time. If the opening is larger than the stoma, skin excoriation can result. Other considerations in choosing an appliance include body contour, stoma location, presence of skin creases and scars and type of ostomy.3 Obesity can be a problem in fitting and maintaining an appliance. The type of appliance may change post-surgically as the stoma heals, and as body contour changes due to weight changes, aging, pregnancy or concurrent medical conditions.
Changing the Appliance
Routine emptying of the pouch is required, usually when it is about one-third full. The directions for changing the appliance vary somewhat from model to model and the directions accompanying the particular pouch should be consulted. However, some general principles do apply: Hands should be washed before beginning.
The appliance should be carefully peeled off to avoid damaging the skin.
The stoma and peristomal skin should be gently washed with warm water and soap, then thoroughly dried. Soap must be completely washed off.
Alcohol should not be used to clean the peristomal skin.
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Once applied, the appliance should be pressed gently into place.
Irrigation
For some persons with colostomies, irrigation is sometimes an alternative to wearing an appliance. It is less expensive and affords some control of fecal outflow. In irrigation, squirting water through the stoma into the intestine stimulates peristalsis which forces waste out. It is usually performed in the bathroom with an irrigation bag, which is much like an enema bag. In addition to an irrigation bag, irrigation systems include an irrigation sleeve, skin barrier and stoma cone. The stoma cone is used with its pointed end inserted into the stoma to act like tubing, but to prevent bowel perforation, which could accompany the use of tubing alone. The irrigation sleeve, attached to the skin barrier, carries the waste material to the toilet. When not being irrigated, a stoma cap or even a pad is all that is required to cover the stoma. Irrigation is performed regularly, the interval ranging from every one to four days. A convenient time may be after the largest meal of the day, because of the peristalsis stimulated by the meal.
Common Problems
Common problems usually involve the stoma or peristomal skin. The actual incidence of skin problems is difficult to determine; however, peristomal skin problems seem to occur frequently involving anywhere from 18–55% of persons living with an ostomy.4,5 Functional, psychological and social factors may contribute to ostomy problems. Poor manual dexterity, visual problems, clothing incompatibilities and dietary issues can lead to appliance leakage and odour. Other concerns, for example, depression, anxiety, sexual or body image concerns, lack of education about the stoma and inability to return to work, can exacerbate any problem.
Peristomal Skin Problems Allergies Skin barrier adhesives and pastes are the most common cause of allergies, and allergic contact dermatitis is the most common manifestation (itching, burning or stinging, redness and areas of moist, denuded skin).6 A switch to another adhesive or appliance may be necessary. A skin barrier may help, but it needs to extend beyond the damaged area. The majority of modern appliances are latex free, reducing the risk of a latex allergy.
Infections Infections can occur under the skin barrier and/or flange. These may be bacterial or fungal; culture and sensitivity testing may be needed to identify the pathogen responsible and ensure appropriate treatment. Proper maintenance is important in preventing infections. Ostomy sites are susceptible to fungal infections with Candida species because they provide a warm, moist environment conducive to fungal growth. The primary symptom of Candida infection is itching, accompanied by a red rash with satellite lesions.7 With an unchecked infection, skin excoriation and additional skin irritation can occur. Use of broad spectrum antibiotics can contribute to Candida infections by changing the normal flora; thus, knowing a patient's medication history is important. Nystatin powder may be used to treat Candida infections. The appliance is applied directly over the powder, with any excess powder brushed off. Usually antifungal powder is continued for 1 week after the Candida infection clears. Treatment may be extended further if the individual is being treated with antibiotics.
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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/... Refer any person living with an ostomy with symptoms of infection, either those of Candida infection or fever, chills, foul odour from the stoma or purulent drainage, to their health care provider, for example a wound ostomy and continence nurse (WOCN), enterostomal therapist (ET) or physician for assessment.
Skin Damage The most common peristomal skin problem is sore skin, usually the result of too frequent removal of the appliance. The skin around the stoma becomes damaged—red, swollen, burning, itchy. Skin damage may be also related to mechanical irritation caused by a poor-fitting appliance, a stoma that is difficult to access or clothing that is too tight.
Skin Excoriation Skin excoriation is abrasion of the skin by digestive enzymes, which may result in bleeding, painful skin (see Photo, Peristomal Skin Excoriation). The most common cause is an appliance that is too big for the stoma and allows leakage. Lax replacement or maintenance may also result in waste material containing digestive enzymes coming into contact with skin. Choosing the proper size of appliance, routine maintenance of the appliance, and use of a skin barrier will avoid the problem. Photo 2: Peristomal Skin Excoriation
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Folliculitis Folliculitis is an inflammation of hair follicles around the stoma and is characterised by redness at the base of hair follicles. Too aggressive removal of an appliance may also pull hair from follicles resulting in inflammation and infection. Shaving the area surrounding the stoma will prevent folliculitis. An electric razor is preferred because it will leave the skin intact. Clipping the hair is an alternative if shaving with an electric razor does cause skin damage.
Leakage
Ill-fitting or badly applied appliances result in leakage around the seal. Proper fit and maintenance of the appliance are therefore the solution.
Bleeding
Bleeding of the stoma is usually due to aggressive cleaning. Proper cleaning technique is required—gentle yet
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Odour
Diet is the most common source of odour. Identifying what food is causing the odour and changing the diet usually solves the problem (Table 2). Pouches usually have an odour barrier and thus are considered odour free, provided they are changed regularly, emptied as needed, cleaned properly, are without flaws or pinholes and are reliably sealed. Emptying a pouch is often accompanied by odour. Deodorants are available to help control odour. These are placed into the pouch after each emptying. Oral deodorants, such as activated charcoal, chlorophyllin copper complex and bismuth subgallate, act on the digestive system to eliminate odours from digested foods. Table 2: Foods with Implications for Ostomy Patients
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Bulk-forming foods: celery, coconut, coleslaw, foods with seeds or kernels (e.g., corn), dried fruits, nuts, meats in casings, popcorn, whole grains, whole vegetables, wild rice. Gas-forming foods: beer, broccoli, brussels sprouts, cabbage, carbonated drinks, cauliflower, corn, cucumbers, dairy products, dried beans, mushrooms, onions, peas, radishes, spinach, string beans or chewing gum with an open mouth. Diarrhea-causing foods: broccoli, beer (other alcoholic beverages are not common offenders), green beans, highly seasoned food, raw fruit, spinach. Odour-forming foods: asparagus, beans, broccoli, cabbage, eggs, fish, garlic, onions, peas, some spices, turnips.
Gas
Foods that caused gas prior to surgery usually cause gas after surgery. Travel in pressurized aircraft cabins can cause distention of an appliance. Relaxation techniques to reduce stress due to travel and careful dietary choices can reduce this distention. Some appliances have charcoal filters—the gas is released and the charcoal absorbs odours. Strategies for decreasing gas include: Using an antacid Eating yogurt7
Eating slowly and chewing food well (with a closed mouth) Avoiding drinking from a straw Avoiding chewing gum
Limiting intake of gas-producing foods, especially prior to social occasions (Table 2).
Crystalline Phosphate Deposits
Crystalline phosphate deposits may build up on urostomies, making the stoma fragile and cutting into the mucosa. These deposits are the major cause of blood in a urostomy pouch. Vinegar mixed with one-third to two-thirds water can be dabbed on the stoma when the appliance is cleaned to dissolve the crystals. Acidifying the urine by consuming foods such as cranberry juice or even ascorbic acid will reduce the formation of these deposits. An ammonia odour may be the first sign of this problem and some individuals monitor the urine pH with urine dip sticks.
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Fluid and Electrolyte Depletion
Persons living with an ileostomy lack normal reserve capacity for absorption of water, sodium and potassium, and should be advised to take extra fluid and electrolytes after exercise and in hot weather. Specialized fluid and electrolyte replacement drinks used by athletes are ideal but beverages with high sugar content should be avoided because they can precipitate diarrhea. Some individuals need routine potassium supplementation and particular attention should be paid to plasma potassium levels if a diuretic is used. To avoid dehydration, fluid intake must be sufficient. This is especially important during illness and for infants. Signs and symptoms of dehydration and common electrolyte abnormalities are summarized in Table 3 and Table 4. Table 3: Symptoms of Dehydration in Children and Adults
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Children
Adults
Dry mouth, tongue and skin
Increased thirst
Few or no tears when crying
Decreased urination
Decreased urination (less than 4 wet diapers in 24 h)
Feeling weak or light-headed
Sunken eyes
Dry mouth/tongue
Grayish skin Sunken soft spot (fontanel) in infants Decreased skin turgor Table 4: Symptoms of Hyponatremia and Hypokalemia
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Hyponatremia
Hypokalemia
Nausea, malaise, headache, lethargy, confusion, obtundation
Muscle weakness, fatigue, shortness of breath, decreased sensation in arms and legs, abdominal bloating (secondary to paralytic ileus)
Constipation
Individuals with colostomies are prone to constipation; fluid, fibre and exercise are recommended to avoid this problem. The causes of constipation are diverse, but it is often related to medications or diet (see Constipation). Laxatives should be used with the advice of a individuals health care provider.
Diarrhea
Persons with ostomies with diarrhea may be at increased risk of fluid and/or electrolyte imbalances (Table 3 and Table 4). Fluid intake should be increased; oral rehydration solutions may be used to replenish electrolytes. Foods like bananas, potatoes, pasta, applesauce, yogurt, cheese and creamy peanut butter can help thicken the stoma output. Refer a person living with an ostomy with diarrhea to their nurse or physician.
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Urinary Tract Infections
Individuals with urostomies have an increased risk for urinary tract infections. They should be aware of the symptoms of these infections: chills, fever, bloody or cloudy urine, foul-smelling urine, back pain in the kidney area, abdominal pain. The presence of these symptoms should prompt them to consult their nurse or physician.
Structural Problems Fistula Formation, Prolapse and Retraction Fistula formation appears as leakage around the base of the stoma, causing skin erosion. All fistula formation should be investigated as it may indicate an underlying disease or condition (e.g., inflammatory bowel disease, cancer, abscess formation, trauma, foreign body retention). The underlying problem should be addressed. Sometimes surgical refashioning of the stoma is required. Inward retraction of the stoma or outward prolapse of the stoma and/or bowel may occur. Either may be due to the way the stoma was originally fashioned or to major changes in the individual's weight. Anything that increases abdominal pressure (e.g., coughing, pregnancy) increases the risk of prolapse. If the bowel is prolapsed, strangulation can occur. A prolapse should be reduced, and sometimes surgery is required. Retraction may be controlled by the use of a convex appliance, but as with a prolapse, surgery may be needed.13
Stenosis Stenosis is a narrowing of the stoma, usually caused by formation of scar tissue due to the surgical construction, ischemia, active bowel disease or dermatitis. Dilation and/or surgery may be required for correction.
Diet
Unless there are medical contraindications, individuals can eat a normal, varied diet, making their own adjustments to omit foods that change the consistency of the feces or cause odour or gas (Table 2).14 A food diary may aid in determining foods that are well tolerated and those that cause problems. Fluid intake is important, especially for individuals with an ileostomy or urostomy. Eight to 10 glasses of fluid each day is recommended. The foods most often cited as causing odour, gas or frequent watery discharge are brans, fish, onions, carbonated beverages and beer. People with an ileostomy will notice that high fibre foods remain undigested. Sometimes this undigested food can cause a blockage or obstruction of the stoma. These foods should be introduced into the diet one at a time. Eating them in small quantities, chewing well and drinking fluids with them will help avoid problems. Symptoms of obstruction include cramping, abdominal pain, vomiting, stoma swelling and watery, foul-smelling waste material. If an obstruction is suspected, refer to their nurse or physician.
Medication Use
With an ostomy, gastrointestinal transit times for medications are altered, which may in turn affect the medication's pharmacokinetics. Extended release formulations may be unsuitable, and some medications are implicated in specific complications seen with ostomies, e.g., broad spectrum antibiotics increase the risk for diarrhea and fungal infections. Table 5 summarizes some medication concerns. Table 5: Medication Concerns for Persons Living with Ostomies Antibiotics
Broad spectrum antibiotics may alter the normal flora of the intestinal tract resulting in
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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/... diarrhea or fungal infections of the skin surrounding the stoma. For persons with urostomies, the use of sulfa-containing antibiotics can lead to crystallization in the urine when high concentrations are obtained or when the urine is acidic. Persons with a urostomy that use urinary acidifiers to prevent urinary tract infection or encrustations are at high risk for sulfa crystal development in the kidneys or ureters. Persons with urostomies often stop taking urinary acidifiers while being treated with sulfa-containing antibiotics Antimotility drugs
May cause constipation in colostomies and some ileostomies
Antidiarrheals
May cause constipation and possible obstruction in persons with colostomies
Antacids
Aluminum-containing antacids can cause constipation in colostomies; calcium-containing antacids can cause calcium stone formation in urostomies and ileostomies; magnesiumcontaining antacids can cause diarrhea in ileostomies
Corticosteroids
Immunosuppressants can delay healing
Diuretics
May cause excess fluid loss and dehydration; with ileostomies monitor fluid balance and electrolytes
Laxatives
May result in perforations of colostomies, stool softeners are preferred; enemas should not be used with colostomies or ileostomies; avoid laxatives. Laxatives are also to be avoided in persons with ileostomies because of the high risk of dehydration and electrolyte imbalance.
Opioids
May cause constipation
Salt substitutes
May cause hyponatremia with ileostomies
Stool softeners
May cause diarrhea with ileostomies
Sulfa drugs
Crystallization in the kidney may be more prominent if the individual is having difficulty with fluid and electrolyte balance; more common with urostomies. Good fluid intake is required
Drugs that may be ineffective because they are poorly absorbed Vitamins A, D, E, K, B12
Variable absorption can occur with extensive resection of the ileum5
Oral contraceptives
May not be adequately absorbed in some persons with ileostomies
Digoxin
Variable bioavailability depending on length of bowel
Warfarin
Hypoprothrombinemia has occurred in some persons with short bowel syndrome
Drug formulations that may be problematic
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Enteric-coated formulations that require the alkaline environment of the small intestine to dissolve may pass through the intestinal tract intact. They are often ineffective in persons with ileostomies and only partially effective for persons with a colostomy. Checking in the pouch for undissolved tablets will identify the problem; alternatives include chewable tablets and liquids. Avoid timed-release preparations, especially with an ileostomy
Drugs that discolour the feces
For example, iron (black), bismuth (greenish black), amitriptyline (blue or green), phenothiazines (pink-red), vitamin B12 (yellow), salicylates (pink to red or black), senna (yellow), aluminum-containing antacids (whitish or speckled)
Lifestyle Considerations
Persons living with an ostomy can be assured that they can wear their usual clothing and that if the pouch is changed and emptied as necessary it will not be visible. Women can continue to wear control top panty hose, but an elastic girdle may need adapting with an opening to prevent pressure on the stoma and pouch. Having an ostomy does not interfere with exercise, sports, occupational work or sexual activity. However, because of the potential for injury to the stoma, avoiding very heavy lifting and extremely rough contact sports is recommended. There are specialized stomal caps and pouches that are intended for wear when swimming. A smaller sized pouch or even emptying the regular sized pouch, along with bathing suits of patterned fabric or boxer trunks for men, may help an ostomy patient feel more comfortable on the beach.15 Bathing and showering is possible with or without the appliance in place. Soap and water will not injure a stoma, but bath oils and soaps may leave a greasy film that can prevent the appliance from adhering. If a long soak in the bathtub is contemplated and the stoma will be below the water line, a cap can be used to prevent water from seeping into the stoma and the bowel. A person with a urinary stoma who wishes to attach a night drainage system to their appliance will require a free-standing holder or one that slides between the box spring and mattress. Hot weather or physical activity can cause sweating between the appliance and skin which can be uncomfortable and may lead to skin problems. Some antiperspirants may be used on the skin, however, check with the individual's nurse or physician. An adhesive change or the use of a breathable skin barrier are other options. With education, persons living with an ostomy will continue to enjoy their previous quality of life. They should know about: The surgical technique, resulting stoma position/characteristics and type of drainage or effluent. The post-operative care with an emphasis on stoma and skin care.
What is considered normal and when to contact the nurse or the physician. Appliance fit, techniques and options.
The amount of time an appliance should be worn—scheduling changes may help prevent problems. The available cleansers and deodorants.
Recognizing and treating common skin problems.
What to do if abdominal changes occur, e.g., weight changes, pregnancy.
Travelling with an Ostomy
It is usually recommended to travel with more supplies than needed and to empty the pouch immediately before boarding an airplane. Supplies should be protected from the extremes of hot and cold temperature. For example, ostomy supplies should not be left in the glove compartment of a very hot car. The changes in temperature, diet and activities that occur during travelling usually decrease the usual wear times for appliances. Compliance with vehicle seat belt legislation is essential. However, placement of a seat belt across the appliance or directly on the stoma may cause pressure or friction. To prevent potential injury place a soft foam padding or a small pillow between the stoma location and the seatbelt. When travelling by airplane, persons with ostomies should carry their ostomy supplies in their carry-on luggage and ensure they have sufficient supplies.
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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/... It is recommended to carry a physician's letter stating that ostomy supplies are required and mentioning that a private area may be necessary for a search. Currently, for security reasons, most airports prohibit scissors in carry-on luggage. Scissors, if required, will need to be packed in checked luggage.
Resource Tips
Canadian Association for Enterostomal Therapy. 66 Leopolds Drive, Ottawa, Ontario K1V 7E3. Telephone: 1-888-739-5072. Available from: www.caet.ca. Canadian Cancer Society. National Office, 55 St. Clair Avenue West, Suite 300, Toronto, Ontario, M4V 2Y7. Telephone: 416-961-7223. Available from: www.cancer.ca. Crohn's and Colitis Foundation of Canada. 600-60 St. Clair Avenue East, Toronto, Ontario, M4T 1N5. Telephone: 1-800-387-1479. E-mail:
[email protected]. Available from: www.ccfc.ca. International Ostomy Association. P.O. Box 512, Northfield, Minnesota, 55057. Telephone: 1-800-826-0826. Available from: www.ostomyinternational.org. United Ostomy Association of Canada. Suite 501, 344 Bloor Street, Toronto, Ontario, M5S 3A7. Telephone: 1-888-969-9698. Available from: www.ostomycanada.ca. Wound, Ostomy, and Continence Nurses Society. 15000 Commerce Parkway, Suite C, Mount Laurel, New Jersey, 08054. Available from: www.wocn.org (more suitable for health care professionals).
Suggested Readings
Basic ostomy skin care: a guide for patients and healthcare providers. Mount Laurel: WOCN; 2006. Dorman C. Ostomy basics. RN 2009;72:22-7. Floruta CV. Dietary choices of people with ostomies. J Wound Ostomy Continence Nurs 2001;28:28-31. Hampton BG, Bryant RA. Ostomies and continent diversions: nursing management. St Louis: Mosby Year Book; 1992. Patient Education Series. Managing your ostomy. Libertyville: Hollister Inc.; 2003. A professional's guide for counselling ostomy patients. Princeton: ConvaTec; 1998. Zanni GR, Wick JY. Ostomy care and the consultant pharmacist. Consult Pharm 2006;21:262-4, 267-70, 272-4.
References 1. Wound, Ostomy, and Continence Nurses Society. Available from: www.wocn.org. Accessed August 31, 2009. 2. Mitchel JV. A clinical pathway for ostomy care in the home: process and development. J Wound Ostomy Continence Nurs 1998;25:200-5. 3. Rozen BL. The value of a well-placed stoma. Cancer Pract 1997;5:347-52. 4. Colwell JC, Goldberg M, Carmel J. The state of the standard diversion. J Wound Ostomy Continence Nurs 2001;28:6-17. 5. Rarliff CR, Donovan AM. Frequency of peristomal complications. Ostomy Wound Manage 2001;47:26-9. 6. ConvaTec Inc. Peristomal skin health. Available from: www.convatec.com. Accessed June 24, 2009. 7. Bradley M, Pupiales M. Essential elements of ostomy care. Am J Nurs 1997;97:38-45. 8. Chicago Dietetic Association; South Suburban Dietetic Association; Dietitians of Canada. Manual of clinical dietetics. 6th ed. Chicago: American Dietetic Association; 2000. 9. Canadian Paediatric Society. Caring for Kids. Dehydration and diarrhea in children: prevention and treatment.
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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/... Available from: www.caringforkids.cps.ca/handouts/dehydration_and_diarrhea. Accessed October 25, 2010. 10. JAMA patient page. Preventing dehydration from diarrhea. JAMA 2001;285:362. 11. Singer GG, Brenner BM. Fluid and electrolyte disturbances. In: Fauci AS, Braunwald E, Isselbacher KJ et al., eds. Harrison's principles of internal medicine. 14th ed. New York: McGraw-Hill; 1998. p. 265-77. 12. Schultz NJ, Slaker RA. Electrolyte homeostasis. In: DiPiro JT, Talbert RL, Yee GC et al., eds. Pharmacotherapy: a pathophysiologic approach. 4th ed. Stamford: Appleton & Lange; 1999. p. 890-917. 13. Metcalf C. Stoma care: empowering patients through teaching skills. Br J Nurs 1999;8:593-600. 14. Wood S. Nutrition and stoma patients. Nurs Times 1998;94:65. 15. Aron S, Carrareto R, Prazeres SM et al. Self-perceptions about having an ostomy: a postoperative analysis. Ostomy Wound Manage 1999;45:46-50, 52-4, 56.
CPhA assumes no responsibility for or liability in connection with the use of this information. For clinical use only and not intended for for use by patients. Once printed there is no quarantee the information is up-to-date. [Printed on: 03-03-2016 02:08 PM] RxTx, Compendium of Therapeutics for Minor Ailments © Canadian Pharmacists Association, 2016. All rights reserved
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