NurseReview.Org - Elimination Nursing Lecture

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Information about NurseReview.Org - Elimination Nursing Lecture

Published on April 15, 2008

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Elimination

Basic Principles Wash Hands & Wear Gloves Infection control, your protection & your client’s protection Privacy Embarrassing Positions for urination Independence

Wash Hands & Wear Gloves

Infection control, your protection & your client’s protection

Privacy

Embarrassing

Positions for urination

Independence

Functions of Urinary System Remove wastes from blood to form urine Remove nitrogenous waste products of cellular metabolism Regulates fluid and electrolyte balance The nephron = functional unit of the kidney and forms the urine

Remove wastes from blood to form urine

Remove nitrogenous waste products of cellular metabolism

Regulates fluid and electrolyte balance

The nephron = functional unit of the kidney and forms the urine

Goal of Urinary System To maintain chemical homeostasis of the blood. Filtration by the Nephrons H2O, glucose, amino acids, urea, creatinine, major electrolytes Not normally large proteins or blood cells Proteinuria is a sign of glomerular injury Normal adult 24hr output = 1500-1600ml.

To maintain chemical homeostasis of the blood.

Filtration by the Nephrons

H2O, glucose, amino acids, urea, creatinine, major electrolytes

Not normally large proteins or blood cells

Proteinuria is a sign of glomerular injury

Normal adult 24hr output = 1500-1600ml.

Overview of Urinary System Kidneys Bean shaped organs Either side of vertebral columns T12 – L3 Right kidney lower due to liver Urine produced with filtration of blood through nephrons Major role in fluid & electrolyte balance

Kidneys

Bean shaped organs

Either side of vertebral columns T12 – L3

Right kidney lower due to liver

Urine produced with filtration of blood through nephrons

Major role in fluid & electrolyte balance

Ureters Connect kidneys to bladder 10 -12 in length, ½ in diameter in adult Peristaltic waves Renal colic Micturition

Ureters

Connect kidneys to bladder

10 -12 in length, ½ in diameter in adult

Peristaltic waves

Renal colic

Micturition

Bladder Distensible, muscular sac Reservoir for urine ( approx. capacity = 600mls ) Organ of excretion ( norm. voiding= 300mls) Lies in pelvic cavity behind symphysis pubis

Bladder

Distensible, muscular sac

Reservoir for urine ( approx. capacity = 600mls )

Organ of excretion ( norm. voiding= 300mls)

Lies in pelvic cavity behind symphysis pubis

Urethra Short, muscular tube Urine from bladder to meatus and from the body Female 4-6.5cm (1 ½ - 2 ½ in.) length Male 20cms ( 8 in.) Urinary and reproductive systems

Urethra

Short, muscular tube

Urine from bladder to meatus and from the body

Female 4-6.5cm (1 ½ - 2 ½ in.) length

Male 20cms ( 8 in.)

Urinary and reproductive systems

Meatus External opening of the urethra, male & female The need to void is a conscious awareness

Meatus

External opening of the urethra, male & female

The need to void is a conscious awareness

Life Cycle Changes Infants & children Unable to concentrate urine b/c kidneys are immature Urine is light yellow Void frequently Voluntary control @ 24mos. when neuromuscular structures develop

Infants & children

Unable to concentrate urine b/c kidneys are immature

Urine is light yellow

Void frequently

Voluntary control @ 24mos. when neuromuscular structures develop

Adult 1500 – 1600 mls urine/24hrs Concentrates urine – normal is amber colored Nocturia Not usually Decreased renal blood flow during rest Ability to concentrate urine

Adult

1500 – 1600 mls urine/24hrs

Concentrates urine – normal is amber colored

Nocturia

Not usually

Decreased renal blood flow during rest

Ability to concentrate urine

Elderly Micturition impaired mobility Diseases, alzheimer’s, CVA Physiological age related changes Bladder loses muscle tone and capacity Kidneys lose ability to concentrate urine Bladder loses muscle strength

Elderly

Micturition impaired

mobility

Diseases, alzheimer’s, CVA

Physiological age related changes

Bladder loses muscle tone and capacity

Kidneys lose ability to concentrate urine

Bladder loses muscle strength

Common Problems Urinary Retention Accumulation of urine in the bladder Inability to empty Pressure, discomfort and tenderness Residual Urine = urine retained in the bladder after voiding

Urinary Retention

Accumulation of urine in the bladder

Inability to empty

Pressure, discomfort and tenderness

Residual Urine = urine retained in the bladder after voiding

Incontinence Loss of voluntary control to void Infection, nerve damage to bladder or brain, spinal cord injury, or aging process Total incontinence = no control Stress incontinence = sm. amts. Urine excreted involuntarily with coughing or laughing At risk for skin breakdown related to acid urine next to skin. Adult Diapers or Attends

Incontinence

Loss of voluntary control to void

Infection, nerve damage to bladder or brain, spinal cord injury, or aging process

Total incontinence = no control

Stress incontinence = sm. amts. Urine excreted involuntarily with coughing or laughing

At risk for skin breakdown related to acid urine next to skin.

Adult Diapers or Attends

Frequency & Urgency Nocturia Enuresis – involuntary discharge of urine Nocturnal Enuresis During sleep Bed-wetting children 5yrs and older Oliguria 30mls/hr or 720 mls/24hrs

Frequency & Urgency

Nocturia

Enuresis – involuntary discharge of urine

Nocturnal Enuresis

During sleep

Bed-wetting children 5yrs and older

Oliguria

30mls/hr or 720 mls/24hrs

Renal anuria cessation of urine production 100mls/24h

Renal anuria

cessation of urine production 100mls/24h

Promoting Healthy Urinary Elimination Urinate as soon as the urge is felt Avoids stasis and distention Prevents urgency, infection, and incontinence Drink about 2liters fluid/day Limit Na, caffeine, and alcohol

Urinate as soon as the urge is felt

Avoids stasis and distention

Prevents urgency, infection, and incontinence

Drink about 2liters fluid/day

Limit Na, caffeine, and alcohol

For people with Nocturia fld. Intake in the p.m. caffiene and alcohol Void before bedtime For Women Wipe perineum front to back Void soon after intercourse Wash hands Pelvic – floor strengthening exercises (Kegel Exercises)

For people with Nocturia

fld. Intake in the p.m.

caffiene and alcohol

Void before bedtime

For Women

Wipe perineum front to back

Void soon after intercourse

Wash hands

Pelvic – floor strengthening exercises (Kegel Exercises)

Client Education S & S of infection Fluid intake ( if no restrictions 2-5 L/day ) Perineal hygiene Meds. & side effects on urination, color, and volume

S & S of infection

Fluid intake ( if no restrictions 2-5 L/day )

Perineal hygiene

Meds. & side effects on urination, color, and volume

Facilitating Micturition Nursing Measures to promote voiding in people who are having difficulty: Privacy and natural position Providing commode or bathroom Running water Warm water to dangle fingers Warm water over perineum ( measure if on In/Out )

Nursing Measures to promote voiding in people who are having difficulty:

Privacy and natural position

Providing commode or bathroom

Running water

Warm water to dangle fingers

Warm water over perineum ( measure if on In/Out )

Gently stroking inner thighs or pressure to symphysis pubis Pain relief Warmth to the bladder & perineum relaxes muscles & facilitates voiding. ( Sitz bath or warm tub ) If unsuccessful- urinary catheterization may be indicated

Gently stroking inner thighs or pressure to symphysis pubis

Pain relief

Warmth to the bladder & perineum relaxes muscles & facilitates voiding. ( Sitz bath or warm tub )

If unsuccessful- urinary catheterization may be indicated

Promoting complete bladder emptying Prevention of infection Good perineal hygiene Adequate fld. Intake Dilutes urine & flushes urethra Acidifying urine ( inhibits microorganisms) Cranberry juice, whole grain breads, meats, eggs, prunes and plums.

Promoting complete bladder emptying

Prevention of infection

Good perineal hygiene

Adequate fld. Intake

Dilutes urine & flushes urethra

Acidifying urine ( inhibits microorganisms)

Cranberry juice, whole grain breads, meats, eggs, prunes and plums.

Indwelling Catheter Care Goal - prevent infection & maintain unobstructed flow of urine. Monitor for problems. Perineal hygiene @ least 2x/day and prn Do not advance catheter further into urethra during perineal care

Goal - prevent infection & maintain unobstructed flow of urine. Monitor for problems.

Perineal hygiene @ least 2x/day and prn

Do not advance catheter further into urethra during perineal care

Catheter Care Fld intake (3L/day ) Handwashing and Gloves Positioning Urine bag Tubing

Fld intake (3L/day )

Handwashing and Gloves

Positioning

Urine bag

Tubing

Bowel Elimination Function - excrete/eliminate waste products of digestion. Maintaining normal bowel elimination is essential to health and efficient body functions.

Function - excrete/eliminate waste products of digestion.

Maintaining normal bowel elimination is essential to health and efficient body functions.

GI System Small Intestine Absorption nutrients & electrolytes 20 ft length, 1 in. diameter 3 sections Duodenum Jejunum Ileum

Small Intestine

Absorption nutrients & electrolytes

20 ft length, 1 in. diameter

3 sections

Duodenum

Jejunum

Ileum

GI Large Intestine Absorbs H2O and electrolytes Temporarily stores waste products Main function is elimination 5 – 6 ft. length, 6 – 7 cm. diameter Cecum Ascending colon ( Right side ) Transverse colon Descending colon

Large Intestine

Absorbs H2O and electrolytes

Temporarily stores waste products

Main function is elimination

5 – 6 ft. length, 6 – 7 cm. diameter

Cecum

Ascending colon ( Right side )

Transverse colon

Descending colon

Patterns through life cycle Babies: 3 – 6 BM’s/day Children: Neuromuscular structures not developed until 15 – 18 mos. Voluntary control 2 – 3 yrs. Pregnant women prone to constipation Pressure on abd. Organs Iron supplements

Babies: 3 – 6 BM’s/day

Children:

Neuromuscular structures not developed until 15 – 18 mos.

Voluntary control 2 – 3 yrs.

Pregnant women prone to constipation

Pressure on abd. Organs

Iron supplements

Elderly prone to constipation Slowing of peristalsis

Elderly prone to constipation

Slowing of peristalsis

Determinants affecting elimination Dietary patterns & fld. Intake 6 – 8 glasses H2O/day ( 1400- 2000mls ) fld. Liquifies stool Dietary fiber stimulates peristalsis Soft stool

Dietary patterns & fld. Intake

6 – 8 glasses H2O/day ( 1400- 2000mls )

fld. Liquifies stool

Dietary fiber stimulates peristalsis

Soft stool

Factors affecting elimination Fiber ( undigestible residue ) provides bulk Absorbs fluid Increases stool mass Bowel wall stretches Peristalsis stimulated Defecation results

Fiber ( undigestible residue ) provides bulk

Absorbs fluid

Increases stool mass

Bowel wall stretches

Peristalsis stimulated

Defecation results

Factors affecting elimination Personal habits Busy schedule, postpone BM, constipation Activity & exercise Immobile activity in colon Medications Laxatives Narcotics with codiene

Personal habits

Busy schedule, postpone BM, constipation

Activity & exercise

Immobile activity in colon

Medications

Laxatives

Narcotics with codiene

Factors affecting elimination Emotions Anxiety peristalsis & diarrhea Depression Pain Surgery Anaesthetic causes temporary cessation of peristalsis Direct manipulation of the bowel stops peristalsis

Emotions

Anxiety peristalsis & diarrhea

Depression

Pain

Surgery

Anaesthetic causes temporary cessation of peristalsis

Direct manipulation of the bowel stops peristalsis

Common Problems Constipation – difficult passage of hard, dry stool; infrequent movements Fecal Impaction – unrelieved constipation, feces wedged in rectum, no BM usually 3days, oozing of diarrheal stool develops Diarrhea- # liquid stool Flatulence – abd. Distention & pain

Constipation – difficult passage of hard, dry stool; infrequent movements

Fecal Impaction – unrelieved constipation, feces wedged in rectum, no BM usually 3days, oozing of diarrheal stool develops

Diarrhea- # liquid stool

Flatulence – abd. Distention & pain

Common Problems Incontinence – inability to control passage of stool Hemorrhoids Dilated engorged veins Increased pressure when straining Internal / external Bleeding

Incontinence – inability to control passage of stool

Hemorrhoids

Dilated engorged veins

Increased pressure when straining

Internal / external

Bleeding

Daily BM Not essential.  2 / week a concern Defecation pattern BM, Stool, Feces, Defecate – all mean waste products expelled via the bowel

Daily BM Not essential.

 2 / week a concern

Defecation pattern

BM, Stool, Feces, Defecate – all mean waste products expelled via the bowel

Promoting Healthy Bowel Elimination Privacy Squatting position Bedpan position Cathartics & laxatives Anti- diarrheal agents Enemas disimpaction

Privacy

Squatting position

Bedpan position

Cathartics & laxatives

Anti- diarrheal agents

Enemas

disimpaction

Bowel routine Daily time clock Hot drinks Stool softeners Privavy Position and abdominal pressure Bearing down

Bowel routine

Daily time clock

Hot drinks

Stool softeners

Privavy

Position and abdominal pressure

Bearing down

Assissting with Elimination Embarrassing & stressful Usually urge to defecate 1hr. Pc Bedpans Metal or plastic Regular or fracture pan Cleanliness Urinals Commode

Embarrassing & stressful

Usually urge to defecate 1hr. Pc

Bedpans

Metal or plastic

Regular or fracture pan

Cleanliness

Urinals

Commode

Procedure Privacy- close door, Side rail as needed Recumbent with HOB Tissue Call bell Leave alone if possible Gloves Clean genitals

Privacy- close door,

Side rail as needed

Recumbent with HOB

Tissue

Call bell

Leave alone if possible

Gloves

Clean genitals

Procedure Remove pan and cover In & Out Specimens Clean pan Wash hands yours and client’s Lower bed Client comfort

Remove pan and cover

In & Out

Specimens

Clean pan

Wash hands yours and client’s

Lower bed

Client comfort

Peri - Care Cleaning of genitals , routine part of complete/ partial bed bath Incontinence

Cleaning of genitals , routine part of complete/ partial bed bath

Incontinence

Procedure for Peri Care Regular patient Simple explanation- layman’s terms Privacy Gloves Dorsal recumbent position Incontinent pad under buttocks Warm soap and water Female – separate labia

Regular patient

Simple explanation- layman’s terms

Privacy

Gloves

Dorsal recumbent position

Incontinent pad under buttocks

Warm soap and water

Female – separate labia

Procedure for Peri Care Male – begin penile head move down along shaft, retract foreskin, rinse and dry.

Male – begin penile head move down along shaft, retract foreskin, rinse and dry.

Procedure for Peri Care Catheter – Q 8 hrs. Clean perineum & 2in. Of catheter No powders / lotions Avoid advancing catheter Keep urine drainage bag off floor but below level of bladder Empty bag Q8 – 12hrs or when bag is full, remember to mark amt. Emptied on In/Out sheet

Catheter –

Q 8 hrs.

Clean perineum & 2in. Of catheter

No powders / lotions

Avoid advancing catheter

Keep urine drainage bag off floor but below level of bladder

Empty bag Q8 – 12hrs or when bag is full, remember to mark amt. Emptied on In/Out sheet

Avoid use of baby powder/ cornstarch No medicinal purpose Can form clumps or will cake in creases Use vaseline/ zincoxide as skin barrier for incontinent clients

Avoid use of baby powder/ cornstarch

No medicinal purpose

Can form clumps or will cake in creases

Use vaseline/ zincoxide as skin barrier for incontinent clients

Suppository Administration Check physician’s order, protocol Left Lateral position Gloves Lubication Hold with thumb and index finger Insert with index finger (3 – 4”) never force Deep breath = relaxes anal sphincter

Check physician’s order, protocol

Left Lateral position

Gloves

Lubication

Hold with thumb and index finger

Insert with index finger (3 – 4”) never force

Deep breath = relaxes anal sphincter

Caution Vagus nerve stimulation can cause heart rate to slow – avoid excess manipulation

Caution

Vagus nerve stimulation can cause heart rate to slow – avoid excess manipulation

Enema Administration Main purpose Promotion of defecation, stimulate peristalsis The fluid breaks up fecal mass, stretches the rectal wall & initiates the defecation reflex

Main purpose

Promotion of defecation, stimulate peristalsis

The fluid breaks up fecal mass, stretches the rectal wall & initiates the defecation reflex

Types of Enemas

Cleansing Enemas Tap Water Hypotonic Used only once Electrolyte imbalance Water toxicity Circulatory overload ( concentration gradient)

Tap Water

Hypotonic

Used only once

Electrolyte imbalance

Water toxicity

Circulatory overload ( concentration gradient)

Normal Saline Used when more than one enema is needed Safest Isotonic Large volume to distend bowel

Normal Saline

Used when more than one enema is needed

Safest

Isotonic

Large volume to distend bowel

Hypertonic Solution Smaller volume of fluid Draws from surrounding tissue into bowel to soften stool and stimulate peristalsis Fleets – sodium phosphate Low volume, concentrated solution

Hypertonic Solution

Smaller volume of fluid

Draws from surrounding tissue into bowel to soften stool and stimulate peristalsis

Fleets – sodium phosphate

Low volume, concentrated solution

Soap suds Less common Soap irritates the bowel 5 – 15 mls. Castile soap in 1000mls warm water

Soap suds

Less common

Soap irritates the bowel

5 – 15 mls. Castile soap in 1000mls warm water

Oil Retention Oil based solution Lubricates the rectum and colon Softens stool, easier to pass Retain 1 –2 hrs if possible Follow with cleansing enema

Oil Retention

Oil based solution

Lubricates the rectum and colon

Softens stool, easier to pass

Retain 1 –2 hrs if possible

Follow with cleansing enema

Medicated Instill meds. Rectal mucosa absorption Ex. – Kayexalate to K (potassium). Absorbs K from the intestinal tract

Medicated

Instill meds.

Rectal mucosa absorption

Ex. – Kayexalate to K (potassium). Absorbs K from the intestinal tract

Volumes for Enemas Large Volume 500 – 1000mls. Container 12 – 18 in. above the bowel Lg. Volume stimulates & causes evacuation of stool Small Volume 500 mls. Container 12 in.above bowel

Large Volume

500 – 1000mls.

Container 12 – 18 in. above the bowel

Lg. Volume stimulates & causes evacuation of stool

Small Volume

500 mls.

Container 12 in.above bowel

Volumes for Enemas Pre packaged Fleet 150mls Microlax 5mls Hypertonic solution User friendly Hold for 5min. Oral Fleet

Pre packaged

Fleet 150mls

Microlax 5mls

Hypertonic solution

User friendly

Hold for 5min.

Oral Fleet

Prepackaged used more than large volume because: Works Less risk for electrolyte imbalance Rapid administration Less discomfort and distention Convenient and quick

Prepackaged used more than large volume because:

Works

Less risk for electrolyte imbalance

Rapid administration

Less discomfort and distention

Convenient and quick

Physician’s order reads “ enemas to clear” No more than 3 total given Return solution will be highly colored but no solid stool Isotonic solution (normal saline) Excess enema use seriously depletes fluid and electrolytes

Physician’s order reads “ enemas to clear”

No more than 3 total given

Return solution will be highly colored but no solid stool

Isotonic solution (normal saline)

Excess enema use seriously depletes fluid and electrolytes

Procedure for Enema Administration Confirm Dr’s order, prepare client, verbal consent, equipment, privacy Left lateral position ( fld. Flows by gravity) Drape, pad under buttocks Warm solution- stimulates peristalsis Hot sol’n burns mucosa Cold sol’n causes cramping

Confirm Dr’s order, prepare client, verbal consent, equipment, privacy

Left lateral position ( fld. Flows by gravity)

Drape, pad under buttocks

Warm solution- stimulates peristalsis

Hot sol’n burns mucosa

Cold sol’n causes cramping

Procedure for Enema Administration Prime tube Lubricate tip Glove Insert 7 – 10 cm.(3-4in) adult Do not force Deep breath Guide toward umbilicus

Prime tube

Lubricate tip

Glove

Insert 7 – 10 cm.(3-4in) adult

Do not force

Deep breath

Guide toward umbilicus

Procedure for Enema Administration Container at appropriate height Lg. = 12 – 18in Sm. = 12in 1000mls takes ~ 10 min to instill Higher the bag – greater the pressure C/O discomfort, lower bag, slow infusion, stop, then start again Remain side lying to retain 5 – 10 min. or as long as possible

Container at appropriate height

Lg. = 12 – 18in

Sm. = 12in

1000mls takes ~ 10 min to instill

Higher the bag – greater the pressure

C/O discomfort, lower bag, slow infusion, stop, then start again

Remain side lying to retain 5 – 10 min. or as long as possible

Procedure for Enema Administration Assist to bathroom or give bedpan Evaluate results Document Type & volume of enema Color, amount, consistency of fecal return Hygienic measures for client Wash Hands

Assist to bathroom or give bedpan

Evaluate results

Document

Type & volume of enema

Color, amount, consistency of fecal return

Hygienic measures for client

Wash Hands

Ostomy Care

Certain diseases require surgical interventions to create an opening into the abdominal wall for fecal and urinary elimination Enterostomy – the surgical procedure performed to produce the artificial stoma.

Certain diseases require surgical interventions to create an opening into the abdominal wall for fecal and urinary elimination

Enterostomy – the surgical procedure performed to produce the artificial stoma.

Definitions Ostomy = opening made to allow passage of urine or stool Piece of intestine is brought out onto the client’s abd. Lacks nerve endings Doesn’t hurt to touch but has other implications Stoma = mouth like opening in the abdominal wall to drain urine or stool

Ostomy = opening made to allow passage of urine or stool

Piece of intestine is brought out onto the client’s abd.

Lacks nerve endings

Doesn’t hurt to touch but has other implications

Stoma = mouth like opening in the abdominal wall to drain urine or stool

Effluent – drainage from stoma Bowel ostomies Cancer ( Ca) Drain fecal material Consistency depends on location Higher up = more liquid Greater risk skin irritation b/c concentration of digestive enzymes

Effluent – drainage from stoma

Bowel ostomies

Cancer ( Ca)

Drain fecal material

Consistency depends on location

Higher up = more liquid

Greater risk skin irritation b/c concentration of digestive enzymes

Ileostomy End of small intestine By passes lg. Intestine = freq. Liquid stools Colostomy Large intestine More solid stool

Ileostomy

End of small intestine

By passes lg. Intestine = freq. Liquid stools

Colostomy

Large intestine

More solid stool

Ostomies may be permanent More common temporary Rest the bowel Crohn’s

Ostomies may be permanent

More common

temporary

Rest the bowel

Crohn’s

Urinary Ostomies Provide drainage of urine that bypasses the bladder = Urinary Diversion Ureterostomy Ureter to abd. Wall Lt., Rt., Bilateral

Provide drainage of urine that bypasses the bladder = Urinary Diversion

Ureterostomy

Ureter to abd. Wall

Lt., Rt., Bilateral

Ileal Conduit 6 – 8 in. ileum 1 end for external opening Other end closed off Ureters implanted into this piece of bowel Pouch Urine will have shred of mucus b/c bowel still produces same

6 – 8 in. ileum

1 end for external opening

Other end closed off

Ureters implanted into this piece of bowel

Pouch

Urine will have shred of mucus b/c bowel still produces same

Concerns Infection Sterile ureters provide opening into system Skin Breakdown Continuous drainage Moisture on skin Replace urinary pouch q 2-3 days

Infection

Sterile ureters provide opening into system

Skin Breakdown

Continuous drainage

Moisture on skin

Replace urinary pouch q 2-3 days

Pouching an Enterostomy Effluent ( drainage ) may begin immediately Collects all effluent Protects the skin Stoma should be moist and reddish pink (same as other mucus membranes) Flush to skin or bud-like protrusion Black, purple, dry = inadequate circulation

Effluent ( drainage ) may begin immediately

Collects all effluent

Protects the skin

Stoma should be moist and reddish pink (same as other mucus membranes)

Flush to skin or bud-like protrusion

Black, purple, dry = inadequate circulation

Pouch with Skin Barrier Comfortable fit Cover skin surrounding stoma Good seal Post-op pouch should allow for visibility of stoma

Comfortable fit

Cover skin surrounding stoma

Good seal

Post-op pouch should allow for visibility of stoma

Types of pouches and skin barriers One Piece Pouching System Skin barriers preattached, precut, custom fit Two Piece System Skin barrier with flange ( plastic ring) Corresponding size pouch Assess stoma Measure correct size Change q 3-7 days Empty 1/3 to ½ full, expel flatus prn

One Piece Pouching System

Skin barriers preattached, precut, custom fit

Two Piece System

Skin barrier with flange ( plastic ring)

Corresponding size pouch

Assess stoma

Measure correct size

Change q 3-7 days

Empty 1/3 to ½ full, expel flatus prn

Steps to Care for Ostomies Supine position Wash hands, glove Remove pouch & skin barrier, push skin away from barrier Cleanse peristomal skin gently with warm tap water and clean cloth Do not scrub, Avoid soap ( residue- pouch won’t adher)

Supine position

Wash hands, glove

Remove pouch & skin barrier, push skin away from barrier

Cleanse peristomal skin gently with warm tap water and clean cloth

Do not scrub, Avoid soap ( residue- pouch won’t adher)

Steps to Care for Ostomies Correct sizing Cut opening 1/16 – 1/8 larger than stoma Remove backing Ileostomy- apply thin circle barrier paste around opening of pouch and allow to dry (if creases or bumps use barrier paste to even surface for pouch application)

Correct sizing

Cut opening 1/16 – 1/8 larger than stoma

Remove backing

Ileostomy- apply thin circle barrier paste around opening of pouch and allow to dry (if creases or bumps use barrier paste to even surface for pouch application)

Steps to Care for Ostomies Pouch should point to client’s knees Maintain gentle finger pressure around barrier for 1-2 min. Picture frame flange with non allergic paper tape Ostomy deodorant for pouch Tub bath or shower

Pouch should point to client’s knees

Maintain gentle finger pressure around barrier for 1-2 min.

Picture frame flange with non allergic paper tape

Ostomy deodorant for pouch

Tub bath or shower

Steps to Care for Ostomies Normal stoma oozes blood if rubbed Actual bleeding into pouch is abnormal Pouch covers are available The client will be watching the nurse during ostomy care to gage reaction. Be conscious of facial expression & nonverbal cues

Normal stoma oozes blood if rubbed

Actual bleeding into pouch is abnormal

Pouch covers are available

The client will be watching the nurse during ostomy care to gage reaction.

Be conscious of facial expression & nonverbal cues

Steps to Care for Ostomies Education Counseling Body image Self care Fear of rejection Sexual function Powerlessness over bowel regulation

Education

Counseling

Body image

Self care

Fear of rejection

Sexual function

Powerlessness over bowel regulation

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