PROVIDING

OSTOMY CARE
An ostomy is a surgical formed opening
from an internal structure of the body.
Ostomies in newborns are created in the
gastrointestinal system to relieve bowel
obstruction caused by conditions such as
ileal arresia, necrotizing enterocolitis, and
imperforate anus.
In older children, gastrointestinal
otomies are constructed for
conditions such as inflammatory
bowel disease, Crohn disease and
ulcerative colitis.
If an ostomy is created in the ileum, the
stoma is located on the rigth side of the
abdomen and drains liquid stool, which is
extremely irritating to the skin because of the
digestive enzymes it contains. If an ostomy is
crested in the sigmiod portion of the bowel,
the stoma is on the left lower abdomen and
passes normally formed stool.----
An ileostomy requires the use of a
collecting ostomy appliance to contian
acid stool and to prevent excoriation of
the abdominal skin. Older children also
may use an appliance with a colostomy.
For an infant with a colostomy, parents
may choose (with support and advice)
to use an appliance or just apply a
diaper.----
Two basic problems commonly arise
when using an ostomy appliance
with an infant: It may be difficult to
locate one small enough to contain
liquid drainage without leaking, and
the skin under the appliance may
become extremely irritated.
Consulting with a wound ostomy
continence nurse (WOCN) can be helpful
to resolve these problems. As a rule,
clear plastic, ringless colostomy bags are
more easily cut to fit the size of the
stoma and the contour and size of an
infants abdomen than bags with a ring
attached.
When using a commercial skin sealant to
harden the skin surrounding the stoma,
apply it according to the brand direction
and allow it to dry. If a spray is used,
protect the infants face so that the infant
does not inhale the solution. Tuck the
chosen stoma collection appliance inside
the diaper to help keep the infant from
pulling it loose.----
Check the appliance or bag for collecting stool
at least every 4 hours. To protect the
underlying skin, do not remove a self-adhering
bag if it is full but drain collected stool from
the bottom of the appliance into basin or
paper cup for disposal. To reduce odor, flush
the appliance bag with warm water and soap
solution, using a bulb-type syringe, and rinse
with clear water.
The collection bag may stay in place for
long as 1 week if properly secured. To
remove a bag placed with a sealant, use
the designated solvent to prevent pulling
or harming the underlying skin. After
removal, wash the skin with soap and
water or the solvent can become an
irritant.
Because most infants enjoy tub
bathing, along, soaking bath is an
excellent way to loosen an adherent
appliance.----
If a parent choose not to use an
appliance, stool will be discharged onto
the abdomen three or four times a day,
similar to the usual newborn or infant
stool pattern. Wash and dry the stoma
and surrounding skin area well after
defecation. Follow your agency’s protocol
for skin care, such as applying karaya
powder or a skin protection cream.
Apply ample absorbent gauze and an
absorbent pad over the stoma. Secure in
place with nonadhesive tape or an binder.
Without an appliance in place, stool is
kept from touching the skin only by the
protection of the ointment and frequent
changing of the dressing, so assess for
stool about every 4 hours.
Turning an infant from side to side
after every feeding can be helpful in
keeping stool from flowing
continuously to one side. Leaving the
abdominal skin exposed to air for at
least 1 hour per day helps protect
skin integrity.----
Reassure parents caring for an infant
with an ostomy that little is different
from usual because all parents must
change their infant’s diapers
frequently and clean the diapered
area.
Discuss with parents that the stoma has
no nerves, so a parent can feel free to
wash it without hurting the child and that
compression against the stoma will not
cause a child pain, so the parent can feel
comfortable placing the infant on their
abdomen or holding the infant closely
against their body for comfort.----
Colostomies are rarely irrigated in
children. On occasion, to prepare a child
for second-stage abdominal surgery,
irrigation of the “blind-end” bowel ( the
bowel between the rectum and
colostomy ) of a double-barreled
colostomy may be prescribed daily to
keep it lubricated and to maintain bowel
tone.
The primary care provider should
specify the exact amount of flud to be
used; typically, th amount in infants is
small only 40 to 100 mL. Normal
saline (0.9% sodium chloride) should
be used in place of tap water; using
tap water could lead to water
intoxication because it is not isotonic.-
Children who have a colostomy since
infancy adapt well to having it
because they hav never known
another method of defecation.
Suggest that parents begin toilet
training for urine control at the usaul
time (2 to 3 years of age).
In contrast, school-aged children
often have a great deal of difficulty
adjusting to a new colostomy.
Encourage children to perform
complete self-care as soon as possible
to develop early independence.
Preschool children usually benefit from
therapeutic play that helps them work
through their feelings about a colostomy.
Provide some time for older children to
discuss concerns about being accepted by
others and how to answer questions from
other children about a colostomy.
Adolescents with a colostomy may
have questions regarding sexuality
and need reassurance that this should
not interfere with intimate
relationships.