Ileostomy Care

1. Definition of "ileostomy."

1. An ileostomy is a surgical connection between the ileum, which is the last portion of the small intestine, and the abdominal wall.

2. A small portion of the intestine is sewed to the surface of the abdomen to create a "stoma."

3. The purpose of an ileostomy is to bypass a diseased colon and rid the body of wastes.

2. Basic anatomy and physiology of the small intestine.

1. Digestion is completed in the small intestine.

2. Contents are moved along by peristalsis.

3. The ileum is connected to the large intestine at the ileocecal valve.

3. Measures important in managing an ileostomy.

1. Laxatives, enteric-coated pills, and time-released pills should be avoided.

2. Food should be chewed slowly and completely.

3. Avoid stress.

4. Avoid smoking.

4. Ileostomy odor management.

1. Use deodorizing solutions or tablets.

2. Limit or avoid foods such as eggs, fish, onions, cabbage, etc., which can increase odor.

3. Eat foods such as spinach, parsley, yogurt, or buttermilk, which can decrease odor.

5. How to change a wafer apparatus.

1. Assemble all equipment.

2. Use plastic wrap or a paper towel to trace a pattern around the stoma, being sure to label the top of the pattern.

3. Trace the stomal pattern on the paper side of the wafer.

4. Cut the pattern out of the wafer and label the top.

5. Remove the pouch being worn.

6. Wash the skin thoroughly; rinse and dry well.

7. Assess the stoma for any change in size or color.

8. Assess the skin for signs of irritation, and apply skin barrier as needed.

9. Apply wafer and pouch as directed.

10. "Window frame" the wafer with tape.

11. Apply liquid deodorizer as desired.

12. Change the appliance as needed - usually every five to seven days.

6. Procedure to manage skin irritation.

1. Mild irritation.

1. Wash skin with soap and water.

2. Apply sween, and massage well.

3. Apply skin prep before applying wafer.

2. Severe irritation.

1. Wash skin with soap and water.

2. Apply sween, and massage well.

3. Apply amphogel and dry.

4. Apply skin prep and karaya powder.

7. Possible complications

1. Dehydration (symptoms are confusion, lethargy, dry skin and dry mouth, muscle weakness).

1. Increase fluids to prevent dehydration.

2. Decrease fiber in diet if stools are excessively loose.

2. Bowel obstruction (symptoms are foul odor, cramping, nausea, very liquid increased output from ileostomy, distended abdomen, and vomiting).

1. If symptoms appear, try a hot shower; then get into a knee-chest position. If no relief, call physician.

2. Avoid foods that may cause blockage, such as celery, corn, lettuce, popcorn, nuts, coleslaw, and seeds.

3. Drink at least 6-8 glasses of fluids per day.

4. Eat slowly and chew food well.

3. Electrolyte imbalance (Provide "Electrolyte Imbalance" handout.)

1. Eat a well-balanced diet.