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A variety of gastrointestinal/genitourinary etiologies may necessitate the creation of a fecal or urinary diversion. Teaching the patient how to care for a new ostomy can be a challenging experience for the nurse. The patient with an ostomy needs encouragement, support, and counseling to learn how to integrate self-ostomy care into daily activities.
A variety of gastrointestinal/genitourinary etiologies may necessitate the creation of a fecal or urinary diversion. These may include diverticular disease, inflammatory bowel disease, colon-rectal cancer, intestinal obstruction, gastrointestinal trauma, and gynecological cancers (Beitz, 2004). Indications for creating a urinary stoma are bladder cancer, neurogenic bladder, interstitial cystitis, and refractory radiation cystitis. The etiology of the disease will determine if the ostomy is going to be temporary or permanent (Tomaselli & McGinnis, 2004).
Among the different types of surgically created ostomies, a colostomy is an opening constructed in the colon (large intestine) to allow for the elimination of stool. A colostomy may be located in the ascending, transverse, or sigmoid colon. The point of surgical resection will determine the consistency of the stool output. An ileostomy is surgically constructed from the ileum (small intestine). It is created high in the gastrointestinal tract; therefore, the stool output is of relatively high amount and of liquid consistency (Vasilevsky & Gordon, 2004). A urostomy or ileal conduit is created using a short segment of the ileum to aid in eliminating urine. The ureters are connected to the conduit for urine to flow out of the body via the stoma into an ostomy pouch (Tomaselli & McGinnis, 2004).
Whether an ostomy is permanent or temporary, nurses must have the knowledge to provide the patient and family with the appropriate information to maximize recovery and allow for a positive experience when learning ostomy care.
Patient Education
When a patient is scheduled for ostomy surgery, he or she may experience many feelings, such as anxiety, fear, loss of body image, and depression, especially if a diagnosis of cancer is the cause for surgery. Preoperative teaching can help relieve some of these feelings and contribute to the patient's positive recovery (O'Shea, 2001). One essential component of the patient's preoperative teaching is a consultation with a wound ostomy and continence nurse (WOCN). Preoperative counseling provides the opportunity to assess the...