Fundamentals - Practice & Skills, part 24: Constipation, Diarrhea, and Ostomies

by Meris Shuwarger August 16, 2021 Updated: August 23, 2021

Full Transcript

Hi. I'm Meris. And in this video I'm going to be talking to you about constipation, diarrhea, and different types of ostomies. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. And if you already have a set of your own, you can follow along with me, starting on card number 124. Let's get started.

Okay. So first up, we are talking about constipation and diarrhea. Constipation is going to be either decreased stool output or stool that is really hard, dry, maybe lumpy. And it puts your patient at risk for a lot of things. But it's also very painful. One of the things that I want to talk to you about is what do we do about constipation. So big, big, big stuff to know for nursing school and clinical practice is that constipation, the patient teaching is almost always going to be the same. It's to increase fluids, increase fiber in your diet, and increase activity. The more fluid we have, the more we can pull it into the bowel and soften the stool. The more fiber we have, the more we can bulk up the stool and promote peristalsis. And then the more activity we do, the more we promote peristalsis as well. Now, when I have diarrhea, what is my patient education, right? So patient education for diarrhea is going to be to rest the bowel in terms of don't eat anything that's really out of your norm, don't eat anything spicy or really intense. You want to eat things that are going to be like the BRAT diet, so bananas, rice, applesauce, and toast. Because what is your patient at risk for if they have diarrhea? Pause the video, think about it, and then come back.

Your patient with diarrhea is at risk for fluid-volume deficit. They are losing too much fluid in the stool. So we also want them to increase their fluid intake and, shockingly, increase that fiber too, right? The bananas as well. So important things to know about diarrhea is it's not just fluid balance I need to worry about, it's going to be things like excoriation of the skin. So I'm going to have irritated skin, right? I could end up having, actually, impaired skin integrity from diarrhea. So very important to be assessing your patients who have these conditions.

Now, let's talk about ostomies. And if you stay until the end of this video, I'm going to tell you about a personal experience with ostomies. So on card 125, we talk about the different types of ostomies. So an ostomy is a surgically created opening. So a tracheostomy, right, that's in the neck. But when we're talking about ostomies as it relates to bowel elimination, we're talking about surgical openings that somehow divert the normal passage of the bowel. So we have an ileostomy, and as the name would suggest, that's a surgical opening created in the ileum of the small intestine. So that output is going to be very, very liquidy and very frequent because the colon's job, the large intestine, is to remove fluid to condense that stool. So it's important to understand that when we don't make it to the colon, we're going to have really watery output. A colostomy is created in the colon, the large intestine. It can be in the ascending, transverse, descending, and sigmoid colon. So the output is going to vary based on where it is in the colon. The closer we get to the rectum, the more formed the stool is going to be. So in the ascending colon, pretty watery still. In the transverse colon, we're thinking more this is semisolid or pudding-like consistency. And from descending and sigmoid, it's going to be essentially formed stool.

So on card 126 - I want you to really pay attention - this is the nursing considerations and patient education for ostomies. Super-duper important stuff. Lots of red and bold text here, which means it's important to know. So empty the bag-- obviously, I need a collection bag on the outside so that I'm not just emptying my bowels onto my skin. So empty the bag when it is a third full, but change the appliance immediately if it is leaking. Also, the stoma should be-- the stoma is the actual opening itself. The stoma should be red or pink and moist. All of that indicates good blood supply. We are not having any problems there. But if it is pale or cool or dusky or blue, we need to report this finding immediately to the provider. There's nothing you as the nurse can do about it. This patient needs emergency surgery due to the ischemia that is causing these color changes.

All right. Other things to know would just be education on how to cut the wafer. So the wafer is the part of the device that sticks to the patient's skin. You need to educate the patient that they should measure their stoma. Usually, there's a little template card that you can use. You place it over the stoma and see which one fits it best. And then you want to cut the opening less than or equal to about an eighth of an inch wider in diameter. Reason being I don't want to expose too much of my skin because of the risk of skin breakdown from moisture, but I also don't want it to be too tight. Because if the device is too tight, it's going to cause what? Ischemia. So very important patient teaching there. All right. So that is it for constipation, diarrhea, and ostomies.

I hope that review was helpful. If it was, please like this video so that I know that you enjoyed it. If you have a great way to remember something, I'd love to hear in the comments, and I'm sure the others watching this video would too. And be sure to subscribe to the channel so that you are the first to know when our new videos drop. The next video in this series is going to be talking about laxatives, enemas, and fecal-occult-blood testing. Thanks so much, and happy studying.

So I actually had a colostomy for a year. I have a genetic condition called familial Mediterranean fever. And at the time, it was undiagnosed. But I was having a lot of colorectal problems and a lot of colorectal surgeries. So I had a temporary diverting colostomy, a loop colostomy placed in my sigmoid colon. So that was on the left side of my abdomen. I had it there for a year, from the time that I was 24 to 25. And then almost exactly to the day, a year later, I had it reversed, and it was reversed without any problems or complications. I can tell you that as an ostomate - that's what we call someone who has a stoma - and especially as an ostomate who had her colostomy placed very young, it's a huge life change, a huge life change. But the person who made a really big impact in my life was my wound and ostomy care nurse. She came to see me before my surgery. She helped identify the best location for my ostomy. And then she helped connect me with resources in my community to help me learn how to care for myself and how to care for my stoma because you have to learn how to take care of yourself from scratch. It's very disorienting and confusing and has a lot of psychosocial impact as well. So if you are interested in wound care, if you are interested in ostomies, I would very much encourage you to look into this field because that woman-- I don't remember her name, but I can remember her face, and I can remember how she made me feel. Sorry. So very important to have those incredible resources and incredible people in the nursing field, in the nursing profession. And if that is something that you are interested in, I would really encourage you to pursue it.


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