A rectal suppository is a small, wax-like cone or oval that is inserted into the anus. The wax-like substance dissolves at body temperature, stimulating peristalsis or lubricating and softening the stool. Glycerin rectal suppositories are often used to help with bowel elimination before resorting to an enema. Some rectal suppositories also contain medication. These should only be inserted by a nurse.
CARING FOR A PERSON WITH AN OSTOMY
As a nursing assistant, you may care for people with ostomies. For example, a person with a tumor in the large intestine may have surgery to remove the diseased part of the intestine. Depending on the location of the tumor and the length of the segment of the intestine that had to be removed, the person may need an alternate way of eliminating feces from the body following the surgery. In this case, the person may have an ostomy. An artificial opening, called a stoma,is made in the abdominal wall and the remaining portion of the intestine is connected to it. Feces pass through the stoma and into a pouch (called an ostomy appliance) that is worn over the stoma.
■ An ileostomy is created if the entire large intestine must be removed. The end of the small intestine (that is, the ileum) is attached to the abdominal wall. Because the chyme does not have the chance to travel through the large intestine(where water is reabsorbed), the person’s feces are very liquid and may flow fairly continuously.For this reason, a person with an ileostomy is quite prone to dehydration.
■ A colostomy is created if part of the large intestine is still present. After the diseased part of the large intestine is removed, the healthy end is attached to the abdominal wall. Among people with colostomies, the feces vary in consistency. If the portion of the intestine that was removed was near the beginning of the large intestine, then the feces will be more liquid because the chyme will spend less time in the large intestine. On the other hand, if the portion of the intestine that was removed was near the end of the large intestine,then the feces will be move solid and formed.Cancer is not the only reason a person might have to have an ostomy procedure. Bowel trauma and disease such as diverticulitis (an inflammatory disease of the bowel) are other common reasons that ostomies are preformed. Sometimes, a temporary ostomy is done to allow a portion of the bowel to “rest.” Later,the ends of the bowel are sew back together and normal bowel elimination resumes.
Some of the people you will care for may have had surgery to remove all or part of the large intestine. Such a surgery may be necessary because of
cancer, a bowel obstruction, or trauma. (A) Ileostomy.The entire large intestine is removed. A stoma is made in the abdominal wall, and the end of the small intestine(the ileum) is sewn into place. (B) Colostomy. Part of the large intestine is removed. A colostomy can be done at any point along the large intestine; here, a section of the descending colon was removed. A stoma is made in the abdominal wall, and the healthy end of the remaining large intestine is sewn into place
In some states and facilities, helping patients or residents to care for an ostomy is within the nursing assistant’s scope of practice. Ostomies, like the people who have them, are very individual. Ostomies can be located in many different places on the abdomen. In addition, abdomens vary from person to person. For these reasons, the supplies used for ostomies vary greatly. Some ostomy appliances consist of a bag with an adhesive opening that adheres to the skin around the stoma. Other ostomy appliances have two pieces—a ring of flexible rubber that is applied to the skin around the stoma and a bag that is snapped onto the ring.Some appliances are used only once and then discarded, whereas others are emptied, cleaned, and used again. If you are permitted to provide ostomy care,make sure that you are familiar with the different types of ostomy appliances used in your facility and ask the nurse for help with any that are new to you.No matter what type of ostomy appliance is used, certain principles of ostomy care remain the same for every patient or resident with an ostomy.
Because the skin around the ostomy comes into contact with feces, it must be kept clean to prevent irritation. The ostomy appliance can be changed with the person sitting or standing in the bathroom,or while the person is in bed. If the ostomy appliance is being changed while the person is in bed,the person should either sit upright or lie flat.
An ostomy appliance is worn over the
stoma to collect the feces
Assisting With Bowel Elimination 