Colostomy & its Care
Definition
Colostomy is the surgical creation of an opening of the colon to the outside through the anterior abdominal wall.
Temporary or permanent measure.
It allows the evacuation of the contents of the colon to the outside of the body
The consistency of the drainage is dependent on which part of the colon is drained
Types of colostomy:- Temporary colostomy permanent colostomy
Temporary colostomy is done
1. To relieve any obstruction which can be corrected by resection of the bowel and later the bowel continuity can be restored.
2. Or to divert the faecal stream to permit healing of a portion of the bowel
Permanent colostomy is done
Usually after excision of the rectum for a carcinoma by abdomino perineal resection
After the sigmoid colon is resected the proximal end is brought out through abdominal wall and sutured to it to form a permanent opening for the elimination of faeces.
Indications
1. Rectal cancer
2. Inflammatory Bowel Disease
Preoperative managemant
prepare the patient for general abdominal surgery - Do all the routine investigations - correct any fluid and electrolyte imbalance. And improve the nutritional condition of the patient.
Inj.Lidocaine sensitivity
Inj. TT
Administer prophylactic antibiotic
Bowel wash - with PEGLEC
Administer Oral Neomycin 1 grm 4 hrly x 3 days
If the patient is able to eat advise fluid diet for 4 days befor surgery
Nil orally from the eve of the surgery
Teach the patient about colostomy and where it will be positioned - arrange for skin marking
Alleviate the fears and anxieties - assure the patient that 'ostomy' can be cared for without it interfering with daily activities and social life.
Support the patient and family with the many psychosocial considerations of ostomy surgery.
Post operative management
Administer general abdominal surgery care
Assess stoma every shift for colour and record findings
normal colour : pink –red
ischaemic sign - dusky ; dark red, purplish hue
necrotic : brown or black may be dry ( notify health care provider to determine extent of necrosis)
apply pouching system with ½ inch clearance to prevent stomal constriction, which contributes to oedema.
check for abdominal distension, which reduces blood flow to stoma through mesenteric tension
evaluate and empty drains and colostomy pouch frequently to promote patency and maintain seal
monitor intake and output with extreme accuracy because output may remain high during early post operative period.
suction and irrigate NG tube frequently, as ordered to relieve pressure and decrease gastric contents.
offer continued support to patient and family
Colostomy Care
Colostomy will start functioning in 3-6 days
The nurse manages and teaches about its care
Skin care – peristomal skin - look for irritation or breakdown and apply skin barrier paste Caution about excoriation and ulceration Guard against yeast infections and allergic dermatitis. (Nystatin)
Teach the methods of applying and removing the drainage pouch,
The stoma must be measured so that the right size appliance chosen
Use only well fitting appliance;
Control odor by a clean odor free,
Regular change of bag, cleaning, and use of deodorant
clean stomal area with mild soap and water pat it dry, reapply pouch or covering over stoma.
Clean equipment with soap and water; dry and store in well ventilated area
Wherever applicable, the patient should use a pouch until the colostomy is sufficiently controlled
Complications
Prolapse
Retraction
Necrosis of the distal end
Stenosis of the orifice
Colostoy hernia
Bleeding (usually from granulomas around the margin of the colostomy)
Colostomy ‘diarrhoea’ : an infective enteritis - will respond to oral metronidazole 200 mg three times daily
Colostomy Care Nursing Procedure
1. Gather equipment
Ensure that you have all the materials that you need based on the type of colostomy your client has.
2. Encourage clients to look at the stoma
Rationale: This encourages participation in stoma care. A drastic change in self-physical perception may occur in clients. Keep an open mind and maintain therapeutic communication at all times. Engage the client in care but do not pressure them.
3. Explain the procedure to the client
Rationale: This brings into light concerning things that your clients may have. Remain factual and answer all their queries with prompt and direct answers. Guide them throughout the procedure especially if they will have permanent stomas.
4. Provide privacy
Rationale: Privacy is very important especially if your client is to receive his first ostomy care. Remember that the ostomy has created an imbalance in your client’s self-perception. Do not underestimate that. Always provide privacy. Ask your client if he is comfortable doing this with significant others, or if he will need time to adjust first. Be sensitive to your client’s needs. You may ask the client if he wishes to do it in the bathroom so that he may see how it is done at home.
privacy
5. Perform hand hygiene and wear gloves
Rationale: Protects you and the clients as well. Gloves need not be sterile as the ostomies are unsterile and cater to fecal material.
6. Inspect the ostomy and determine the need for change of appliance
Rationale: Inspection will allow you to make a judgment. You may change the ostomy pouch if it is one-thirds full, of more frequently if the client desires or complains of skin irritation, which is very common with colostomies. Note for any leakage. Avoid changing ostomies during meal times, before and after meal times, or during visiting hours.
7. Assist the client to stand or sit
Rationale: Promotes better evacuation of stool and avoids wrinkles on the colostomy. Unfasten belts if clients wear one.
8. Empty the pouch and remove the ostomy skin barrier.
Rationale: Always empty the pouch through the bottom to prevent spillage of contents into the client’s skin. When removing the skin barrier, gently peel from top to bottom while holding the client’s skin tout in order to minimize discomfort. Always inspect the contents for color.
9. Clean and dry the stoma and the peristomal skin
Rationale: Promotes hygiene ad comfort for the client. Use a tissue to remove excess stool. When cleaning the stoma, use warm water and a clean washcloth. The use of “strong” soaps is discouraged as they promote dryness and are irritating to the stoma. If you use soap however, avoid moisturizing soaps as they interfere with the adhesiveness of the new skin barrier that is to be applied. Dry the area by patting, not by rubbing as it causes abrasions.
10. Place a piece of cloth or tissue over the stoma as it is being cleaned.
Rationale: Absorbs any seapage as stoma care is being actively done.
11. Prepare the skin barrier, the peristomal seal
Rationale: Ensures cleanliness and proper adhesion and appliance of a new skin barrier. Use the guide to measure the appropriate stoma size. On the back of the skin barrier, trace the appropriate stoma size and cut it, making sure that there is 1/8 to 1/4 allowance on the size to allow the stoma to expand when functioning.
12. Remove the adhesive backing to expose the sticky side. Place the skin barrier over the client’s skin and press for 30 seconds.
Rationale: The pressure and the heat from the skin will activate the adhesives of the skin barrier, successfully patching it to the skin.
13. Remove the tissue from the stoma and snap the pouch onto the skin barrier wafer.
Rationale: Provides attachment and ensures drainage of stool using a new, and clean skin barrier. Promotes comfort and allays anxiety.
14. Document
Rationale: Do not forget to document all the nursing care you have rendered. It does not necessarily mean that you must document the procedure in a step by step fashion. Be selective and use your judgment.
