Prepared by

Dr/ Furat hussein

Dr/ Baghdad hussein
Lecturers in
Faculty of Nursing
Helwan University

1
Out lines:
1-Definition.
2-Indications.
3-Types of colostomy.
4-Colostomy care.
A-assessment of colostomy.
b- Assessment of feces.
c-Changing colostomy appliance.
5-Complications.
6-Client teaching.

2
Definition of colostomy:

 Surgical creation of an opening (i.e., stoma) into the colon. It can be

created as a temporary or permanent fecal diversion. It allows the
drainage or evacuation of colon contents to the out side of the body.

 Indications:

1- Inflamatory bowel disorders that fail to respond to medical treatment.

2- Rupture of a portion of intestine.

3- Volvulus: twisting of the intestine.

4- Intussusceptions: (telescoping of a segment of the intestine within

itself).

5- Irreversible obstruction.
6-Compromised blood supply to the intestine.
7-Cancerous tumors ex. Colon cancer.

3
♣ Types of colostomy:

Type Stoma location Fecal Fecal control

consistency
Ascending Middle right Semi liquid Never
colosto my. abdomen
center of the
-Transverse Semi liquid Never
abdomen
colosto my.
Descending middle left soft sometimes
colosto m. abdomen
Sigmoid lower left formed usually
colosto my. abdomen

 Colostomy care:
1-Assessment :
A- assessment of colostomy.
B- Assessment of feces.
2-Changing colostomy appliance.

4
 Characteristics Healthy stoma Unhealthy stoma
color bright pink or red dusky blue or black
size comparable in diameter to large or smaller in
The intestine .may be large comparison to size
After surgery.
opening patent ,un obstructed tight or narrow
length protrudes from or is just protrudes beyond 2 inches
flush With the skin from the skin
Surface moist ,shiny layer of moist ,shiny layer of
mucus, May bleed mucus, May bleed
slightly during cleansing slightly during cleansing
sensation painless painless
function regular passage of feces regular passage of feces

Healthy and Unhealthy colostomy

b- Assessment of feces:

 Assess of amount, color, odor, consistency.

 Inspect for abnormalities such as pus, blood.
 Assess client and family member learning needs regarding colostomy
and self care.
 Assess client emotional status, coping with colostomy especially permanent.

2- Changing colostomy appliance:

1- Disposable gloves.

2- Bed pan.

5
 3- solvent (presaturated sponges or liquid).

4 - cleansing materials (tissues, warm water, mild soap, wash cloth or cotton
balls, towel).

5 -Clean stoma appliance.

6- Electric or safety razor.

7- Tissue or gauze pad.

8- Special adhesive.

9- Stoma measuring guide.

10-Pen ,pencil and scissors.

11-Deodorant (liquid or tablet).

12 -Tail closure clamp.

 Procedure:
Steps Rationale
1- Determine the need for an appliance change.
- Effluent can irritate the
peristomal skin.
*Leakage of effluent.
- Burning sensation may
indicate break down beneath
*Disco mfort at or around the stoma. the pouch.

- Full pouch may loosen the and

*Fullness of the pouch.
bag separate it fro m the skin.
2-Prepare equipments. -To save time and efforts.

6
3-Explain procedure to the client. - To gain cooperation and
reduce fear.

4-Wash hands and apply clean gloves. - To prevent cross infection.

5-Maintain client privacy. - To prevent embarrassment .

6-Assist the client to a comfort position (sitting - To facilitate pouch application

,lying ,or standing position). and avoid wrinkles.

7-Un fasten the belt if the client is wearing one.

8-Shave the peristomal skin of well –established To remove excessive hair
stoma by using safety razor. which interfere with adhesive
action.
9-Empty and remove the stoma appliance.
*Empty the content of the pouch through the - To prevent spillage of effluent
bottom opening into a bed pan on to the client's skin.
*Assess the consistency and the amount of --To determine any
effluent. abnormalities. ----
To minimize the client
*Peel the bag off slowly while holding the client's discomfort and prevent
skin. abrasion of the skin.

*Discard the appliance if disposable.

10- Cleanse and dry the peristomal skin and
stoma.
-To remove excess stool.
*Use toilet tissue.
*Use warm water ,mild soap, wash cloth and -To clean the skin and stoma.
towel.
*Use especial cleanser for dried and hard stool. - To make removal less
damaging to the skin.
*Dry the area with the towel or cotton balls gently. - Excess rubbing can abrade the
skin.
11-Assess the stoma and peristomal skin.
*Inspect a stoma for color ,size ,shape and
bleeding.

7
*Inspect peristomal skin for any redness
,ulceration or irritation .

*Place a piece of tissue or gauze pad over the -To absorb any seepage from
stoma and change it if needed. the stoma.
12- Prepare and apply the clean appliance.
*Remove the tissue over the stoma before
applying the pouch.
*For disposable pouch:

-Cut out a circle in the adhesive and avoid cut any

portion of the pouch.

-Center the opening of the pouch over the stoma.

- Gently press the adhesive backing onto the skin - Wrinkles allow seepage of
and smooth out any wrinkles. the effluent which can irritate
the skin or soil cloths.

- Remove the air and place deodorant on the pouch

-Close and secure it with closure clamp

*For a reusable pouch: - For more fixation and prevent
irritation
-Using the guide strip , center the face plate over
the stoma.
-Firmly press the adhesive seal to the peristomal
skin.
-Sealing the pouch against the face plate.
 Place a deodorant in the bag and close the end of
pouch with clamp.
-Attach the pouch belt and fasten it around client
waist.
13- discard the disposable and clean the reusable To prevent cross infection.
equipment.
14- Remove gloves and hand washing.

8
 COMPLICATIONS:
-Paralytic ileus.
-Mechanical obstruction.
-Peritonitis.
-Abscess formation.
-Infection.
-Fistula.
 Client teaching:
1- Empty pouch when one-third full of stool or flatus.
a. Empty into toilet.
b- Pouch should last for 3-4 days.

2- Empty each morning and last thing at night even if not one-full third.
3- Check seal on daily basis for tight fit, change if needed.
4-instruct client to always carry a supply of stoma equipment for
emergency use.
5-instruct client on emptying and cleaning pouch , opening and closing
clamp, observing and cleaning peristomal area, and changing pouch.
6-Have client return demonstration until able to perform activities
correctly.

9
 Performance check list of Colostomy
Student Name:
Group:
Date:
Steps: Satisfied Not Need
Satisfied more
Practice
1- Determine the need for an
appliance change:
-Leakage of effluent
-Discomfort at or around the stoma
-Fullness of the pouch
2-Prepare Equipment

3-Explain the procedure to the patient.

4- Wash hands and apply clean gloves

5- Maintain patient privacy

6- Assist the patient to comfortable

position.

7- Unfasten the belt if the patient is

wearing one.

8- shave the periostomal skin of well –

established stoma by using safety razor.

9 Empty and remove the stoma appliance.

-Empty the content of the pouch through the
bottom opening into the bed ban .
- Assess the consistency and the amount of
effluent.
- peel the bag off slowly while holding the
patient's skin.
-Discard the appliance if disposable.

10- cleanse and dry the periostomal skin

and stoma.
 Use toilet tissue
 Use warm water , mild soap, wash cloth
and towel.
 Dry the area with the towel or cotton balls
gently.

10
 11- Assess the stoma and periostomal skin.
 -Inspect stoma for color, size, shape ,and
bleeding
 Inspect periostomal skin for any redness,
ulceration, or irritation.
 -Place a piece of tissue or gauze pad over
the stoma and change it if needed.

 -12- Prepare and apply the clean
appliance.
 -remove the tissue over the stoma before
applying the pouch.

 For disposable pouch:
 - Cut out a circle in the adhesive and avoid
cut any portion of the pouch.
 - Center the opening of the pouch over the
stoma.
 -Gently press the adhesive backing onto the
skin and smooth out any wrinkles.
 -Remove the air and place deodorant in the
pouch.
 -Close and secure it with closure clamp.

 For a reusable pouch:
 - Using the guide strip, center the face plate
over the stoma.
 - Firmly press the adhesive seal to the
periostomal skin.
 -Sealing the pouch against the face plate.
 -Place deodorant in the bag and close the
end of the pouch with clamp.
 -Attach the pouch belt and fasten it around
the patient waist.
 13- discard a disposable and clean the
reusable equipment.
 14- remove gloves and hand washing.



Student Sign.

Demonstrator Sign.

11
 Performance check list of Tracheostomy
Student Name:
Group: Date:
Steps: Satisfied Not Need
Satisfied more
Practice
 1-Assess need for tracheostomy care:
 2- Prepare the equipment
 3- Hand washing
 4-Explain the procedure to the patient
 5- Put on clean gloves, remove and
discard the soiled dressing in a
biohazard container.
 6-Put on sterile gloves
 7- cleanse the wound and the plate of
tracheostomy tube with cotton -tipped
applicators . Rinse with sterile saline.
 8-Soak inner cannula in hydrogen
peroxide or sterile saline , rinse with
saline and inspect to be sure that all
dried secretion have been removed, dry
and reinsert inner cannula or replace it
with new inner cannula.
 9- Apply a sterile dressing by using
prepared dressing 4x4 gauze dressing in
to a v shape. Avoid cotton filled gauze
or cutting gauze.
 10- Place a clean twill tape in position to
secure the tracheostomy by inserting one
end of the tape through the side opening
of the outer cannula, take the tape
around the back of the patient's neck and
thread it through the opposite.
 11- Document all information(Suctioning,
Tracheostomy care, dressing ,assessment).
 12- Discard the disposable, and clean the
reusable equipment.
 13- Remove gloves and hand washing.

Student Sign.

Demonstrator Sign.

12
 Performance check list of wound dressing
Student Name:
Group: Date:
Steps: Satisfied Not Need
Satisfied more
Practice
 1-Close the doors and curtains around
the bed.
 2- Prepare the equipment
 3- Hand washing
 4-Explain the procedure to the patient
 5- Put on clean gloves, remove and
discard the soiled dressing in a
biohazard container.
 6- Observe dressing for amount and
characteristics of drainage, note color
and odor.
 7- Inspect the incision for bleeding ,
inflammation, drainage and healing.
 8 remove clean gloves, wash hands -
Put on sterile gloves.
 9- Set up sterile supplies:
 -Open sterile towel, hold it by edges.
 -place it on clean flat surface without
contaminating the center of the towel.
 -Open dressing package by peeling
paper down to expose dressing , let it
fall on sterile surface.

 A-Applying dry sterile dressing:
 - Open cleansing solution, Pour
solution into sterile bawl .

 -Don sterile gloves, grasp applicator
at non absorbent end dip them into
cleansing solution.

 -clean drainage from wound center
outward using each applicator only
once, discard without placing
applicator back into cleansing

13
 solution
 - Dry the surrounding skin.
 -Apply Sterile dressing, Secure
dressing with tape.
 B- Applying saline moistened
dressing:

 - Place fine mesh gauze into basin,
Pour solution over gauze to saturate.
 -Don sterile gloves.
 - Cleanse or irrigate wound as
prescribed, or with normal saline
moving from less contaminated to
more contaminated area,
 - Squeeze excess fluid from gauze
dressing.
 -Apply several dry , sterile pads over
the wet gauze.
 - Secure dressing with tape.
 10-Assist client to a comfortable
position.
 11-Wash hands
 12-Document procedure and
observations.

Student Sign.

Demonstrator Sign.

14
 Performance check list of wound Irrigation
Student Name:
Group: Date:
Steps: Satisfied Not Need
Satisfied more
Practice
 1-Close the doors and curtains around the
bed.
 2- Prepare the equipment
 3- Hand washing
 4-Explain the procedure to the patient
 5- Put on clean gloves, remove and discard
the soiled dressing in a biohazard container.
 6- Position patient comfortably to allow
irrigating solution to flow by gravity across
the wound and into a collecting bag.
 7- Expose only wound area , place water
proof pad under the patient.
 8- Pour warmed irrigating solution into
sterile basin.
 9- Open irrigating syringe and place in to
basin with solution.
 10- Place second basin at the distal end of
wound.
 11- Don sterile gloves.
 12- Fill irrigating syringe with solution,
holding syringe tip 1 inch above the wound,
gently flush all wound areas , continue
flushing until solution draining is clear.
 13- Dry the surrounding skin thoroughly.
 14- Apply sterile dressing
 15- Dispose of sterile gloves.
 16- Secure dressing with tape.
 17- Assist patient to a comfortable position.
 18-Wash hands
 19- Document procedure and observation.


Student Sign.

Demonstrator Sign.

15