COLOSTOMY CARE

INTRODUCTION

A colostomy is a surgical procedure that brings one end of the large intestine
through the abdominal wall. During this procedure one end of the colon is
diverted through an incision in the abdominal wall to create a stoma. A stoma is
the opening in the skin where a pouch for collecting faeces is attached. People
with temporary or long term colostomies have pouches attached to their sides
where faeces collected and can be easily disposed off

DEFINITION OF COLOSTOMY:

Is the surgical procedure creation of an opening (i.e. Stoma) into the colon
intestine through the abdominal wall.

PURPOSE OF COLOSTOMY:
It allows for drainage or evacuation of colon contents to the outside of the
body

NEEDS FOR THE COLOSTOMY CARE:

1. To maintains integrity of stoma and peristomal skin (skin surrounding
stoma)
2. To prevents lesions, ulcerations, excoriation, and other skin breakdown
caused by faecal contaminants
3. To prevents infection
 4. To promotes general comfort and positive self-image /self-concept
5. To provides clean ostomy pouch for faecal evacuation
6. To reduce odour from overuse of old pouch

INDICATION:
1. Tumours of the colon.
2. Trauma to perforation of the colon.
3. Inflammatory diseases of the colon as ulcerative colitis.
4. Congenital anomalies of G.I.T such as, Hirsh sprung, necrotizing enter
colitis, imperforate anus.

TYPE OF COLOSTOMY:
Type of colostomy according to site:

A. The ascending colostomy.

B. The transverse loop colostomy.
C. The transverse double barrelled
colostomy
D. The descending colostomy
E. The sigmoid colostomy.

CHARACTERISTICS OF FAECES ACCORDING TO THE SITE

OF COLOSTOMY:
1. Ileostomy: produces liquid and frequent, contain digestive enzymes
which damage the skin, and must be pouched at all time.
2. Ascending colostomy: is similar to an ileostomy but odour is a
problem requiring control.
3. Transverse colostomy: it produces mal odour, mushy (thicker)
drainage because some of the liquid has been reabsorbed.
4. Descending colostomy: produces increasingly solid drainage.
5. Sigmoid colostomy emits stool almost identical to that normally passed
through the rectum.

CLASSIFICATION OF COLOSTOMY:
Colostomy can be either temporary or permanent:

Temporary colostomy Permanent colostomy

  It is created for elimination when  A permanent it provides a mean of
healing needs to take place in the elimination when the end portion
case of trauma or inflammatory of colon, rectum or anus in non-
condition of the bowel. functional and must be totally
removed.
 It used for few weeks, months or  It used for long term and may be
even years. for long life.

 It will be closed and normal  It will not be closed at any time.

bowel continuity is restored.

CHARACTERISTICS OF AN IDEAL HEALTHY STOMA

Each stoma is unique, just as each patient’s physiology is unique. Different surgical
techniques will result in stomas of different appearance. At the same time, the
“ideal” stoma has some identifiable characteristics:

Moist

The inner surface of the stoma continually produces mucus to cleanse the stoma.
Mucus production is a normal function of the intestines that serves as natural
lubrication for food passing through the body. The mucus gives the healthy stoma a
wet appearance.

Beefy red

Blood flow is essential to the health of the stoma. Normal stoma tissue is highly
vascular and will appear deep pink to red. Pale pink is also normal in a urinary
stoma. Stoma tissue may even bleed slightly when rubbed or irritated, which is
normal. When a stoma turns pale, or dark, it means there’s a problem with the blood
supply, so be sure to investigate.

Round
A round stoma is easiest to measure with circular rulers. It also works best with pre-
cut skin barriers (the part of the ostomy appliance that affixes to the skin and
attaches to pouch). An oval or irregularly shaped stoma may require cut-to-fit skin
barriers.

The shape is affected by the type of ostomy and the individual’s body composition.
The shape can also vary with the wave-like muscular contractions of the intestines,
the peristaltic movement.

Budded/protruding

When a stoma has a rosebud shape (rather than flat or retracted), it protrudes into
the pouching system. This allows the effluent to fall out into the pouch away from
the body. The ideal protrusion is 2-3 cm with a lumen in the very center.

Strategically located

To easily accommodate the skin barrier, it’s ideal to have 2-3 inches of flat skin
around the stoma. Avoid beltlines, bony prominences, skin folds, suture lines, or the
umbilicus (belly button). Also, the patient will have more success managing a stoma
located in an area that they can see and reach.

STOMA ASSESSMENT
The stoma itself has no sensory nerve endings, which means there is no sensation
for the patient. In other words, the patient may not feel pain or discomfort if the
stoma becomes lacerated or injured. Therefore, your thorough clinical assessment of
the stoma and the surrounding skin is essential to catching problems early.

DIET FOR PATIENT WITH COLOSTOMY

 A colostomy diet is a short-term diet you follow during the days and weeks
after colostomy surgery.
 Immediately after your surgery, you may need to follow a clear liquid diet for
several days. This consists of broth, water, and plain gelatin
 Next, you will likely be able to transition to a low residue, high protein diet,
which is usually required the first few weeks after surgery as you recover
 A low residue diet leaves minimal material in your gut after nutrient
absorption.
 The low residue, high protein diet typically consists of bland foods that are
easy to digest to help prevent gastrointestinal symptoms.
 It may also involve limiting your intake of foods high in fiber, since these
foods can increase the size of stool and could temporarily block your bowel.
 Keep in mind that this diet is usually only needed for the first few weeks after
surgery as you recover.
 Eventually, you will be able to resume your typical diet by slowly
 Reintroducing foods, under the supervision of your doctor or dietician.
WARNING SIGNS:
 Bleeding from stoma.
 Bleeding from the skin around the stoma.
 Change in the bowel pattern.
 Change in the stoma size.
 Increased in the body temperature above 38 C.

COMPLICATIONS
 Leakage.
 Prolapse.
 Obstruction or stenosis.
 Stoma become oedematous and enlarged

ASSESSMENT
Determine the following,
The type of ostomy and as placement on the abdomen Surgeons often draw
diagrams when there are two stomas. If there is more than one stoma, it is important
to confirm which the functioning Stoma.
The type and size of appliance currently used and the special barrier substance
applied to the skin, according to the nursing care plan

ASSESS
1. Stoma Color: The stoma should appear red, similar in color to the mucosal
lining of the inner cheek and slightly moist. Very pale or darker-colored
stomas with a dusky bluish or purplish hue indicate impaired blood
circulation to the area Notify the surgeon immediately
2. Stoma size and shape: Most stomas protrude slightly from the abdomen
new stoma normally appear swollen, but swelling generally decreases over 2
or 3 weeks or for as long as 6 weeks Failure of swelling to recede may
indicate a problem, for example, blockage
3. Stoma bleeding: Slight bleeding initially when the stoma is touched is
normal but other bleeding should be reported.
 4. Status of peristomal skin: Any redness arid irritation of the peristomal skin
—the 5 to ‘13 cm (2 to 5 inch of Skin Surrounding the stoma—should be
noted Transient redness, after removal of adhesive is normal
5. Amount and type of faeces: Assess the amount color odor and consistency
inspect for abnormalities such as pus or blood
6. Complaints: complaint of burning sensation under skin barrier may indicate
skin break down the present of abdominal discomfort and/ or distension also
need to be determined
7. Learning need of the client and family members regarding the ostomy and
self
8. The client’s emotional status especially strategies used to cope with the body
image changes and the ostomy

EQUIPMENTS:

9. Clean gloves
10. Bedpan
11. Moisture-proof bag (for disposable pouches)
12. Cleaning materials, including warm water, mild soap
13. (Optional), washcloth. towel
14. Tissue or gauze pad
15. Skin barrier (optional)
16. Stoma measuring guide
17. Pen or pencil and scissors
18. New ostomy pouch with optional belt
19. Tail closure clamp
20. Deodorant for pouch (optional)

PROCEDURE RATIONALE
1. prior to performing the procedure. Introduce self 1. An explanation encourage client
and verify the client’s identity using agency protocol. cooperation
Explain to the client what you are going to do, why it
is necessary, and how he or she can participate.
Discuss how the results will be used in planning
further care or treatments. Changing an ostomy
appliance should not cause discomfort, but it may be
distasteful to the client, Communicate acceptance and
support to the client. It is important to change the
appliance competently and quickly. Include support
persons as appropriate
2. Perform hand hygiene and observe appropriate 2. prevent cross infection
infection control procedures.
3. Apply clean gloves. 3. prevent cross infection

4. Provide for client privacy preferably in the 4. To facilitate client cooperation

bathroom, where clients can learn to deal with the
ostomy as they would at home.
5. Assist the client to a comfortable sitting or lying 5. Lying or standing positions may
position in, bed or preferably a sitting or standing facilitate smoother pouch
position in the bathroom’ application, that is, 8vOid wrinkles

6. Unfasten the belt if the client is wearing one 6. to open the colostomy bag and to
perform the procedure
7.Empty the pouch and remove the ostomy skin 7. Emptying before removing the
barrier Empty the contents of a drainable pouch pouch prevents spillage of stool onto
through the bottom opening into a bedpan or toilet the client’s skin. If the pouch uses a
clamp, do not throw it away because
it can be reused Assess the
consistency, color, and amount of
stool Peel the skin barrier off slowly,
beginning at the op and working
downward, while holding the client’s
Skin taut
Rationale: Holding the skin taut
minimizes client discomfort and
prevents abrasion of the skin Discard
the disposable pouch in a moisture-
proof bag

8. Clean and dry the peristomal skin and stoma. Use 8. Soap is sometimes not advised
toilet tissue to remove excess stool. because ‘T can be irritating to the
Use warm water, mild soap (optional), and a skin It soap s allowed, do not use
washcloth to clean the skin and stoma. O Check deodorant or moisturizing soaps
agency practice on the use of soap Rationale: They may interfere
with the adhesives in the skin barrier
Dry the area thoroughly by patting
with a towel Rationale: Excess
rubbing can abrade the skin

9. Assess the stoma and peristomal skin 9. To prevent complication

  Inspect the stoma for color, size, shape, and
bleeding
 Inspect the peristomal skin for any redness,
ulceration, or irritation Transient redness after
the removal of adhesive is normal

10. Place a piece of tissue or gauze over the Stoma, 10.This absorbs any seepage from
arid change it as needed the stoma while the Ostomy
appliance is being changed

11. 11. This allows space for the stoma

 Prepare and apply the skin barrier to expand slightly when functioning
(peristomal seal) and minimizes the risk of stool
 Use the guide O to measure the size of the contacting peristomal skin
stoma.
 On the backing of the skin barrier, trace a
circle the same size as the stomal opening.
 Cut out the traced stoma pattern to make an
opening in the skin barrier.
 Make the opening no more than 1 to 1/4 inch
larger than the stoma.
 Remove the backing to expose the sticky
adhesive side the backing can be saved and
used as a pattern when making an opening for
future skin barriers.

For a One-Piece Pouching System

Center the one-piece skin barrier and pouch over the
stoma, and gently press it onto the client’s skin for 30
seconds Rationale: The heat and pressure help
activate the adhesives in the skin barrier. O O

For a Two-Piece Pouching System

 Center the skin barrier over the Stoma and
gently press it onto the clients skin for 30
seconds
 Remove the tissue over the stoma before
applying the pouch.
 Snap the pouch onto the flange or skin barrier
wafer.
 For drainable pouches, close the pouch
according to the manufacturer’s directions.
 Remove and discard gloves Perform hand
hygiene.

12. Document the procedure in the client record 12. To maintain the record and report
using forms or checklists supplemented by narrative
notes when appropriate Report and record pertinent
 assessments and interventions. Report any increase in
stoma size, change in color indicative of circulatory
impairment, and presence of skin irritation or
erosion. Record on the client’s chart discoloration of
the stoma, the appearance of the peristomal skin, the
amount and type of drainage, the client’s reaction to
the procedure, the client’s experience with the
ostomy, and skills learned by the client

Variation: Emptying a Drainable Pouch

1. Empty the pouch when it is one-third to one-half full of stool or gas.
Rationale: Emptying before it is overt full helps avoid breaking the seal with
the skin and stool then coming in contact with the skin
2. While wearing gloves, hold the pouch outlet over a bedpan or toilet Lift the
lower edge up
3. Unclamp or unseal the pouch.
4. Drain the pouch. Loosen feces from sides by moving fingers down the pouch
5. Clean the inside of the tail of the pouch with a tissue or a Pre moistened
towel
6. Apply the clamp or seal the pouch.
7. Dispose of used supplies.
8. Remove and discard gloves Perform hand hygiene
9. Document the amount, consistency, and color of stool.

EVALUATION
Relate findings to previous data if available. Adjust the teaching plan and nursing
care plan as needed. Reinforce the teaching each time the care is performed.
Encourage and support self-care as soon as possible as clients should be able to
perform self-care by discharge. Client learning is facilitated by consistent nursing
Interventions
BIBLOGRAPHY

1. Annamma Jacob,.Rekha &Jadhav sonali - Clinical Nursing Procedure The

Art of Nursing Practice 5th edition published by Jaypee Brothers Page No
2. kozier & Ebb’s Fundamentals of nursing 9th edition Page No 1371-1572
3. https//fac.ksu.edu.sa/default/files/colostomy-care