Procedurs

248

DEFINITION
14.8: PERFORMING COLOSTOMY CARE

Nursing Colostomy care refers to cleaning of thesloma area usingwarnn water and dry wipes to gently clean around the toma
Acolostomy is asurgically created opening in the abdominal wall through which digested food and stool pases thttuud
the stoma into apouch attached to the stomaon the outside of abdomen. The pouch, the stoma and skin surroundinw t
Medical stoma require care and maintenance by patient or caregiver.

IPURPOSES
Section
2: 1. To prevent leakage.
2. To prevent excoriation of skin and stoma.
3. To observe stoma and surrounding skin.
4. To teach patient and relatives about care of colostomy and collection bag.
IARTICLES
Atray containing (Fig 14.8A).
1. Rubber sheet.
2. Long sheet.
3. Towel.
4. Clean gloves.
5. Cotton swabs and gauze pieces.
6. Wash cloth.
7. Water in basin.
8. Soap in dish.
9. Disposable colostomy bag with clamp.
10. Stoma measuring guide.
11. Zinc oxide ointment.
12. Skin barrier.
13. Bedpan with cover.
Fig. 14.8A: Colostomy care tray.
IPROCEDURE
Nursing action Rationale
Before procedure
1. Explain procedure to the patient and explain to him how he has to Helps in obtaining cooperation of the patient.
cooperate.
2. Assemble the necessary equipment nearby [Fig. 14.8B()). Organization facilitates performance of the task.
During procedure
3. Wash hands and don gloves. Prevents spread of microorganisms.
4. Provide privacy and assist the patient to a comfortable position (Fowler, Positioning allows the patient to view the procedure in preparation
semi- Fowler, standing, or sitting position in bathroom). for learning.
5. Empty the partially filled appliance into the bedpan if it is adrainable Emptying the contents before removal of the pouch prevents
pouch. accidental spillage of fecal material. Pouches that are full can
detach and leak.

6. Remove the appliance slowly beginning at the top while keeping the Careful removal protects the underlying skin from damage 3nd
abdoninal skin taut. If any resistance is felt, use warm water or adhesive minimizes discomfort for the patient.
solvent to facilítate removal [Fig. 14.8B(i).
7. Use tissue paper torernove any excess stool from the stoma.Cover stoma Gauze absorbs any drainage from the stoma while the skn sbeg
wíth a gauze pad [(Fig. 14.8B(iiü)]. prepared.
8. Gently wash and pat dry the peristomal skin. Mild soap and cleansing
agent may be used according to agency policy.
9. stoma
Assessistheconsidered
appearance of peristormal skin and stoma. Amoist reddish pink Change in normal appearance may indicate anema a
norrmal. circulation, and it should be informed to physician
10. Apply paste type skin barrier (zinc oxide) if required and allow the paste Establishes asmooth surface for the appicaation ot skn barrier

to dry for 1-2 minutes (Fig. 14.8B(vii). and pouch.

Contd..
249

Nursing action Rationale

11. Apply the skin barrier and appliance together.
a. Select size of stoma opening by using the measurement guide
(Fig. 14.8B(iv)].
b. Trace same size circle on the back at the center of the skin barrier.
C. Use scissors to cut an opening 1/4 or 1/8inch larger than stoma
Chapter
14:
(Fig. 14.8B(v)].
d. Remove the backing to expose sticky side [Fig. 14.8B(vi)].

GaSstryoisnteeml
e. Remove gauze pad covering stoma.
f
Place barrier and pouch over the stoma and gently press onto skin Placing both the skin barrier and appliance together over the storna
while smoothing out creases or wrinkles. Hold the pouch in place for makes application easier for the patient. Smooth application of
5 minutes [Figs. 14.8B(viii) and 14.8B(ix)]. pouch prevents escape of odor and feces.

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Fig.14.8B: Steps of changing a colostomy bag (2-piece system).

Medical College
12. Instilldeodorant in bag if required.
13. and
Closeusing
the apouch if it is drainable by folding the end upward Atightly sealed appliance willnot leak and cause embarrassment
clamp or clip according to manufacturer's direction and discomfort for the patient.
(Fig. 14.8B(×)].
After procedure
14. Dispose off used eguipment, discard gloves, and wash hands. Prevents spread of microorganisms.

13. Document appearance of stoma, condition of peristomal skin, and Facilitates continuity of care.
patient's reaction to the procedure.

Emptying Colostomy Bag without Changing

Rinsing provides clean appearance and minimizes odor.
Empty contents into bedpan or toilet. Rinse pouch with tepid water. additional fecal material.
Wipe the lower 2 inches of the pouch with toilet tissue. Drying the lower section of the pouch removes
Prevents bad odor. Clamp secures closure of the appliance.
th deodorant in bag and uncuff the edge of the pouch and apply
the clamp.
4 Prevents spread of microorganisms.
OIspose off used equipment, discard gloves, and wash hands. staff members.
5.
Document the procedure and patient's reaction to the procedure. Ensures communication between
 SPECIAL CONSIDERATIONS
1. Flatus may cause a pouch to balloon out. This requires immediate attention becauseif flatus is not released, the pouch
may separate from the skin barrier causing seepage of fecal contents or release of fecall odor. Open the clarmp and release
the flatus(never puncture a hole in the appliance). discharoe n
Check the stoma appliance for quality and quantity of
2. Measure the patient's fluid intake andoutput. following surgery.
intake and outputevery 4 hours for the first 3 days
moisture increases the chance for Candida or yeast infection
3. Stoma site should be always dry. Presence of functioning Aleee. .
flatus. Advice patients that thisis indicative of bowel
4. Return of peristalsiscauses an increase in
voluntarily control passingof flatus.
toavoid gas-containing food since there is no way to

14.9: PERFORMING COLOSTOMY IRRIGATION

DEFINITION
colon at a schedule time.
Colostomy irrigation is a way to regulate bowel movements by emptying the

PURPOSES
1. To clean colon.
2. To establish regular pattern of evacuation.
3. To prevent excoriation of skin around stoma.
4. Toobserve stoma and surrounding skin.
5. To teach patient and family about care of colostony, especially if colostomy is permanent.

ARTICLES (FIG. 14.9A)

Atray containing:
1. Irrigation can with tubing and clamp.
2. Rectal catheter and funnel.
3. Irrigation sleeve.
4. Jug with solution at body temperature.
5. Lubricant.
6. Clean cotton swabs.
7. Rag pieces/paper tissues.
8. Dressing articles.
9. Protective ointments such as zinc oxide.
0. Protective sheet/mackintosh.
1. Clean gloves and colostomy bag.
2. Wash cloth.
3. Soap.
4. Towel and clean linen.
5. Kidney tray and paper bag.
6. Receptacle with disinfecting lotion for soiled linen. Fig. 14.9A: Colostomy
irrrigation tray.
7. Bedpan/bucket for return flow.

PROCEDURE
Nursing action Rationale
function.
Before procedure elimination
the needto irrigate and stimulate
1 Assess the frequency of defecation, character oof stool, and placement Indicates