PAPERS ENGLISH THE CONCEPT OF A

COLOSTOMY

Made to complete the task English of Nursing

compiled by :

AMELIA SULISTYA NINGRUM

B0009051

D III MIDWIFERY STUDIES PROGRAM HIGH SCHOOL SCIENCE OF

HEALTH

SEKOLAH TINGGI ILMU KESEHATAN BHAMADA SLAWI

Jalan. Cut Nyak Dhien No. 16 Kalisapu Slawi

2012
 FOREWORD

Praise be to Allah who has bestowed Grace, Taufik and Inayah to all His
servants. Salawat and greetings are always devoted to our master the Prophet
Muhammad and his family, his friends and relatives until the end of time. Thank God
for grace thanks to Allah we can complete the writing of this paper relating to "The
concept of colostomy" as a structured task Nursing British subjects.
During the preparation of this paper we as writers have a lot to get support
from other parties, especially from Mr. Didik as lecturers of this course. Do not forget a
thank you we dedicate to my friends who have provided support in completing this
paper. And all those who contribute and get involved either directly or indirectly in the
writing of this paper, which we can not mention one by one.
The author is aware of the shortcomings and errors in this paper, therefore,
suggestions and constructive criticism so we hope for the perfection of this paper.
Finally we just hope that this paper can provide benefits and add insight for us all,
especially in the field of Nursing.

Slawi, Mey 5, 2012

author

CHAPTER 1
INTRODUCTION
A. Background problem
Colostomy surgery performed for various diseases and conditions. some
colostomy performed because of malignancy (cancer). In children, who may
created with a disability since birth. colostomy can be temporary or permanent.
Some colostomy there are large and some small. Some are on the left side of the
abdomen and some are in the right abdomen, and there are also some in the middle.
Colostomy is also called anal kolokutaneostomi preternaturalis made for temporary
or permanent. Temporary colostomy is created for example in patients with acute
abdomen with peritonitis who had done some of colon resection. In such
circumstances, a burden, a new anatomosis with the passage of stool is an action
that can not be accounted for. Therefore, for security anstomosis, temporarily
diverted the flow of stool through the colostomy stoma is usually called a two-
barrel stoma ganda.
Permanent colostomy created on rektoanal abdominoperianal resection
according to Miles Quenu-preternaturalis correct form of the anus. Esofagostomi,
gastrostomi, yeyunostomi, and sekostomi is usually a temporary stoma. Ileostomy
and colostomy is often a permanent stoma. Colostomy stoma can be a hook (loop
kolostoma) or end stoma (end kolostoma). In kolostoma sigmoid bowel habit
usually the same as the original. Many people hold a rinse once a day, so they are
not disturbed by the expenditure of stomanya stool. Kolostoma in the colon
contents of intestinal tranversum issued several times a day because of the contents
of the colon tranversum not solid, making it more difficult to manage.

B. The author's purpose

For students able to find out and explain about the colostomy

CHAPTER 2
CONTENS

A. Definition
ANATOMY AND PHYSIOLOGY COLON
Embryology and Anatom
In embriologik, right colon from the middle intestine, whereas the left colon to
the rectum comes from the gut belakang.Lapisan longitudenal colonic muscle to
form three bands, called the tenia, which is shorter than the colon colon itself so
many times and shaped like a saccule called haustra. Tranversum colon and colon
sigmoideum located intraperitoneally and equipped with mesenterium.
In developmental disorders sometimes occur embriologik embryonic intestinal
rotation so that the right colon and cecum had a complete mesentery. This situation
facilitates the rotation or bowel volvulus largely the same as can happen with a long
mesentery in the sigmoid colon with a narrow radiksnya.
The boundary between the colon and rectum was evident since the third rectum
tenia not looked back. This limit lies below the height of promontory, about 15 cm
from the anus. The third meeting tenia cecum area showed the base of the appendix
if the appendix is not clear because perlengketan.Sekum, ascending colon,
transverse colon and right part didarahi oelh a.mesenterika superior branch of
a.ileokolika, a.kiloka artery, and a.kolika media. Tranversum the left colon,
descending colon, sigmoid colon and a.hemoroidalis superior.
Colonic veins running parallel to the arteries. Venous blood flow is channeled
through v.mesenterika superior to the ascending colon and transverse colon and
through v.mesenterika inferior to the descending colon, sigmoid, and rectum. Both
empties into the inferior v.mesenterika v.porta but through v.lienalis. alran veins of
the anal canal to the inferior v.kava. Therefore children scatterplot derived from
malignancies of the rectum and anus can be found diparu, whereas that of the colon
was found in the liver. In the limit of the rectum and anus there are many collateral
arteries and veins through hemoroidal circulation between the gastrointestinal tract
and vascular system arterial and venous systems iliaka.
Colonic lymph flow in line with the flow of blood. It is important to know in
connection with the spread of malignancy and its importance in the resection of
colonic malignancy. Sources present in muscularis flow limf mikosa. So during a
colonic malignancy has not reached the muscularis mucosa layer is most likely
there is no metastasis. Metastasis from sigmoid colon mesentery was found
dikelenjar regional and retroperitoneal in a.kolika the left, while from the anal
glands are found regionally diregio inguinalis.
Colon innervated by sympathetic fibers originating from n.splanknikus and
presakralis plexus and parasympathetic fibers that originate from the gut
innervation n.vagus.Karena distribution center and intestines back, referred pain in
both left and right part of the colon is different. Lesions in the right colon from the
middle intestine was first on the epigastrium or over the abdomen. Pain in acute
appendicitis at first felt in the epigastrium, then move to the lower right abdomen.
The pain from the lesions in the descending colon or sigmoid colon originating
from the back was initially dihipogastrium or under center and pain perut.
Entering the rectal feces (2) of the colon (1). There are two major muscles that must
be passed by a stool to get out of the body, the muscular sphincter of internal and
external muscular sphincter (4). Internal muscular sphincter is involuntary. Above
will automatically open a channel to allow the stool through the anus . External
muscular sphincter is voluntary muscle control means we can assist in maintaining
this tersebut.Hal stool in the rectum until we are ready to mengeluarkanya. External
sphincter muscular push stool out of the anus (5) and rectum relax. The drive is
going to disappear until there is bowel movement.
Colonic Physiology
Bowel function is to absorb water, vitamins, and electrolytes, mucus excretion, as
well as storing feces, and then push it out. 700-1000 ml of fluid from the small
intestine that is received by the colon. 150-200 ml a day spent as feses.
Air swallowed while eating, drinking, or swallowing. Oxygen and carbon
dioxide absorbed by the intestines while the nitrogen in it along with the results of
digestion and fermentation gases released as flatus. The amount of gas in the
intestine to 500 ml a day. In the gas production increased intestinal infections and
intestinal obstruction if gas gets buried under the streets that lead to digestive
flatulensi.
Colostomy colostomy was made in the colon, is formed when the intestine is
blocked by a tumor (Harahap, 2006).
An artificial hole made by a surgeon in the abdominal wall to remove the feces
(M. Bouwhuizen, 1991).
Making a hole temporarily or permanently from the large intestine through the
abdominal wall to remove the feces (Randy, 1987).
Holes are made through the abdominal wall into the iliac colon to remove fecal
(Evelyn, 1991, Pearce, 1993).
B. Stomas
Ostomy supplies consist of one layer or two layers with a hypoallergenic skin
barrier to retain the integrity of the peristomal skin. The bag should be large enough
to accommodate the feces and flatus in moderation but not too big not to overload
the infant or child. Peristomal skin protection is an important aspect of stoma care.
Size appropriate equipment is essential to prevent leakage of contents (Wong,
2009).
1. Location colostomy determine the consistency of either solid or liquid stool. In
general, transverse colostomy produces more solid stool. Location colostomy is
determined by the patient's medical problems and general condition. There are
three types of colostomy, namely: loop colostomy or loop colostomy, usually
performed in an emergency.
2. End colostomy, consisting of a stoma is formed from the proximal end of the
distal colon with digestive tract. End colostomy is the surgical treatment of
colorectal cancers.
3. Double-barrel colostomy stoma consists of two distinct parts of the proximal
stoma and distal stoma (Perry & Potter, 2005).

C. Types of colostomy by location

This type of colostomy is based on its location; transversokolostomi a
colostomy in the transverse colon, the colostomy sigmoidostomi in the sigmoid,
descending colostomy colostomy in the descending colon and ascending colostomy,
is a colostomy in the ascending (Suriadi, 2006).

D. Indications Colostomy
1. Atresia Ani
Disease is not the occurrence of atresia ani membrane perforation
that separates the entoderm which resulted in the manufacture of the anal canal
are not directly related to the rectum (Purwanto, 2001).
Atresia ani is a congenital abnormality known as imperforate anus include
anal canal, rectum or both (Betz, 2002). According Suriadi (2006), Atresi ani
or imperforate anus is not complete embryonic development in the distal
colon (rectum) closing of the anus is abnormal.
2. Hirschsprung
Hirschsprung disease or congenital aganglionic megacolon is caused by
abnormalities of intestinal innervation, begins on the internal anal sphincter
and extends to the proximal, involving the varying length of intestine (Nelson,
2000).
Hischprung disease is also called congenital megacolon aganglionosis or
absence of ganglion cells in the rectum and some did not exist in the colon
(Suriadi, 2006).
3. Malforasi Anorektum
Malforasi Anorektum term refers to a spectrum of disability. The main
concern addressed at the next bowel control, sexual function and urinary tract.
Some disorders that require surgery is a colostomy :

a.) Fistula Rektovesika

In patients with fistula Rektovesika, rectum associated with urinary tract in
the neck as high as urinary vesicles. Sphincter mechanism often develop
very ugly. The sacrum is often not formed or is often absent. Perineum
looks flat. These defects represent 10% of all male patients with this
defect. The prognosis is usually poor gut function. Required colostomy
during the newborn period are accompanied by corrective repair operation
(Nelson, 2000).
b.) Fistula Rektouretra
In the case of Rektouretra fistula, rectal urethra associated with the bottom
or the top of the urethra. Those who have experienced the development of
fistula Rektoprostatik sacrum and the ugly often flat perineum. Patients
underwent protective colostomy during the newborn period. Anorektum
Rektouretra fistula is the most common defects in male patients (Nelson,
2000).
c.) Atresia Rectum
 The rectum atresia is a rare defect, only 1% of the anomalies anorektum.
Unique mark on this flaw is that patients have the anus and anal canal is
normal (Nelson, 2000).
d.) Vestibular Fistula
Vestibular fistula is the most common defects found in women. Protective
colostomy is needed before any corrective surgery, although the colostomy
is not necessary as an emergency measure because often fistulanya
competent enough to decompress the gastrointestinal tract (Nelson, 2000).
e.) Persistent Cloaca
In the case of Persistent Cloaca, rectum, vagina, and urinary tract meet and
converge in a single shared channel. Perineum has one hole that is located
slightly behind the clitoris. Indicated diversion colostomy at birth, besides
the patient who suffers cloacal experienced urologic emergencies, because
about 90% diserai with disabilities urology. Before the colostomy, the
diagnosis urology should be upheld to empty the urinary tract, if necessary
at the same time performed a colostomy (Nelson, 2000).

E. Complications of Colostomy
Incidence of complications in patients with colostomy sedikit higher than those
ileostomy. Some common complications are stoma prolapse, perforation, retracted
stoma, faecal impaction and skin irritation. Leakage from the side anastomotik can
occur when the residual intestinal segments experiencing pain or weakness.
Anastomotik bowel causing leakage of abdominal distension and rigidity, increased
temperature, and signs of shock. Required surgical repair (Brunner and Suddarth,
2000).
The most common problem encountered after colostomy surgery is the
development of hernia around the stoma site. This is shown as a bulge in the skin
around the stoma, difficulty irrigation and partial obstruction. Lifting heavy loads
should be avoided immediately after surgery. Anus preternaturalis often causes
complications. Hernia parastoma may contain colon, omentum, or small intestine
that often occurs in obese people. Prolapse, stenosis, and retraction is a
complication of a less than perfect technique. Infection of the abdominal wall and
skin irritation sometimes occurs often seen as residual excitatory
pencernaan.Terapis enterostoma is an expert on duty specifically for the care and
guide patients and their families to face life with anal preternaturalis. Patients with
a colostomy should contact a doctor or nurse if found complications such as:
 Severe seizure lasts more than two or three hours
An unusual odor that lasts more than a week
Changes in stoma size and shape of the unusual
Obstruction of the stoma and / or prolapse of the stoma
Excessive bleeding from the stoma opening, or the number is in the bag
Severe injury of the stoma.
Persistent bleeding in the transition between the stoma and skin.
Chronic skin irritation
Stenosis of the stoma (narrowing).

F. Colostomy Care
Colostomy function will begin to appear on day 3 through postoperative day 6.
Nurses deal with a colostomy until the patient can take over this treatment. Skin
care should be taught along with how to apply and implement irrigation drainage
bag. According to Brunner and Suddarth (2000), there are some that must be
considered in dealing with a colostomy, among others :
1. Skin Care
Effluent discharge will vary according to the type of ostomy. In transverse
colostomy, the feces are soft and slimy that irritate the skin. In descending
colostomy or sigmoid colostomy, stool is rather dense and slightly irritating to
the skin. Patients are encouraged to protect the skin peristoma with frequent
washing of the area using mild soap, giving the skin barrier protectively around
the stoma, and securing it in conjuction with drainage bag. Skin gently cleaned
with mild soap and a washcloth damp and soft. The existence of excess skin
barrier cleared. Soap acts as a mild abrasive agents to remove residual droplets
of fecal enzymes. During the cleansing, netting can be used to cover the stoma.
2. Setting Up Pouch
Stoma is measured to determine the exact size bag. Sac hole should be
about 0.3 cm larger than the stoma. The skin is cleaned first. Peristoma skin
barrier is installed. Then the bag is installed by opening the paper and adhesive
menekanya above the stoma. Mild skin irritations need the powder scattered
stomahesive before sac attached.
3. Lifting Equipment Drainage
Drainage appliance replaced when it has reached one-third to one-quarter
the weight of its contents so it does not cause the bag loose from the adhesive
disc and its contents out. Patients can choose the position of a comfortable
sitting or standing position and gently push the skin away from the surface of
the plate while pulling the bag up and away from the stoma. Pressure slowly to
prevent the skin from trauma and prevent any fecal contents are spilling out.
G. Drain Colostomy
Colostomy irrigation purpose is to empty the colon of gas, mucus, and feces.
So that patients can run the business and social activities without fear of faecal
drainage occurs. With mengirigasi stoma at regular time, there is little gas and fluid
retention Drain.

H. Preparation Tool
1. Two pairs of gloves
a) Pedestal
b) Kom of warm water warm water
c) Gauze or washlap
d) New colostomy bag
e) Cleaners such as soap
f) Scissors
g) Plastic bags
h) Tissue
2. Preparation of the patient
a) Adjust the position of the patient lying
b) Explain to patients and parents about the procedures to be performed and
the guard patient privacy.
c) Create an atmosphere as comfortable as possible

3. Procedure
a) Wash hands
b) Explain the procedure on the client and maintain client privacy
c) Use gloves
d) Place the fabric pengalas around the abdomen and a colostomy bag open.
e) Open a colostomy bag carefully, non-dominant hand (left) hit the skin and
the dominant hand (right) releases a colostomy bag.
f) Empty pockets: measuring the amount of feces, feces discharged into the
toilet dumped into a colostomy bag plastic bag
g) Clean the stoma and skin around the hole with gauze or a moist and warm
washlap, or soapy water if sisah adhesive and stool is difficult
dibersihkan.Cuci hands and wear gloves again.
h) Dry the skin and attach a colostomy bag new
i) Open trim gloves and tools and garbage. Wash hands (Joyce, 2002).
 CHAPTER 3
COVER

A. Conclusion
Colostomy colostomy was made in the colon, is formed when the intestine is
blocked by a tumor (Harahap, 2006)
This type of colostomy is based on its location; transversokolostomi a
colostomy in the transverse colon, the colostomy sigmoidostomi in the sigmoid,
descending colostomy colostomy in the descending colon and ascending colostomy,
is a colostomy in the ascending (Suriadi, 2006)

B. Advice
Authors hope this paper can be useful for the reader so it can apply the
knowledge gained from this paper for everyday life.
Authors realize that this paper is far from perfect for that criticism from readers
who we expect an extremely constructive.
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tanggal 25 april 2012, jam 14:06 WIB.

Smeltzer, Suzanne C., 2001, Buku Ajar Keperawatan Medikal Bedah Brunner dan
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