Perform Colostomy Care

Nursing Diagnosis:

1. Comfort Alteration related to abdominal incision evidenced by:

• Reports of pain at the incision site.
• Grimacing or guarding behavior.
• Elevated pain scores on a pain scale.
• Difficulty with movement or ambulation.
• Restlessness or anxiety related to pain.

2. Impaired Skin Integrity related to the presence of stoma evidenced by:

• Presence of redness, swelling, or irritation around the stoma.
• Skin breakdown, such as abrasions, fissures, or ulcers.
• Reports of discomfort or itching around the stoma.
• Leakage or drainage from the stoma.

3. Body Image Disturbance related to the presence of stoma evidenced by:

• Expressing negative feelings or self-consciousness about the stoma.
• Avoiding social situations or activities.
• Difficulty looking at or touching the stoma.
• Statements about feeling unattractive or different.

4. Knowledge Deficit related to stoma care and lack of experience evidenced by:

• Asking numerous questions about stoma care.
• Demonstrating incorrect stoma care techniques.
• Expressing anxiety or fear about managing the stoma.
• Lack of confidence in performing self-care activities.

Nurses Consideration

Assessment of the Stoma

• The stoma should be pink. A dusky blue stoma indicates ischemia, and a brown-black stoma indicates necrosis.
• Assessment of stoma color should be done every 8 hours.
• There is mild to moderate swelling of the stoma in the first 2-3 weeks after surgery. This could be due to trauma to the stoma or any medical condition that results in edema. Severe edema could be due to obstruction of the stoma, allergic reaction to food, or gastroenteritis.
• Small oozing/bleeding from the stoma mucosa when touched is normal because of its high vascularity. Moderate to large amounts of bleeding from the stoma could indicate coagulation factor deficiency, lower gastrointestinal bleeding, etc.

Protecting the Skin

• The skin should be washed with mild soap, rinsed with warm water, and dried thoroughly before the skin barrier is applied.
• Skin barriers include petroleum jelly gauze or protective ointment smeared around the stoma to keep the skin from becoming irritated. Hollister skin or stoma adhesive barriers are applied. However, the ointment must be removed at frequent intervals to ascertain that the skin under the protective coating remains in good condition.
• The patient is provided with dressing items for changing the dressings and colostomy. A dressing tray is needed for this.

Clothing

• Immediately after surgery, many patients choose to wear loosely fitting clothes.
• Clients should not wear a leather belt over the stoma to avoid irritation.
• All pouching systems are waterproof, so clients can bathe, shower, and swim while wearing them.
• Clients can remove soiled pouches and shower without them but not with an ileostomy because bowel function with an ileostomy is fairly frequent and unpredictable.

Activity

• Heavy lifting is prohibited for 6-8 weeks after abdominal surgery to prevent hernia, which can occur in the incision and around the stoma.

Diet

• Clients should follow a low-fiber diet for approximately 1 month. After one month, a person with a colostomy can follow a regular diet.
• Ileostomy diet should be closely monitored. Foods that cause blockage, such as popcorn, many vegetables, nuts, and meat, should be avoided.

Client and Family Teaching

• The medical team assists the client and family with various aspects of ostomy care.

Health Education

The patient should be able to do the following before being discharged:

• Change the colostomy bag: apply and change the pouch to collect intestinal drainage and empty it when it is 1/3 full to prevent leakage.
• Care for the skin, control odor, maintain general hygiene, care for the stoma, and identify signs of complications. They should be able to cleanse the skin and use skin barriers and deodorants to prevent skin breakdown and bad odor.
• Understand the importance of fluids and food in the diet: identify a well-balanced diet and dietary supplements to prevent nutritional deficiencies, identify foods that reduce diarrhea, gas, or obstruction, drink at least 3 liters per day to prevent dehydration unless contraindicated, and increase fluid intake during hot weather, excessive sweating, and diarrhea to replace losses.
• Know how to get additional supplies—addresses of supply departments.
• Understand the importance of follow-up care: report signs and symptoms of fluid and electrolyte deficits, fever, diarrhea, skin irritation, other stoma problems such as changes in appearance or function, changes in the peristomal area, tenderness, redness, and pain.

Selecting the Pouch

• The colostomy bag should be transparent, plastic, odor-proof, cut large enough to envelop the stoma, and fit snugly to prevent fecal contents from getting onto the skin and staining the patient’s gown or bed linen. It should have a valve for drainage of the content or be changed whenever it is full if it does not have this provision.
• The pouch should not be placed directly on the skin without the skin barrier.
• The volume, color, and consistency of the drainage are recorded each time the bag is changed, and the condition of the skin is observed for irritation. The content of the ascending and transverse colon is liquid in nature, while that from the descending and sigmoid colon is semi-formed or formed.
• The patient should be observed for fluid and electrolyte imbalance if large volumes of drainage are present. In the case of an ileostomy, in the first 24-48 hours post-operatively, there will be a high volume output of 1000-1800 ml/day, but it should reduce to 800ml daily.
• Encourage the patient to take 2-3 liters of fluids daily and more if diarrhea is present.

Colostomy Irrigation

• This is intended to regulate bowel function and treat constipation. It is a small enema done through the stoma using lukewarm water (500-1000ml), but a soft large bore catheter is used to avoid bowel perforation. Do not force the tube if there is resistance to Tubal entry.

Feeding after Colostomy and Control of Smell

• The diet should be of low-roughage initially and then reintroduced later gradually. Seeds should be chewed properly, and hard ones avoided to prevent small bowel obstruction.
• Foods that cause smell should be avoided, e.g., eggs, onions, fish, cabbage, alcohol, etc.
• Gas-forming foods should be avoided or eaten in moderation, e.g., beans, onions, cabbage, potatoes, beer, carbonated beverages, etc.
• Diarrhea-causing foods such as alcohol, spinach, green beans, coffee, spicy foods, and raw fruits should be avoided.
• A regular diet is encouraged later on, and a normal one is very important as long as the above is put into consideration.

Assisting the Patient to Adapt Psychologically to a Changed Body and Sexual Activity

• Stress the need for the patient to care for the colostomy but do not force them until they show readiness to do so.
• Every effort should be made to keep the patient as clean and dry as possible, as they may become depressed at the sight of fecal drainage, particularly if it is so liquid and soils the bed linen and gown.
• Soiled linen should be disposed of neatly and quickly.
• Reassure the patient that fear of continuous drainage should not keep them from moving about freely.
• The social impact of the stoma is interrelated with the psychological, physical, and sexual aspects.
• Concerns of people with stomas include the ability to resume sexual activity, altering clothing styles, the effect on daily activities, sleeping while wearing a pouch, passing gas, presence of odor, cleanliness, and deciding when or if to tell others about the stoma. The fear of rejection from a partner or the fear that others will not find them desirable as a sexual partner can be a concern. The nurse should encourage open communication about feelings and realize that the patient needs time to adjust to the pouch and body changes before feeling secure in their sexual functioning.
• Pregnancy is possible with a colostomy, but the number of pregnancies needs to be limited.