perform colostomy care

Perform Colostomy Care

Definition of colostomy:

Is the surgical procedure of  creating of an opening (ie. Stoma) into the colon intestine through the abdominal wall.

Purpose of colostomy care 

-It allows for drainage or evacuation of colon contents to the outside of the body

Needs for the colostomy
care:

  • To maintains integrity of stoma and peristomal skin (skin surrounding stoma)
  •  To prevents lesions, ulcerations, excoriation, and other skin breakdown caused by fecal contaminants
  •  To prevents infection
  •  To promotes general comfort and positive self-image /self-concept
  • To provides clean ostomy pouch for fecal evacuation
  • To reduces odor from overuse of old pouch

Indications of Colostomy

  • Tumors of the colon.
  • Trauma to perforation of the colon.
  • Inflammatory diseases of the colon as ulcerative colitis.
  • Congenital anomalies of G.I.T such as, Hirshsprung, necrotizing enterocolitis, imperforate anus.

Type of colostomy:

Type of colostomy according to site:

  1.  The ascending colostomy.
  2. The transverse loop colostomy.
  3. The transverse double barreled colostomy
  4. The descending colostomy
  5. The sigmoid colostomy.
colostomy types

Characteristics of faces 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 odor is a problem
requiring control.
3. Transverse colostomy: it produces mal odor, 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:

TemporaryPermanent
It is created for elimination when healing needs to take place in the case of trauma or inflammatory condition of the bowel.A permanent it provides a mean of elimination when the end portion of colon, rectum or anus in nonfunctional and must be totally removed
It used for few weeks, months or even yearsIt used for long term and may be for long life.
It will be closed and normal bowel continuity is restored.It will not be closed at any time
colostomy

Procedure of Colostomy Care

Top Shelf

  • Bowl of warm water
  • Gauze swabs
  • Cotton balls
  • Graduated container
  • Large receiver
  • Towel

Bottom Shelf

  • Disposable gloves.
  • Soap in a dish.
  • New colostomy bag.
  • Colostomy adhesive and measuring guide.
  • Barrier cream

Bedside

  • Hand washing equipment Screen
  • Safety box
  • A good source of light at the bedside
Procedure of the Colostomy care
  1. Assemble the needed equipment.
  2. Explain procedure to child, encourage child interaction to alley anxiety.
  3.  Wash hand with soap and water, rinse and dry, to prevent contamination of hand, reduce risk infection transmission
  4. Put on gloves to avoid transmission of infections.
  5. Place towel or disposable waterproof (mackintosh) under child, to prevent seepage of feces onto skin.
  6. Auscultate for bowel sound.
  7. Place linen saver on abdomen around and below stoma opening.
  8. Carefully remove pouch and wafer appliance and place in plastic waste bag (save tail closure for reuse) :remove wafer by gently lifting corner with finger of dominant hand while pressing skin downward with fingers of non-dominant hand remove small sections at a time until entire wafer is removed. place 4×4- in , gauze over stoma opening
  9. Assess stoma and peristomal skin, observe existing skin barrier, and stoma for color , swelling , trauma , healing : stoma should be moist and reddish pink .
  10. Empty pouch ; measure waste in graduated container before discarding and record amount of fecal content .
  11. Remove and discard gloves , perform hand washing , and wear new gloves.
  12. . Remove used pouch and skin barrier gently by pushing skin away from barrier to reduce skin trauma.
  13. Cleans peristomal skin gently with warm tap water using gauze pads .
  14. Measure stoma for correct size of pouching system needed , using the manufacturer’s measuring guide. colostomy
  15. Select appropriate pouch for client based on client assessment. With a custom cut –to- fit Pouch , use an ostomy guide to cut opening on the pouch. prepare pouch by removing backing from barrier and adhesive.                colostomy
  16. Leaving intact adhesive covering of skin-barrier wafer . colostomy
  17. Remove gauze and apply stoma paste around stoma or to edges of opening in wafer .
  18. Remove adhesive covering of wafer, and place wafer on skin with hole centered over stoma: hold in place for
    about 30 sec .
  19. Center pouch over stoma and place on wafer. colostomy
  20. Praise the child for helping
  21. Restore or discard all equipment appropriately
  22. Remove and discard gloves and perform hand hygiene
  23. Spray room deodorizer , if needed to get rid of unpleasant odor.
  24. Record type of pouch ,skin barrier, amount, appearance of faeces, condition of stoma and skin around it

Nursing diagnosis:

  • Comfort alteration in the abdominal pain related to abdominal incision.
  •  Impaired skin integrity related to presence of stoma.
  •  Body image disturbance related to presence of stoma.
  •  Knowledge deficit related to stoma care and lack of experience.

NURSES CONSIDERATION.

Assessment of the Stoma.

  • The stoma should be pink. A dusky blue stoma indicates is ischemia and a brown black stoma indicates necrosis.
  • Assessment of stoma colour should be done 8 hourly.
  •  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 oedema. If there is severe oedema, it 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 amount of bleed coming 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.
  •  The 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.
  •  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 a void irritation.
  • All pouching system is water proof so clients can bathe, shower and swim while wearing them.
  •  Clients can remove soiled pouches and shower without them but not ileostomy because bowel function as ileostomy is fairly frequent and unpredictable.

Activity

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

Diet

  •  Clients should follow a low fiber diet for approximately 1month after one month a person
    with colostomy can follow a regular diet.
  •  Ileostomy diet should be closely monitored, foods that cause blockage should be avoided
    include popcorns, many vegetables, nuts, and meat.
  •  Client and family teaching. The medical team assists the client and family with the
    various aspects of ostomy care.

Health education

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

Selecting the pouch

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

Colostomy irrigation:

  •  This is intended to regulate bowel function, treat constipation. It is a small enema done through the stoma using lukewarm water (500-1000mls) but a soft large bore catheter is used to avoid bowel perforation and 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 and gradually and seeds are chewed properly and hard ones are avoided to prevent small bowel obstruction.
  •  Foods that cause smell is avoided e.g. eggs, onions, fish, cabbage, alcohol, etc.
  •  Gas-forming foods are avoided or eaten in moderation, e.g. beans, onions, cabbage, potatoes, beer, carbonated beverages, etc.
  •  Diarrhoea-causing foods such as alcohol, spinach, green beans, coffee, spicy foods and raw fruits are to be avoided.
  •  A regular diet is encouraged later on and a normal one is very important so long as the above is put into consideration.

Assisting the patient to adopt psychologically to a changed body and sexual activity:

  •  Stress the need to care for the colostomy by the patient but do not force him until he shows readiness to do so.
  •  Every effort should be made to keep the patient clean and dry as possible for he may become depressed at the sight of faecal drainage particularly if it is so liquid and is soiling the bed linen and gown.
  •  Soiled linen should be disposed of neatly and quickly.
  •  He should be reassured that fear of continuous drainage should not keep him from moving about freely.
  •  The social impact of the stoma is interrelated with the psychologic, 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 should realize that
    the patient needs time to adjust to the pouch and to body changes before feeling secure in his or her sexual functioning.
  •  Pregnancy is possible with colostomy but the number needs to be limited.

NURSING CARE GUIDELINES

  •  Be gentle yet professional about everything you do if the various aspects of ostomy care.
  •  Carefully observe the condition of the stoma.
  •  Cleanliness is important, change everything that becomes soiled.
  •  When changing an ileostomy appliance, check for un dissolved tablets or capsules.
  •  Give special skin care.
  •  After the stoma is healed clean it with soap and water do not use alcohol and avoid soap
    in case of irritation if redness/ yeast appearing growth appears consult the provider of
    health care
  •  Encourage and teach the patient to be independent as soon as possible, how to remove and apply a new appliance how and what to report about bowel changes.
  •  Allow patient to express feelings.
  •  Encourage questions and collect any misconceptions, the client might have.

ABNORMAL AND DANGER SIGNS IN ASTOMA

  •  Abnormal sound.
  •  Excessive bleeding.
  •  Darkening in colour (indicating stenosis around the stoma which cuts off the blood
    supply).
  •  Bleaching/ extreme lightening in colour (indicating lack of circulation to stoma).
  •  Drying of stoma.
  •  Signs of infection.
  •  Edema of the stoma.

ROUTINE OBSERVATION.

  •  Size of the appliance (must be large enough so that it does not cut off circulation but
    small enough so that it does not lack input output records).
  •  Daily weight.
  •  Electrolyte balance/imbalance, results of blood work.
  •  Amount and character of stool.
  •  Vital observation
COMPLICATIONS OF COLOSTOMY

COMPLICATIONS OF COLOSTOMY

  1. Skin Issues:

    • Skin Irritation and Breakdown: Prolonged exposure to fecal matter can lead to skin irritation, inflammation, and ulceration around the stoma.
    • Infection: Infection can occur in and around the stoma, leading to discomfort and complications.
  2. Stoma Alterations:

    • Stoma Prolapse: The stoma may protrude further from the abdominal wall than normal, potentially causing pain and difficulty in maintaining a proper seal with the colostomy bag.
    • Retraction: In some cases, the stoma can retract or shrink, making it challenging to attach the colostomy bag securely.
    • Necrosis: The stoma tissue may become necrotic, which can be life-threatening if not treated promptly.
  3. Bleeding and Obstruction:

    • Bleeding: Some bleeding from the stoma is normal, but excessive bleeding can indicate issues such as infection or trauma.
    • Obstruction: Blockages can occur in the colostomy, preventing the passage of stool and leading to discomfort and potential complications.
  4. Fluid and Electrolyte Imbalance:

    • Dehydration: Patients with a colostomy are at risk for dehydration because they lose fluids and electrolytes through the stoma.
    • Electrolyte Imbalance: Patients with a colostomy may also experience an electrolyte imbalance, which can occur when they lose too many electrolytes through the stoma.
  5. Psychosocial and Nutritional Issues:

    • Psychosocial Issues: Patients may experience body image disturbances, depression, or anxiety related to the presence of a colostomy.
    • Nutritional Deficiencies: Patients with a colostomy may also experience nutritional deficiencies because they may not be able to absorb nutrients properly.
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