Colostomy Care: Sital B Sharma MSC Nursing Part I Con, NBMC

Colostomy Care
Sital B Sharma
MSc Nursing Part I
Con, nbmc
Ostomy
• An ostomy is the surgery to create an opening
between an internal organ and the body
surface
Ostomy of GI system
An opening which is made during surgery
that brings a piece of the bowel to the
outside of the abdomen,i.e on the
belly(Certified wound, ostomy,
continence nurse’s, 2012).
Types of intestinal ostomies
• Gastrostomy
• Jejunostomy
• Ileostomy
• Colostomy
• Cecostomy
• Gastrostomy and jejunostomy generally alternate
feeding route.
• Ilestomy Cecostomy,and Colostomy is for fecal
evacuation
Jejunostomy
• Opening through the abdominal wall into the
jejunum
Gastrostomy
• Opening through the abdominal wall into the
stomach
Ileostomy
• Opens through the abdominal wall into the
ileum
Cecostomy
• Opens through the abdominal wall into the

cecum
Anatomy of GI System
Anatomy of colon
A colostomy is a
surgical creation of an
opening i.e stoma into
the colon.
Indication for Colostomy
• Birth defect
• Inflammatory bowel disease.
• Injury to the colon or rectum
• Partial or complete intestinal blockage/
obstruction.
• Rectal or colon cancer.
• Wounds or fistulas in the perineum.
Types of colostomy
According to the
anatomical positon
• Ascending colostomy
• Transverse colostomy
• Descending colostomy
• Sigmoid colostomy
• With the ascending colostomy- the feces are
liquid.
• With the descending colostomy- the feces are
semi formed
• With the transverse colostomy- the feces are
unformed , malodorous
• With a sigmoid colostomy- the feces are
formed and frequency thus can be regulated.
According to duration/ status
• Permanent colostomy.-as a means of elimination
when the rectum or the anus is non functional as
a result of birth defects or disease like cancers of
the bowel.
• Temporary colostomy.- traumatic injuries or
inflammatory condition of the bowels to allow
healing and rest of the distal bowel.
According to the stomal construction
• End stoma/ terminal colostomy- permanent stoma,
single stoma created, one end of the bowel is
brought out to the anterior abdominal wall.
• Loop colostomy-loop of bowel brought out
supported by a rubber tubing, having two
opening , active proximal, inactive distal. In an
emergency, often in rt transverse colon.
• Divided colostomy- two edges of the
bowel brought out together but separated from
each other, proximal active, distal mucous
fistula.
Double barreled/ shot gun type
• The proximal and the distal loops of bowel are
sutured together upto 10cm(4inch) and both
the end are brought up onto the skin.
Colostomy Care
Colostomy care/management
• Psychological support
• Assessment
• Implementation
-Stoma and Skin care
-Application of the appliance.
• Teachings.
Assessment
• Assessment of the color of the stoma-
o Red and moist –normal.
o Pale- anemic.
o Dark red to purple-inadequate blood supply.
• Assessment of bleeding
-Normal bleed- normal due to high vascularity
-Moderate to severe-Coagulation factor deficit
• Assessment of edema-mild to moderate
edema
o Normal in initial postoperative period.
o Later –due to trauma
-Moderate to severe
o Obstruction of the stoma.
o Allergic reaction to the food
o Gastroenteritis
• Assessment of the stool - amount, color ,
odor, consistency
• The size of the stomal size and shape
• The type and size of the appliance used.
• The status of periostomal skin -5-13 cm area
surrounding the stoma.
• Complaints-burning under the skin barrier.
• Presence of abdominal distension or
discomfort
• Client ’s Emotional status.
• Need for education .
• Type of colostomy and confirm the
functioning one.
• Determine the need of changing the
appliance.
• Selection of appropriate time for care-
best in the morning, or, 2-4 hours after
meal when the bowel is least active and
sos. Must avoid feeding time.
Colostomy care
• Taking care of the colostomy includes:
 Changing appliance
 Care of the stoma.
• Implementation
• Preparation of the patient- physically and
psychologically.
• Preparation of the articles required to provide care
• Preparation of self.
Preparation of the patient
• Introduce self to the patient.
• Verify the patients identity.
• Explain about the procedure and reason for
doing it.
• Provide privacy for smooth performance of
the procedure.
• Keep the patient in a comfortable position
usually semi fowler’s.
• Prepare the articles.
Colostomy bag/appliance
Appliance or the bag can one piece or two piece. Bag with
flanges.Can be drainable or closed.
A drainable one usually has clip, the end of the pouch is
folded and applied clip on it.
It must be able to control the odor.
These appliances can provide leak proof seal for about 3-7
days.Pouch should be changed on a regular basis
• Mackintosh and a towel- to protect the bed linen.
• Kidney tray and paper bag to receive the waste.
• Bed pan to receive the feces.
• 2 pair of clean gloves- to maintain universal precaution.
• Basin with warm water to clean the area around stoma.(mild
soap)
• Tissue or gauze pad and pieces- to clean stoma and receive
feces during colostomy, dry the skin.
• Stoma measuring guide-to measure stoma size.
• Scissors to make the hole in the mouthe of the appliance
according to the stomal size.
• May keep wash cloth to clean the area exterior to the stoma
after bag application.
• Plastic apron if available.
Preparation of self
• Perform hand wash/hygiene.
• Wear 2 pairs of gloves one after other.
• Plastic apron can be worn if available
Procedure
• Unfasten the belt/remove the used pouch slowly,

empty the bag in the bedpan or, if possible
empty the content first to prevent spillage.
• Discard the pouch into the paper bag. (wash if
possible.)
• If reusable then keep it for next use after
thorough wash and dry.
• Assess the stool for consistency, odor, amount.
• Assess the stoma wound- color, edema,
infection, bleeding, healing.
• Cover the stoma with a gauze pad/ tissue pad-prevent
spillage if patient passes stool during the procedure, put
off the upper most gloves.
• Clean the peristomal region and skin with the mild soap
and warm water and pat dry.
• Soaps may be contraindicated sometimes due to
irritating properties if it if advised ,avoid using
moisturising or deodorant soaps it may interfere in
adhering of the skin barriers
• Remove the gauze or tissue paper pad clean the
stoma dry it.
• Measure the size of the stoma with the help of a
guide, cover the stoma with dried gauze to
receive feces during cutting of the traced
stoma pattern.
• Use adhesives and powder available with the
pouch.
• Apply the new pouch/ clean dried reuseable
bag.
• Remove gloves wash hands and make the
patient sit comfortably ask if any problem
patient has.
• Wear a clean gloves and clean all the articles
• Discard stool in the toilet pan clean and dry it
and keep it ready for next use.
• Replace all the articles.
• Document the findings.
Record the procedure with following
details
• Date and time of care given.
• Amount, color, consistency of the fecal matter.
• Condition of stoma and its surrounding skin.
• Any sign of complication.
• Healing of the stoma and its size.
Special points to remember
• Report any adverse findings.

• Empty the pouch when it is 1/3rd full .
• Always follow guidelines given by the manufacturing
company.
• Participate patient in the care.
• Be quick and vigilant in providing care.
• Keep odor free as much possible.
• Maintain the output charting in i/o chart.
• Teach patient about diet, avoid gas forming foods,
adequate liquids, chlorophyll rich diet.
• Sports heavy lifting/ work must be avoided.
Conclusion
• A colostomy can be on a temporary as well as
permanent basis, as per the problem of the
patient.
• A colostomy care can provide relief to the
person and provides an opportunity to avoid
complications, that may be life threatening if
left unattended.
• We s a nurse must be competent and vigilant
while providing colostomy care.
Bibliography
• Kozier and Erb’s, Fundamentals of Nursing,10th
Edition,published by Pearson Indiaeducation
Service Pvt Ltd.P.no-1249-73.
• Brunner & Suddarth’s.Textbook of Medical
-Surgical Nursing Volume 2. 12th Edition.
P.No 1105-07 -
• Lewis’s Medical Surgical Nursing, , 2011
Elsevier. P.no-1080-86
• Also available at www.slideshare.net

Colostomy Care: Sital B Sharma MSC Nursing Part I Con, NBMC

Uploaded by

Copyright:

Available Formats

Colostomy Care: Sital B Sharma MSC Nursing Part I Con, NBMC

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Colostomy Care: Sital B Sharma MSC Nursing Part I Con, NBMC

Uploaded by

Copyright:

Available Formats

What are the different types of ostomies?

What are the different types of colostomies?

Colostomy Care

• Opens through the abdominal wall into the

• Unfasten the belt/remove the used pouch slowly,

• Report any adverse findings.

You might also like