Colostomy 4.

No feeling to touch
5. Stools function involuntarily
 Is an incision in the colon ( large intestine)
6. Post-operative swelling gradually decreases
to create an artificial opening or “stoma” to
over several months
the exterior of the abdomen
Nursing Assessment
 Is a surgical procedure that bring the end of
1. Control odors
the large intestine through the abdominal
2. Assess stoma and peristomal skin
wall
3. Report pale or dark colored stoma/ bleeding
Indications:
4. Empty ostomy bag
1. Infection of the abdomen such as perforated
5. Apply barrier over the skin around the stoma
diverticulitis or an abscess
Types of Colostomies
2. Injury to the colon or rectum
There are several different types of
3. Partial or complete blockage of the large
colostomies including ascending, transverse,
bowel
and descending.
4. Rectal or colon cancer
 Ascending. This colostomy has an opening
5. Wounds or fistulas in the perineum
created from the ascending colon, and is
Colostomies Can Be Temporary or Permanent
found on the right abdomen. Because the
 A temporary colostomy may be used when
the part of the colon (typically the lower stoma is created from the first section of the
section) needs to heal, such as after trauma colon, stool is more liquid and contains
or surgery. After the colon is healed, the digestive enzymes that irritate the skin. This
colostomy can be reversed, returning the type of colostomy surgery is the least
bowel function to normal. In a colostomy common.
reversal, the two ends of the colon are  Transverse. This surgery may have one or
reconnected and the area where the stoma
two openings in the upper abdomen, middle,
was created in the abdomen is closed. The
large intestine is made, once again, into a or right side that are created from the
continuous tube between the small intestine transverse colon. If there are two openings
and the rectum. Bowel movements are in the stoma, (called a double–barrel
eliminated through the rectum. colostomy) one is used to pass stool and the
 A permanent colostomy (sometimes also other, mucus. The stool has passed through
called an end colostomy) is necessary for the ascending colon, so it tends to be liquid
some conditions, including about 15% of
to semi-formed.
colon cancer cases. This type of surgery is
commonly used when the rectum needs to  Descending or sigmoid. In this surgery, the
be removed because of disease or cancer. descending or sigmoid colon is used to
Most of the colon may also be removed, and create a stoma, typically on the left lower
the remaining portion used to create a stoma. abdomen. This is the most common type of
Colostomy creation: colostomy surgery and generally produces
1. An abdominal opening is created
stool that is semi-formed to well-formed
2. The intestines are brought out through the
because it has passed through the ascending
skin
and transverse colon.
3. The intestine is sutured to the skin
Stoma classification
4. The stoma is complete
a. End stoma- Proximal bowel is exteriorized
Characteristics of normal stoma:
to abdominal wall, everted and sutured to
1. Pink-red color
dermis or subcutaneous tissue. The distal
2. Moist
bowel is either surgically removed or
3. Bleeds slightly when rubbed
sutured closed with the abdominal cavity.
 An end colostomy is usually a permanent
ostomy, resulting from trauma, cancer or
another pathological condition.
b. Double-barrel stoma- proximal and distal
ends are exteriorized to abdominal wall,
everted and sutured to dermis or
subcutaneous tissue. Here, too, the one
opening discharges feces and the other
discharges mucus (this stoma is referred to
as a “mucous fistula”). Occasionally, the
mucus fistula is sewn closed at the time of
surgery and left inside the abdomen. In such
a case, only one stoma would be visible on
the abdomen (single-barrel colostomy).
Mucus from the resting portion of the bowel
would pass out through the rectum. This is
most often a temporary colostomy
performed to rest an area of bowel, and to be
later closed.
c. Loop stoma- a bowel is bought to the
abdominal wall through an incision and
stabilized temporarily with a rod, catheter or
a skin or facial bridge. Anterior wall of the
bowel is opened surgically or by
electrocautery to expose the proximal and
distal opening. The loop colostomy may
appear like one very large stoma. However,
it actually has two openings. One opening
discharges feces, the other expels only
mucus. A colon normally makes small
amounts of mucus to protect itself from the
bowel contents. The mucus passes with the
bowel movements and is usually not
noticed. Despite the colostomy, the resting
part of the colon continues to make mucus
which will come out either through the
stoma or through the rectum and anus; this is
normal and expected. A loop colostomy is
most often performed for creation of a
temporary stoma to divert stool away from
an area of intestine that has been blocked or
ruptured.
Complications:
F- fluid and electrolyte imbalance
I- infection
C- constipation
A- allergic reactions to products
S- skin breakdown
S- stomal prolapsed, retraction,stenosis,ischemia,
parastomal hernia
 Prolapsed means the bowel becomes longer
and protrudes out of the stoma and above the
abdomen surface. The stomal prolapsed may
be caused by increased abdominal pressure.
Surgery may be done to fix the prolapse in
some people.
 Stoma retraction happens when the height
of the stoma goes down to the skin level or
below the skin level. Retraction may happen
soon after surgery because the colon does
not become active soon enough. Retraction
may also happen because of weight gain.
The pouching system must be changed to
match the change in stoma shape.
 Stenosis is a narrowing or tightening of the
stoma at or below the skin level. The
stenosis may be mild or severe. A mild
stenosis can cause noise as stool and gas is
passed. Severe stenosis can cause
obstruction (blockage) of stool. If the stoma
is mild, a caregiver may enlarge it by
 stretching it with his finger. If the stenosis is
severe, surgery is usually needed.
 Death (necrosis) of stomal tissue. Caused by
inadequate blood supply (Ischemia), this
complication is usually visible 12–24 hours
after the operation and may require
additional surgery.
 Parastomal hernia (bowel causing bulge in
the abdominal wall next to the stoma).
Usually due to placement of the stoma
where the abdominal wall is weak or
creation of an overly large opening in the
abdominal wall. The use of an ostomy
support belt and special pouching supplies
may be adequate. If severe, the defect in the
abdominal wall should be repaired and the
stoma moved to another location.
Nursing Intervention:
1. Educate the patient
2. Reduce anxiety and Promote positive image
-You may feel anxious, nervous, or scared
when you first start to care for your
colostomy. You may not like the way your
body looks. You may feel like you are no
longer in control of your body. These are
normal feelings. Talk to someone close to
you or to your caregiver about these
feelings.
3. Maintain skin integrity
-A number of different protective pastes,
membranes and powders are available
4. Maximize nutritional intake
- If you have had an ilesotomy, it's important
that you chew properly, eat high-fibre foods
in small mouthfuls, and don't eat foods that
can cause blockages. These foods include
celery, nuts, coconut, mushrooms and
sweetcorn. You can carry on eating these
foods if they don't cause you any problems,
but you should only have small amounts at
first and make sure you chew them well.
This is because your ileum is narrow, and
could become blocked temporarily.
5. Achieve sexual being
-Learning to live with a colostomy may be
difficult for both you and your spouse.
Together you can find ways to live with this
change in your life. It will take time for you
to feel better after surgery. If you had an
active sex life before colostomy surgery, it
can be the same after surgery. You cannot
hurt your stoma by having close body
contact. Be sure to empty the pouch before
having sex.
6. Gas and odor control
-You may want to avoid foods that cause gas
and odor. Some foods that may cause gas
and odor are vegetables such as broccoli,
cabbage, and cauliflower. Other foods
include beans, eggs, and fish. You can also
reduce gas by eating slowly and not using
straws to drink liquids. Foods that may help
to control odor and gas in some people
are fresh parsley, yogurt and buttermilk.
7. Activities of daily living:
Traveling: Always carry extra colostomy
supplies and pouches with you when
traveling. Take enough supplies for your
trip. You may not be able to find what you
need while traveling.
o If you fly, pack your supplies in your
carry-on luggage not your checked
suitcase because luggage is
sometimes lost or delayed.
o If you drive, do not put your supplies
in the trunk or glove compartment.
This can cause your supplies to get
hot, melt and not stick well. Keep
your ostomy supplies in the coolest
place in the car.
 Bathing or swimming: You may take a
bath with or without your pouch. You can
take a shower or bath with your pouch off.
Water will not go into the stoma during a
shower or bath. For swimming, you should
always wear your pouch. Empty your
pouch before getting into the water if you
swim. You may want to put waterproof tape
strips over the edges of your skin barrier.
 Work: You can go back to work when your
caregiver says it is OK. You may need
special support to prevent a hernia if you
work is heavy labor, such as lifting or
digging. You may need an ostomy belt over
 the pouch to keep it in place if you move a c. Apply a line of skin barrier paste
lot at your job. around stoma or on lip or wafer
opening. Use skin protection
products if you have irritated
Equipment: skin around the stoma. The skin
1. Duplicate wafer or pouch can be treated with these
2. Tail closure products to protect your skin and
create a dry surface.
3. Wash cloth and towel
d. Remove paper backings from the
4. Mild non-oily and non-perfumed soap wafer, center opening over
(optional) stoma, and press wafer down
5. Accessory product prescribed for patients onto peristomal skin
6. pencil, measuring guide 4. Snap pouch onto the flange of the wafer,
according to manufacturer’s direction
Preparatory Phase: 5. Apply tail closure if available.
Have a patient assume a relaxed position
and provide privacy Follow-up Phase
1. Dispose of plastic bags with waste
Performance Phase: materials
1. Removal of pouching system: 2. Clean drainable pouch with soap and
a. Wear non-sterile gloves wafer, if appropriate. Drainable maybe
b. Pushdown gently on skin while re-used several times
lifting up on the wafer 3. A commercial deodorant can be placed
c. Discard soiled pouch and wafer in a pouch to remove the odor
in indoor proof plastic bag 4. Gas can be released from the pouch
2. To cleanse the skin
a. Use toilet tissue to remove feces
from stoma and skin if needed
b. Cleanse stoma and peristomal
skin with soft cloth and warm
water, soap (optional). The
patient may shower with or
without pouching system in
place. Clip or shave peristomal
hair appropriate
c. Rinse and dry skin thoroughly
after cleansing. It is normal for
the stoma to bleed slightly during
cleansing and drying
3. To apply wafer
a. Use measuring guide or pattern
determine stoma size
b. Trace correct size on to back of
the wafer and cut to stoma size. It
is acceptable to cut 1/16- 1/8
inches larger than stoma.