COLOSTOMY CARE

PREPARED BY: MR. CHALMER L. MANUELA, RN

What is COLOSTOMY
A colostomy is an opening that is made in the colon with surgery. After the opening is made, the colon is brought to the surface of the abdomen to allow stools to leave your body.

Indication:
Cancer Chrohns disease Trauma Injury

2 kinds of Colostomy
Temporary Colostomy - maybe placed for a weeks, months or years. Permanent Colostomy when part of colon is removed pr cannot be used.

Where is the colon located?

The colon is part of the digestive system. The digestive system consists of the parts of the body that are involved in the digestion (breakdown) of food. Food moves from your stomach to the small intestine where food is digested and nutrients are absorbed. The food then goes to the colon (part of the large intestine). The colon absorbs water from digested food and turns the digested food into stool.

DIFFERENT TYPES OF COLOSTOMY

Ascending colostomy:
This colostomy has a stoma (opening) that is located on the right side of the abdomen. The output (stool) that drains from this stoma is in liquid form.

Transverse colostomy:
This colostomy has a stoma that is located in the upper abdomen towards the middle or right side. The output that drains from this stoma may be loose or soft.

Descending or sigmoid colostomy

This colostomy has a stoma that is located on the lower left side of the abdomen. The output that drains from this stoma is firm

CHANGING A TWO PIECE DRAINABLE FECAL POUCHING

EQUIPMENT
Duplicate wafer and pouch Tail closure Washcloth and towel Mild non oily soap (optional) Accessory products prescribed for patients

PROCEDURE
NURSING ACTION

PREPARATORY PHASE
1. Have patient assume a relaxed position and provide privacy. The best position maybe sitting, reclining, or standing. Rationale Patient must see to learn care

PERFORMANCE
1. To remove pouching system: a. Wear nonsterile gloves rationale Maintains universal precautions. b. Push down gently on skin while lifting up on the wafer (ostomy adhesive remover maybe used) Rationale Minimizes skin trauma.

c. Discard soiled pouch and wafer in odorproof plastic bag Rationale Removes room odor and maintains universal precaution

2. To cleanse skin: a. Use toilet tissue to remove feces from stoma and skin if needed. Rationale Stoma may function during the change.

b. Cleanse stoma and peristomal skin with soft cloth and water, soap optional. Rationale Minimizes skin breakdown and promotes hygiene.

c. Rinse and dry skin thoroughly after cleansing. It is normal for the stoma to bleed slightly during cleansing and drying. Rationale Removes residue , which may interfere with adhesion of water.

3. To apply wafer: a. Use measuring guide or pattern to determine stoma size. Rationale This step is omitted when stoma shrinkage is complete, about 2 months postop.

b. The correct size onto back of wafer and cut to stoma size. It is acceptable to cut 1/16 1/8 inch larger than stoma. Rationale Avoids wafer rubbing stoma; omit this step if the wafer is precut

c. Apply a line of skin barrier paste around stoma. Allow to set According manufacturers instructions. Other barrier maybe used in place of paste such as strips or washer). Some may find the paste too difficult to see or have developed an allergy to the alcohol within the paste). Rationale Extra skin protection is imperative for ileostomy and right sided colostomy. A left sided colostomy may not need a secondary barrier because formed stool is less harmful to skin. Paste acts as caulking to prevent undermining of feces..

d. Remove paper backing (s) from the wafer, center opening over stoma, and press wafer down onto peristomal skin. Rationale Ensure adherence.

4. Snap pouch onto the flange of the wafer according to maufacturers directios. Rationale If attaced properly, there will be no leakage or odor.

5. Apply tail closure to pouch tail. Rationale Proper closure will controls odor.

FOLLOW UP PHASE
1. Dispose of plastic bag with waste materials. Rationale Complies with universal precautions.

2. Clean durable pouch with soap and water, if appropriate. Drainable pouches maybe reused severable times. Rationale Controls odor; reduces cost.

3. A commercial deodorant can be placed in the pouch to reduce odor. 4. Gas can be released by the pouch by releasing the tail closure or by snapping off an area on the pouch flange. Never make a pinhole in the pouch to release gas. Rationale Destroys the odorproof seal.

IRRIGATING A COLOSTOMY

EQUIPMENT
Reservoir for irrigating fluids; irrigator bag or enema bag if irrigator bag not available. Irrigating fluid: 500 1,500 mL lukewarm water or other solution prescribed by health care provider (volume is tiltrated based on patient tolerance and results; average amount is 1,000mL.)

Irrigating tip: Cone tip or soft rubber catheter #22 or #24 with shield to prevent backflow of irrigating solution (use only if cone not available. The cone is the preferred method to avoid possibility of bowel perforation.) Irrigating sleeve (long large capacity bag with opening at the top with to insert cone or catheter into stoma); available in different styles: Snap on, self adhering to skin, or held in place by belt Large tail closure Water soluble lubricant

PROCEDURE
NURSING ACTION

PREPARATORY PHASE
1. Explain the details of the procedure to the patient and answer any questions. Rationale Relieves anxiety and promotes compliance.

2. Select a consistent time, free from distractions. If the patient is learning to irrigate for bowel control, choose the time of day that will best fit into the patients lifestyle. Rationale Establishes regularity.

3. Have the patient sit in front of the commode itself, providing privacy and comfort. 4. hang irrigator reservoir with prescribed solution so the bottom of the reservoir is approximately at the level of the patients shoulder and above the stoma. Rationale Height of irrigation bag regulates pressure of irrigant.

Note: Colostomy irrigation may also be performed to empty the colon of its contents (feces, gas, mucus) before a diagnostic procedure or surgery and to cleanse the colon after fecal impaction removal or with constipation.

PERFORMANCE PHASE
1. Remove pouch or covering from stoma, and apply irrigation sleeve, directing the open tail into the commode. Rationale Allows water and feces to follow directly into commode.

2. Open tubing clamp on the irrigating reservoir to release a small amount of solution into the commode. Rationale Removes air from the setup; avoids air being introduced into the colon , which can cause crampy pain.

3. Lubricate the tip of the cone/catheter, and gently insert into the stoma. Insert catheter no more than 3 inches. Hold cone/shield gently, but firmly, against stoma to prevent backflow of water. Rationale Prevents intestinal perforation and irritation of mucous membranes.

4. If catheter does not advance easily, allow to flow slowly while advancing catheter. NEVER FORCE CATHETER. Dilating the stoma with lubricated, gloved pinky finger maybe necessary to direct cone/catheter properly. Rationale Slow rate relaxes bowel to facilitate passage of catheter.

5. Allow water to enter colon slowly over 5 to 10 minute period. If cramping occurs, slowly flow rate or clamp tubing to allow cramping to subside, if cramping does not subside, remove cone/catheter to release contents. Rationale Cramping may occur from too rapid flow, cold water, excess solution, or colon ready to function.

6. Hold cone/shield in place 10 seconds after water is instilled, then gently remove cone /catheter from stoma. Rationale Discourages premature evacuation of fluid. 7. As feces and water flow down sleeve, periodically rinse sleeve with water. Allow 10 to 15 minutes for most of the returns, then dry sleeve tail and apply tail closure.

8. Leave sleeve in place for approximately 20 more minutes while patient gets up and moves around. Rationale Ambulation stimulates peristalsis and completion of irrigation return. 9. When returns are complete, clean stomal area with mild soap and water; pat dry; reapply pouch or covering over stoma. Rationale Cleanliness and dryness promote comfort.

FOLLOW UP PHASE
1.Clean equipment with soap and water; dry and store in well ventilated area. Rationale This will control odor and mildew, prolonging the life of equipment.

2. If applicable, the patient should use a pouch until the colostomy is sufficiently controlled. Rationale It may take several months to establish control. The patient can then use minipouch, stoma cap, or gauze covering are desired.

END THANK YOU!!!