COLOSTOMY

CARE AND
IRRIGATION

SUBMITTED BY: BSN-III MRS. ARIANNE ENECIO

OCUBILLO, FRANCISE ELYN RN,MAN
B.
TAMBIS, CONSTANCIO C.

SUBMITTED TO:

1
OBJECTIVES:

At the end of 2.5 hours lecture-discussion, the Level III nursing students

will be able to:

1. Define colostomy

2. Describe the following:

2.1. Types of colostomy

2.2. Forms of ostomy appliances

3. State the purpose of the following:

3.1. Stoma care

3.2. Colostomy care

3.3. Colostomy irrigation

4. Explain the indications and contraindications of colostomy care and

irrigation.

5. Identify the various signs to assess in patients with colostomy.

6. Illustrate the nursing responsibilities in the care of patients with

colostomy

7. Demonstrate beginning skills in stoma care and irrigation.

2
COLOSTOMY
- is a surgical procedure in w/c a stoma is formed by drawing the healthy
end of the large intestine/colon through an incision in the anterior
abdominal wall and suturing it into place.

TYPES OF COLOSTOMY
A. ACCORDING TO PERMANENCE:

 Loop colostomy- type of colostomy is usually used in emergencies and is a

temporary and large stoma.
 End colostomy- A stoma is created from one end of the bowel. The other portion
of the bowel is either removed or sewn shut.
 Double barrel colostomy- The bowel is severed and both ends are brought out
onto the abdomen only is the proximal stoma is functioning.

B. ACCORDING TO ANATOMICAL POSITION:

 Ascending Colostomy
- is located in the ascending colon.
The stool is liquid to semi-liquid and contains digestive enzymes that can be
irritating to the skin around the stoma. You will probably empty your pouch 4-6
times a day.

3
  Transverse Colostomy
-is located in the transverse colon.
The stool is usually liquid to semi-formed (paste-like) because the colon has
absorbed some of the water from the stool as it moved through the ascending
colon. You will probably empty your pouch 4-6 times a day.

 Descending Colostomy
-is located in the descending colon.
The stool is semi-formed (paste-like) to formed because much of the water in the
waste materials has been absorbed as it moved through the ascending and
transverse colon. You will probably empty your pouch 1-3 times a day.

 Sigmoid Colostomy
-is located in the sigmoid colon.
Stool from a sigmoid colostomy is usually formed since most of the water has been
absorbed as the waste passed through the ascending, transverse and descending
colon. You may empty your pouch 1-2 times a day, or once every 2 days

FORMS OF OSTOMY APPLIANCES

 One-piece system- is designed to be disposable. The wafer and the bag itself are
all one and cannot be pulled apart.
 Two-piece systems- means that the wafer and the bag are separate and are
joined together by what is commonly reffered to as a ‘tupperware-type ring” on the
wafer.

PURPOSE OF STOMA CARE, COLOSTOMY CARE AND IRRIGATION

 To prevent irritation in the periostomal skin
 To provide comfort to the patient.
 To minimize odors for the client’s comfort and self-esteem
 To collect stool for assessment of the amount and type of output
 To distend the bowel sufficiently to stimulate peristalsis w/ stimulates evacuation.

INDICATIONS OF COLOSTOMY CARE AND IRRIGATION

INDICATIONS RATIONALE
 Pt. w/ Constipation - To regulate bowel movement

 Pt. w/ Diverticulitis - To empty and cleanse the colon.

 Pt. w/ fecal incontinence - To monitor stool output.

 Pt. w/ imperforate anus - To have alternative way of stool

passing.

 Penetrating abdominal surgery - For faster recovery.

CONTRAINDICATIONS OF COLOSTOMY CARE AND IRRIGATION

CONTRAINDICATIONS RATIONALE
 Pregnant women( 4-9 mos) - potential risks of uterine and fetal
injury.
4
  Pt. w/ GI hemorrhage -
- To prevent further complications.

 Pt. w/ perforation
- Prevention of further injury

SIGNS TO ASSESS IN PATIENTS WITH COLOSTOMY

- Rectal discharge - Stoma blockage
- Infection - Skin problems
- Parastomal hernia - Stoma ischemia
SEEK IMMEDIATE CARE IF THERE IS :
 continuous nausea and vomiting
 dramatic change in stoma size, shape, or color
 continuous bleeding at the junction between the stoma and the skin that
does not stop by applying pressure
 obstruction, prolapse, or narrowing of the stoma
 a deep cut in the stoma
 no output of intestinal content or stool from the stoma for 4 to 6 hours, with
cramping and nausea
 severe diarrhea with risk of dehydration
 excessive bleeding from the stoma opening

NURSING RESPONSIBILITIES
BEFORE:
 Gather the equipment
 Encourage the client to look at the stoma
 Explain the procedure to the client
 Provide privacy
 Inspect appearance of the skin and surrounding of the stoma (shiny, red or pinkish,
moist and normal skin tone)
 Perform medical hand washing
 Lubricate tubing before inserting to the stoma
 Gentle massage to the abdomen to facilitate peristalsis
 During irrigation instill 300-500 mL of fluid to stimulate evacuation

DURING:
 Wear gloves
 Inspect the ostomy and determine the need for change of appliance
 Assist the client to stand or sit
 Empty the pouch and remove the ostomy skin barrier
 Clean and dry the stoma and the periostomal skin
 Place a piece of cloth or tissue over the stoma as it is being cleaned.

AFTER:
 Document
 Do Medical Handwashing
 Do after care

5
6