Care of the Patient with a Colostomy

FUNDAMENTALS

STANDARD FORMS
These templates are included in the Appendix; copy before each use.

LEARNING OUTCOMES The participant will be able to:

Cognitive 1. Communicate effectively with healthcare team
members in the care of a patient with a colostomy.
The participant will be able to:
2. Communicate effectively with the patient and
1. Describe signs and symptoms of a healthy stoma.
family in the care of a patient with a colostomy.
2. Correlate signs and symptoms of infection
to the physiology of wound healing.
3. Identify factors in a patient’s history that
increase the risk of colon cancer.
4. Identify factors in a patient’s current condition
that increase the risk of complications with the
colostomy.
5. Identify the appropriate interventions for a patient
with a colostomy.
6. Differentiate the roles of team members in
response to a patient with a colostomy.
Psychomotor
The participant will be able to:
1. Perform an appropriate assessment for a patient
with a colostomy.
2. Initiate appropriate interventions including stoma
assess- ment, cleansing the stoma, applying the
appliance, and teaching self-care management for
a patient with a colostomy.
3. Work collaboratively as part of the healthcare
team in the care of a patient with a colostomy.
Affective
The participant will be able to:
1. Reflect upon performance in the care of a patient
with a colostomy.
2. Express personal feelings in delivering care to a
patient with a colostomy.
3. Discuss feelings related to working as a
member of a team in the care of a patient with
a colostomy.
4. Identify factors that worked well during the
simulation of care of a patient with a colostomy.
5. Identify factors that needed improvement
during the simulation of care of a patient with a
colostomy.
6. Develop self-confidence in the care of a patient
with a colostomy.
Communication
3. Use SBAR when communicating with team
members in the care of a patient with a
colostomy.
4. Practice Transparent Thinking (thinking out
loud) to facilitate group problem solving.
5. Use Directed Communication (directing a
message to specific individual) when
delegating tasks.
6. Employ Closed-Loop Communication
(acknowledgment of receipt of the message and
status) to acknowledge communications from
others.
Safety
The participant will be able to:
Administer and maintain specific protecting
interven- tions with attention to safety of the client
and healthcare professional.
1. Demonstrate a safe environment with
attention to haz- ards to healthcare providers,
visitors, and the client. Includes body
mechanics, tripping hazards, and equip- ment
issues.
2. Demonstrate attention to national patient safety
goals. Includes patient identification standards,
effective communication among healthcare
providers, and safe medication administration.
3. Demonstrate attention to standard precautions.
Includes hand washing, infection control
measures, and use of personal protective
equipment (PPE) as needed.
Leadership and Management/Delegation
The participant will be able to:
1. Identify tasks that can be legally, ethically, and
safely delegated to unlicensed assistive
personnel (UAP) or licensed practical nurse
(LPN) in the care of a patient with a colostomy.
2. Identify and prioritize patient’s needs in the
care of a colostomy.
Teaching and Learning
The participant will be able to:
1. Demonstrate to the patient how to change the
colostomy appliance.
2. Describe the signs and symptoms of a
functional colostomy to the patient.
3. Include the family in the teaching session
with the patient’s consent.
4. Evaluate the teaching session and assess the
patient’s knowledge.
35
 Care of the Patient with a Colostomy 1

OVERVIEW OF THE PROBLEM ■ Monitor I & O

Definition ■ Administer IV fluids
Colostomies and their care.
Fecal diversion procedures create stomas, which
may be temporary or permanent.
Types of stomas include:
■ Temporary: The fecal stream is rerouted to
allow the GI tract to heal or provide an outlet in
obstruction.
■ Permanent: The intestine cannot be
reconnected, often performed for cancer of the
colon and/or rectum.
■ Continent ileostomy: A pouch is created inside
the wall of the intestine. The pouch serves as a
reservoir similar to the rectum. The pouch is
emptied on a regular basis with a small tube.
■ Ileoanal anstamosis: The large intestine is
removed and the small intestine is inserted into
the rectum and attached just above the anus.
Pathophysiology
Stomas are performed because of disease or trauma.
■ An ileostomy may be performed for
unresponsive or complicated ulcerative colitis or
suspected carcinoma.
■ A colostomy may be performed for colon
or rectal cancer or to relieve an obstruction.
Risk Factors
Risk factors vary according to the disease process
resulting in the need for a stoma. Risk factors for
colonrectal cancer include:
■ Male
■ Middle aged
■ Personal or family history of polyps or cancer
■ Ulcerative colitis
■ High-fat low-fiber diet
■ Gardner’s syndrome (autosomal dominant
disease, familial adenomatous polyposis)
Assessment
Subjective
■ Assess client response to stoma and stoma care
Objective
■ Observe appearance of stoma—should be pink,
moist
■ Monitor for signs of bowel obstruction
■ Check skin around stoma for signs of
breakdown
Diagnostic Tests
Not applicable
Treatment
■ Administer medications and IV fluids as ordered
■ Irrigate if ordered
Nursing Management
Goal: Maintain fluid balance.
2 Fundamental Skills

Goal: Prevent other postoperative complications. sleeve, and a closure and tail.
■ Monitor for signs of intestinal obstruction
■ Use aseptic technique
■ Observe stoma
appearance Goal: Related Evidence-Based Practice Guidelines
Initiate ostomy care. National Guideline Clearinghouse. Rectal cancer.
■ Prevent skin breakdown https://
■ Change appliance appropriately www.guideline.gov/summaries/summary/46238/
■ Use deodorizing drops practice-parameters-for-the-management-of-rectal-
Goal: Promote psychological comfort. cancer-revised?q=colon+cancer+colostomy
■ Support patient and family
■ Assess grieving
process Goal: Initiate
Health teaching.
■ Self-care management
■ Diet adjustments
■ Signs of complications
■ Community referral and follow-up care
Evaluation/Outcome Criteria
■ Demonstrates self-care for independent living
■ Makes dietary adjustments
■ Ostomy functions well
■ Adjusts to alterations in bowel elimination
patterns
REVIEW QUESTIONS
1. What are the key nursing interventions for the
care of a patient with a colostomy?
Answer: The key interventions for the care of a patient with
a colostomy include monitoring I & O, administering IV fluids
as ordered, monitor vital signs, monitor laboratory results,
and administer electrolytes as indicated.

2. What are the complications of a colostomy?

Answer: The complications of a colostomy could include;
medically restricted intakes, different intake of fluid, extra
loss of e.g. diarrhea.

3. What electrolyte imbalances or conditions

would you observe in a patient who has had
a colostomy?
Answer: Diarrhea, vomiting, and a lot of sweating are a few
of the conditions that could increase the risk of an
electrolyte imbalance. In order to avoid dehydration the
patient should drink at least 8 to 10 glasses of water a day. If
the problem is excess diarrhea the patient should drink
more.

4. What does a normal stoma look like?

Answer: A healthy one is pinkish-red and moistish.

5. What are the parts of a colostomy appliance?

Answer: The parts of a colostomy appliance include a plastic
irrigating container with a long tube an a tip, irrigation
 Care of the Patient with a Colostomy 3

National Patient Safety Goals. Retrieved from Topics to Review Prior to the Simulation
https://www
.jointcommission.org/standards_information/npsgs.aspx ■ Medical/surgical nursing
SBAR Technique for Communication: A situational ■ Ostomy care
briefing ■ Skin and abdominal assessment
model. The Institute for Healthcare. Retrieved from ■ Colon cancer
http://www.ihi.org/IHI/Topics/PatientSafety/Safety ■ Nutrition
General/Tools/SBARTechniqueforCommunication ■ Fluid balance
ASituationalBriefingModel.htm

SIMULATION Demographic
Client Background
■ Marital status: married
Mrs. Jones had been experiencing bloody stools for ■ Educational level: grade 12
over a month. She had also been complaining of ■ Religion: Catholic
increasing weakness and stomach cramps. ■ Occupation: care aide
Biographical Data Current health status
■ Age: 42 ■ Diagnosis of colon cancer and a colostomy
■ Gender: female
■ Height: 5 ft 5 in History
■ Weight: 140 lb ■ Psychosocial history
■Married, 4 children
Cultural Considerations:
Family support
■ Language: English as a second language, primary
dialect Mandarin ■ Past health history
■ Ethnicity: Asian ■Tubal ligation: 4 years ago
■ Nationality: Canadian citizen for 20 yr ■Appendectomy: 18 years ago
■ Culture: Chinese

Admission Sheet

Name: Mrs. Jones

Age: 42
Gender: Female
Marital Status: Married
Educational Level: Grade 12 graduate
Religion: Catholic
Ethnicity: Asian
Nationality: Canadian citizen–immigrated to Canada 20 years ago
Language: English as a second language. First language Mandarin
Occupation: Care aide
Continued
Hospital Patient’s Name: Mrs. Jones
Provider’s Orders Allergies: NKDA

Diagnosis: Colon cancer–colostomy

Date Time Order Signature

Vital signs: Routine

Diet: Full liquid diet, advance as tolerated
to house diet
Activity: Activity as tolerated
IV therapy: NSS 1,000 mL at 75 mL/hr
Medications: Morphine 2 mg q 2 hr IV prn for pain
Diagnostic studies:
Frequency: daily at 6 AM
BMP (basic metabolic panel), CBC
Treatments: SCDs (sequential compression
devices) until patient ambulating down
hallway three times daily
Incentive spirometry q 1 hr Dr. Robinson

Nursing Report - You arrive on the unit at 0700 and have been assigned Mrs. Jones. She will require colostomy care
teaching and the appliance needs to be changed. Her husband and children are present in the room. She met with the
enterostomal therapist yesterday and feels well enough to begin independent care. She has requested morphine 2mg IV
twice in the last 12 hours.

Simulation Prep Assignments

1. Identify items and their purpose in the care of a patient with a colostomy.

Item Purpose
Stethoscope Take bp and listen for bowel sounds.
Colostomy equipment Supplies include flange, ostomy bag and clip, scissors, stoma measuring guide,
waterproof pad, pencil, adhesive remover for skin, skin prep, stomahesive paste or
powder, wet cloth, non-sterile gloves, and additional cloths
2. Identify
Clean glovesteam members and their Less
specific riskinofthe
roles infection.
care of a patient with a colostomy.

Team Member Role

Primary nurse Teach, educate, and provide care.
WOCN or enterostomal nurse treatment of complex wounds, ostomy issues and incontinence
Family members Be supportive and care provider when at home if needed.
Physician/surgeon Explain and do procedure.
 Care of the Patient with a Colostomy 5

3. Treatment
Identify drugs that are used to treat a patient with a colostomy. Complete the table using Deglin et al, Davis’s Drug
Guide for Nurses 15e, or other drug reference.

Medication Dose, Route, Indications Side Effect Nursing Implications

Frequency
Morphine 2 mg IV q  Chest pain  Fainting  Monitor blood
2 hr prn associated with  Seizure pressure prior to
administration.  Hold
acute coronary  Slow/shallow if systolic BP < 100
syndrome mm Hg or 30 mm Hg
breathing
below baseline.
 Acute cardiogenic  Severe drowsiness
pulmonary edema  Mental/mood  Monitor patient's
respiratory rate prior
changes to administration.
 Severe stomach
 Difficulty urinating  Reassess pain after
administration of
 Signs of your morphine.
adrenal glands
not working well  Monitor for
respiratory
depression and
hypotension
frequently up to 24
hours after
administration of
morphine.

 Place call light signal

close to patient. 
Accompany patient if
need to get out of bed
to minimize risk of
falls.