INTRODUCTION TO COLOSTOMY

Definition
A colostomy is a surgical procedure that involves creating an
opening in the abdominal wall called a stoma to divert a
portion of the colon (large intestine) through the stoma. This
procedure is typically performed when there is a need to
bypass or remove a diseased or damaged section of the colon,
allowing waste material to exit the body through the stoma
instead of passing through the anus.

REASONS FOR COLOSTOMY

A colostomy may be performed for various reasons, including:
1. Bowel obstruction: When there is a blockage in the colon
that cannot be easily cleared, a colostomy can be done to divert
the bowel contents and relieve the obstruction.
2. Cancer: In some cases of colorectal cancer or other cancers
affecting the colon(Cancer of the rectum or anus) a colostomy
may be necessary to remove the affected portion of the colon
and redirect the bowel contents.
3. Inflammatory bowel disease (IBD): Severe cases of
conditions such as Crohn's disease or ulcerative colitis may
require a colostomy to manage symptoms and improve quality
of life.
4. Trauma or injury: In cases of severe trauma or injury to the
colon, a colostomy can help in the healing process and provide
temporary or permanent bowel diversion

PREVENTION
Prevention strategies for conditions that may require a
colostomy can vary depending on the underlying cause.

1. Healthy diet: A well-balanced diet rich in fiber can help

prevent constipation and promote regular bowel movements.
Include plenty of fruits, vegetables, whole grains, and legumes
in your diet. Stay hydrated by drinking an adequate amount of
water.

2. Regular exercise: Engaging in regular physical activity can

help regulate bowel function and promote overall colon health.
Aim for at least 30 minutes of moderate-intensity exercise most
days of the week.
3. Avoiding tobacco and alcohol: Smoking and excessive
alcohol consumption have been linked to an increased risk of
colorectal cancer. Quitting smoking and moderating alcohol
intake can help reduce the risk.

4. Screening for colorectal cancer: Regular screening for

colorectal cancer is recommended, especially for individuals
over the age of 50 or those with a family history of the disease.
Screening methods may include colonoscopy, sigmoidoscopy,
or stool tests.

5. Managing chronic conditions: If you have a chronic condition

such as inflammatory bowel disease (IBD), it's important to
work closely with your healthcare provider to manage
symptoms and reduce the risk of complications. Following
prescribed treatment plans and attending regular check-ups are
crucial.

6. Safety precautions: Taking safety precautions can help

prevent traumatic injuries to the abdomen, which can
sometimes lead to the need for a colostomy. Use seat belts in
vehicles, practice proper workplace safety measures, and be
cautious during physical activities to minimize the risk of
serious abdominal injuries.

NURSING CARE FOR PATIENTS WITH COLOSTOMY

PRE-OPERATIVE NURSING CARE
 Psychological preparation: Assure the patient that ostomy
can be cared for without it interfering with daily activities
and social life.
 Nutrition: a low residue diet is given for at least 1-2 days
perior to the surgery.
 Care of the bowl: Sterilization of the bowl perior to the
surgery to reduce bacteria flora can be achieved through
administration of poorly absorbed antibiotics such as
neomycin 1grm 4 hourly 1-3 days, laxative and enema may
be done.

POST OPERATIVE NURSING CARE

 Access skin for signs of irritation or breakdown, apply skin
barrier paste
 The nurse should help the patient to accept the colostomy
and teach patient the necessary care and management
 Provide written or verbal instructions on colostomy care,
pouch management, skin care and irrigation for client.
  Education and post medication observations are necessary
as some medication can change the colour, odor and
consistency of stool.
 Control odor by clean odor free, well fitting appliance,
regular change of bag, cleaning and use of deodorant.
 Applying an ostomy appliance the stoma must be
measured so that the right size appliance can be chosen.
COLOSTOMY WASHOUT
Requirements on a Trolley
Top Shelf
1. Covered bowl containing sterile swabs, guaze and cotton
wool pads.
2. Covered bowl containing (Rectal tube, Rubber tubing,
Glass connection, funnel.
3. Covered kidney dish with two pairs of dressing forceps,
one pair of dissecting forceps
4. A gallipot for cleansing lotion
5. A small bowl for resting forceps
6. A gallipot for lubricant
7. A gallipot for 4×4cm gauze square
8. A litre jug containing the required lotion e.g Normal saline
temperature 100°F (37.7°C)
9. A tray containing a bottle of the required cleansing lotion,
a tin of barrier cream
 10. A kidney receiver containing a pair of scissors,
bandage, spatula for taking required barrier cream.
11. Lotion thermometer in a jar of antiseptic e.g hibitane
1-250.

On Rails of trolley
1. 1 plastic apron
2. 1 treatment plastic.

At the Bottom Trolley

1. Covered destructor bowl lined with polythene for used
dressings
2. A kidney receiver for used instruments
3. A bucket for collecting the retuned fluid
4. A kidney receiver for the used rectal tube
5. A salvage bowl for used treatment plastic
6. A pair of disposable gloves
7. Colostomy bag

PROCEDURE PROPER
 Identify patient by name and explain the procedure to the
patient and obtain concent
 Moving to the equipment room mop the trolley and
assemble all the equipment and wheel in the trolley to the
patient bed side.
 Provide privacy or screen the patient
 Place the patient in a sitting position and put on your
gloves.
 Arrange the plastic under the hip with the edges folded to
form a trough, the end hanging over edge towards the
bucket.
 Lubricate the end of the rectal tube and run in fluid to
expel air.
 Pinch or clip the tubing.
 Introduce about 15cm of the rectal tube and allow the
fluid to run in gently.
 Pinch the tubing below the funnel, lower over the bucket
and siphon fluid back
 Repeat the procedure until fluid is clear
 Ensure all fluid fluid given is returned
 Pinch the rectal tube and remove it through a square of
4×4cm gauze
 Disconnect rectal tube, discard into kidney receiver
 Return funnel, tubing and glass connection to the bowl
 Dress the colostomy and apply barrier cream around the
wound
 Apply colostomy bag
 Make patient comfortable and remove screen
 Discard your trolley and equipment properly
 Discard your gloves and wash your hands, then document
procedure and findings.