COLOSTOMY CARE NURSING PROCEDURE

A Colostomy is an artificial opening that is created as a means for

evacuation of bowel contents in the event that the large intestine, otherwise known
as the colon, is incapable of performing this function. A colostomy can be created
for a number of reasons and they may or may not be temporary.In cases of colo-
rectal cancer however, these colostomies are almost always permanent as
sometimes the entire colon is removed.

The mere creation of one requires a feasible amount of money and the
majority of the people in the country do not have the means of having one, even
though it is necessary for survival. Hence, the nurse does not encounter this in his
everyday life and not all nurses are equipped with the knowledge and skills in
handling these. When the time does come, however, that the nurse handles clients
with these, how can the nurse successfully render care? Ostomy care is a nursing
procedure and it is NOT delegated to unlicensed assist personnel so the nurse
must always be prepared to render appropriate care.
Here are some guidelines that you, as a nurse, without any experience in
colostomy care, may use:
1. Gather equipment
Rationale: It ensures that you have everything necessary to render
colostomy care. Ensure that you have all the materials that you need based
on the type of colostomy your client has.

2. Encourage clients to look at the stoma

Rationale: This encourages participation in stoma care. A drastic change in
self-physical perception may occur in clients. Keep an open mind and maintain
therapeutic communication at all times. Engage the client in care but do not
pressure them.

3. Explain the procedure to the client

Rationale: This brings into light concerning things that your clients may have.
Remain factual and answer all their queries with prompt and direct answers.
Guide them throughout the procedure especially if they will have permanent
stomas.

4. Provide privacy
Rationale: Privacy is very important especially if your client is to receive his
first ostomy care. Remember that the ostomy has created an imbalance in
your client’s self-perception. Do not underestimate that. Always provide
privacy. Ask your client if he is comfortable doing this with significant
others, or if he will need time to adjust first. Be sensitive to your client’s
needs. You may ask the client if he wishes to do it in the bathroom so that
he may see how it is done at home.

5. Perform hand hygiene and wear gloves

Rationale: Protects you and the clients as well. Gloves need not be sterile as
the ostomies are unsterile and cater to fecal material.

6. Inspect the ostomy and determine the need for change of appliance
Rationale: Inspection will allow you to make a judgment. You may change the
ostomy pouch if it is one-thirds full, of more frequently if the client desires
or complains of skin irritation, which is very common with colostomies. Note
for any leakage. Avoid changing ostomies during meal times, before and after
meal times, or during visiting hours.

7. Assist the client to stand or sit

Rationale: Promotes better evacuation of stool and avoids wrinkles on the
colostomy. Unfasten belts if clients wear one.

8. Empty the pouch and remove the ostomy skin barrier.

Rationale: Always empty the pouch through the bottom to prevent spillage of
contents into the client’s skin. When removing the skin barrier, gently peel
from top to bottom while holding the client’s skin tout in order to minimize
discomfort. Always inspect the contents for color.

9. Clean and dry the stoma and the peristomal skin

Rationale: Promotes hygiene ad comfort for the client. Use a tissue to
remove excess stool. When cleaning the stoma, use warm water and a clean
washcloth. The use of “strong” soaps is discouraged as they promote dryness
and are irritating to the stoma. If you use soap however, avoid moisturizing
soaps as they interfere with the adhesiveness of the new skin barrier that
is to be applied. Dry the area by patting, not by rubbing as it causes
abrasions.

10. Place a piece of cloth or tissue over the stoma as it is being

cleaned.
Rationale: Absorbs any sippage as stoma care is being actively done.

11. Prepare the skin barrier, the peristomal seal

Rationale: Ensures cleanliness and proper adhesion and appliance of a new
skin barrier. Use the guide to measure the appropriate stoma size. On the
back of the skin barrier, trace the appropriate stoma size and cut it, making
sure that there is 1/8 to 1/4 allowance on the size to allow the stoma to
expand when functioning.
12. Remove the adhesive backing to expose the sticky side. Place the
skin barrier over the client’s skin and press for 30 seconds.
Rationale: The pressure and the heat from the skin will activate the
adhesives of the skin barrier, successfully patching it to the skin.

13. Remove the tissue from the stoma and snap the pouch onto the skin
barrier wafer.
Rationale: Provides attachment and ensures drainage of stool using a new,
and clean skin barrier. Promotes comfort and allays anxiety.

14. Document
Rationale: Do not forget to document all the nursing care you have rendered.
It does not necessarily mean that you must document the procedure in a
step by step fashion. Be selective and use your judgment.
Nonetheless, when the nurse does encounter this, he must have the
knowledge and the skills to carry out the procedure with safety and
precision. Always ensure that you are competent enough to perform any
procedure that requires you. Remember, you were educated as a generalist
nurse and ostomy care is in fact, a part of the Fundamentals of Nursing
Practice. You must posses this skill, at all times.