Care for patient with colostomy PREPARATIONS 1- Assess: Stoma color Stoma size and shape Stomal bleeding

Any redness and irritation of the peristomal skin Amount and type of feces Complaints The clients and family members learning needs regarding the ostomy and selfcare The clients emotional status, especially strategies used to cope with the ostomy The used appliance for leakage of effluent 2- Determine: The need for an appliance change The kind of ostomy and its placement on the abdomen The type and size of appliance currently used, and the special barrier substance applied to the skin Taoe allergy If client has any discomfort at or around the stoma The fullness of the pouch If there is pouch leakage or discomfort at or around the stoma, change the appliance. 3- Select an appropriate time to change the appliance: Avoid times close to meal or visiting hours. Avoid times immediately after meals or the administration of any medications that may stimulate bowel evacuation. PROCEDURES: 1. Explain to the client what you are going to do, why it is necessary, and how she can cooperate. 2. Wash hands and observe other appropriate infection control procedures. Apply clean gloves. 3. Provide for client privacy. 4. Assist the client to a comfortable sitting or lying position in bed or, preferably, a sitting or standing position in the bathroom.

5. Unfasten the belt, if the client is wearing one. 6. Shave the peristomal skin of wellestablished ostomies, as needed. Use an electric or safety razor on a regular basis, to remove excessive hair. 7. Empty and remove the ostomy appliance: Empty the contents of the pouch through the bottom opening into a bedpan. Assess the consistency and the amount of effluent. Peel the bag off slowly while holding the clients skin taut. If the appliance is disposable, discard it in a moisture-proof bag. 8. Clean and dry the peristomal skin and stoma: Use toilet tissue to remove excess stool. Use warm water, mild soap (optional), and cotton balls or a washcloth and towel to clean the skin and stoma. Use a special skin cleanser to remove dried, hard stool. Dry the area thoroughly by patting with a towel or cotton balls. 9. Assess the stoma and peristomal skin. Inspect the stoma for color, size, shape, and bleeding. Inspect the peristomal skin for any redness, ulceration, or irritation. Place a piece of tissue or gauze pad over the stoma, and change it as needed. 10. Apply paste-type skin barrier, if needed: Fill in abdominal creases or dimples with paste. Allow the paste to dry for 1 to 2 minutes, or as recommended by the manufacturer. Prepare and apply the skin barrier (peristomal seal). 11. For a Solid Water or Disc Skin Barrier: Use the guide to measure the size of the stoma. On the backing of the skin barrier, trace a circle the same size as the stomal opening. Cut out the traced stoma pattern to make an opening in the skin barrier.

Make the opening no more than 0.30.4 cm (1/81/6 in) larger than the stoma. Remove the backing to expose the sticky adhesive side. Center the skin barrier over the stoma, and gently press it onto the clients skin, smoothing out any wrinkles or bubbles. 12. For Liquid Skin Sealant: Either wipe or apply the product evenly around the peristomal skin to form a thin layer of the liquid plastic coating to the same area. Allow the skin sealant to dry until it no longer feels tacky. 13. Fill in any exposed skin around an irregularly shaped stoma: Apply paste to any exposed skin areas. Use a nonalcoholic-based product if the skin is excoriated. Or: Sprinkle peristomal powder on the skin, wipe off the excess, and dab the powder with slightly moist gauze or with an applicator moistened with a liquid skin barrier. 14. Prepare and apply the clean appliance: Remove the tissue over the stoma before applying the pouch. 15. For a Disposable Pouch with Adhesive Square: If the appliance does not have a precut opening, trace a circle 0.30.4 cm (1/81/6 in) larger than the stoma size on the appliances adhesive square. Cut out a circle in the adhesive. Peel off the backing from the adhesive seal. Center the opening of the pouch over the clients stoma, and apply it directly onto the skin barrier. Gently press the adhesive backing onto the skin, and smooth out any wrinkles, working from the stoma outward. Remove the air from the pouch. Place a deodorant on the pouch (optional). Close the pouch by turning up the bottom a few times, fanfolding its end lengthwise, and securing it with a tail closure clamp.

16. For a Reusable Pouch with Faceplate Attached: Apply either adhesive cement or a doublefaced adhesive disc to the faceplate of the appliance. Insert a coiled paper guide strip (15- cm [6in] strip of 1.3-cm- [_ in] wide paper) into the faceplate opening. The strip should protrude slightly from the opening and expand to fit it. Using the guide strip, center the faceplate over the stoma. Firmly press the adhesive seal to the peristomal skin. Place a deodorant in the bag, if the bag is not odor-proof. Close the end of the pouch with the designated clamp. Attach the pouch belt, and fasten it around the clients waist (optional). 17.Variation: Applying a Reusable Pouch with Detachable Faceplate: Apply a skin sealant to the faceplate before attaching the adhesive disc. Remove the protective paper strip from one side of the double-faced adhesive disc. Apply the sticky side to the back of the faceplate. Remove the remaining protective paper strip from the other side of the adhesive disc

Assess the location of the stoma and the type of colostomy performed. Stoma location is an indicator of the section of bowel in which it is located and a predictor of the type of fecal drainage to expect. Assess stoma appearance and surrounding skin condition frequently Assessment of stoma and skin condition is particularly important in the early postoperative period, when

complications are most likely to occur and most treatable. Position a collection bag or drainable pouch over the stoma. Initial drainage may contain more mucus and serosanguineous fluid than fecal material. As the bowel starts to resume function, drainage becomes fecal in nature.The consistency of drainage depends on the stoma location in the bowel. In ordered irrigate the colostomy, instilling water into the colon similar to an enema procedure. The water stimulates the colon to empty. When a colostomy irrigation is ordered for a client with a doublebarrel or loop colostomy, irrigate the proximal stoma. Digital assessment of the bowel direction from the stoma can assist in determining which is the proximal stoma. The distal bowel carries no fecal contents and does not need irrigation. It may be irrigated for cleansing just prior to reanastomosis. Empty a drainable pouch or replace the colostomy bag as needed or when it is no more than one-third full. If the pouch is allowed to over fill, its weight may impair the seal and cause leakage. Provide stomal and skin care for the client with a colostomy as for the client with an ileostomy (Box 24-15). Good skin and stoma care is important to maintain skin integrity and function as the first line of defense against infection. Use caulking agents,such as Stomahesive or karaya paste, and a skin barrier wafer as needed to maintain a secure ostomy pouch. This may be particularly important for the client with a loop colostomy. The main challenge for a client with a transverse loop colostomy is to maintain a secure ostomy pouch over the plastic bridge.

A small needle hole high on the colostomy pouch will allow flatus to escape. This hole may be closed with a Band-Aid and opened only while the client is in the bathroom for odor control. Ostomy bags may balloon out, disrupting the skin seal, if excess gas collects. CLIENT AND FAMILY TEACHING Prior to discharge, provide written, verbal, and psychomotor instruction on colostomy care,pouch management, skin care, and irrigation for the client. Whether the colostomy is temporary or permanent, the client will be responsible for its management.Good understanding of procedures and care enhances the ability to provide self-care, as well as self-esteem and control. Allow ample time for the client (and family, if necessary) to practice changing the pouch, either on the client or a model. Practice of psychomotor skills improves learning and confidence. If an abdominoperineal resection has been performed, emphasize the importance of using no rectal suppositories, rectal temperatures, or enemas. Suggest that the client carry medical identification or a MedicAlert tag or bracelet. These, measures are important to prevent trauma to the tissues when the rectum has been removed. The diet for a client with a colostomy is individualized and may require no alteration from that consumed preoperatively. Dietary teaching should, however, include information on foods that cause stool odor and gas and foods that thicken and loosen stools. Foods that cause these effects on ostomy output are listed below. Foods That Increase Stool Odor

 Asparagus Fish Beans Garlic Cabbage Onions Eggs Some spices Foods That Increase Intestinal Gas Beer Cucumbers Broccoli Dairy products Brussels sprouts Dried beans Cabbage Peas Carbonated drinks Radishes Cauliflower Spinach Corn Foods That Thicken Stools Applesauce Pasta Bananas Pretzels Bread Rice Cheese Tapioca Yogurt Creamy peanut butter Foods That Loosen Stools Chocolate Highly spiced foods Dried beans Leafy green vegetables Fried foods Raw fruits and juices Greasy foods Raw vegetables Foods That Color Stools Beets Red gelatin