RALPH RIGOR M.

CANLAPAN, RN
Faculty, College of Nursing and Midwifery
College of Our Lady of Mt. Carmel – Pampanga
INTRODUCTION
• The word ostomy means an opening which is
made during surgery that brings a piece of the
bowel (intestines) to the outside of the
abdomen, i.e. on the belly (Certified Wound,
Ostomy, Continence Nurses, 2012).
• A colostomy may be temporary or permanent.
• Most permanent colostomies are "end
colostomies,”
• while many temporary colostomies bring the
side of the colon up to an opening in the
abdomen (Johns Hopkins Medicine, 2012).
INDICATIONS
• Birth defect e.g, an imperforate anus
• Serious infection, such as diverticulitis
• Inflammatory bowel disease
• Injury to the colon or rectum
• Partial or complete intestinal or bowel
blockage
• Rectal or colon cancer
• Wounds or fistulas in the perineum.
LOCATION
• the most common placement is on the
lower left side near the sigmoid where
a majority of colon cancers occur.
TYPES OF COLOSTOMY
• Loop Colostomy
• End Colostomy
• Double Barrel Colostomy
Part of colon Characteristic of stool

Sigmoid colostomy Produce stool that is more solid and

regular than other colostomies

Ascending colostomy Usually liquid

Descending colostomy Usually firm

MANAGEMENT OF A PATIENT
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 (Hellinger,
2011).
• Nutrition: A low residue diet is given
for at least 1-2 days prior to the surgery
PRE-OPERATIVE NURSING CARE
• Psychological preparation: Assure the patient
that ‘Ostomy’ can be cared for without it
interfering with daily activities and social life
(Hellinger, 2011).
• Nutrition: A low residue diet is given for at
least 1-2 days prior to the surgery
• Care of the Bowel: “Sterilization” of the bowel
prior to surgery to reduce bacterial flora can
be achieved through administration of poorly
absorbed antibiotics such as neomycin 1grm 4
hourly for 1-3 days; Laxatives and enema may
be done (Lyerly, 2013).
POST-OPERATIVE NURSING CARE
• Skin Care: Access skin for sign of irritation or
breakdown; apply skin barrier paste.
• Psychosocial Adaptation: The nurse should
help the patient to accept the colostomy and
teach patient the necessary care and
management.
• Nutrition: the colostomate is started on a light,
low-residue diet (Patel, 2012).
• Patient Education: provide written, verbal and
psychomotor instruction on colostomy care,
pouch management, skin care and irrigation
for the client.
POST-OPERATIVE NURSING CARE
• Medications: Some medications or nutritional
supplements may change the color, odor, or
consistency of stool just like before surgery.
Patient education and post-medication
observation are therefore necessary.
• Control of Odor: control odor by a 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. The pouch attaches over the stoma
and is fastened unto the faceplate.
Nursing Care for
Colostomy
A Clean tray must contain the ffg:
• Mackintosh with draw sheet
• Kidney Basin
• Pair of clean gloves
• Colostomy bag
• NS/Basin with warm tap water
• Gauze pieces
• Gauze pad/tissue paper
• Skin barrier
A Clean tray must contain the ffg:
• Stoma measuring guide
• Pen or pencils & scissors
• Bed pan
PROCEDURE
• Gather equipment.
• Ensure that everything is there to render
the care.
• Encourage clients to look at the stoma.
• It encourages participation in the stoma
care.
• Explain the procedure to the patient.
• To gain confidence of the patient.
• Provide privacy.
• For smooth performance of procedure.
PROCEDURE
• Perform hand hygiene & wear gloves
• To prevent infection
• Spread mackintosh & draw sheet.
• To protect the linen
• Remove used pouch & skin barrier
gently by pushing the skin away from
the barrier
• Reduces trauma, jerking, irritates skin &
can cause tear.
PROCEDURE
• Remove clamp and empty the content
into bed pan. Rinse the pouch with
tepid water/NS.
• To minimize the odor & growth of
microbes.
• Discard the disposable pouch in paper
bag
PROCEDURE
• Observe stoma for color, swelling, trauma &
healing. Stoma should be moist & pink.
• To find out complication
• Cover the stoma with a gauze piece.
• To prevent the feccal matter from contacting
with skin.
• Clean peristomal region gently with warm
tap water using gauze pad. Don't scrub the
skin, dry by patting the skin.
• Stoma surface is highly vascular. Skin barrier
does not adhere to wet skin.
• You may apply moisturizer
PROCEDURE
• Use the pouch if it is drainable using a
clamp or clip
• Remove gloves and wash hands.
• Make the patient comfortable
• Document
• Date/Time
• Amount
• Colour
• Consistency of feccal matter
• Sign of any infection