purbanchal university B.sc. nursing 4th year student

6. DEFINITION
• A colostomy is an opening that is made in the colon with surgery. After the
opening is made, the colon is brought to the surface of the abdomen to allow
stools to leave the body.
• A colostomy is a reversible (cut) is made into the colon (large intestine) to create
an artificial opening or “stoma” to the exterior of the abdomen. This opening serve
as a substitute anus through which the intestines can eliminate waste products until
the colon can heal or other corrective surgery can be done. The colostomy may be
temporary or permanent.

8. TEMPORARY
• Temporary colostomies bring the side of the colon up to an opening in the
abdomen to eliminate the waste product, until the colon can heal.

13. INDICATION
• LEAFLETS

14. NURSING CARE
1. BEFORE SURGERY:
 Patients need to have certain routine examination such as chest X-ray, and blood
analysis.
Patients need to explain where stoma will be placed on abdomen, what kind of
supplies will need immediately after surgery, and how to best fit ostomy into
lifestyles.
Require a bowel preparation to clean out the colon in the day or two prior to
surgery by enemas or laxatives.

15. CONT.…
Patients may also need take antibiotics or other medications to prevent infection
prior to, during and after the surgery.
2. PREOPERATIVE NURSING CARE:
Care should be focused on patients, so nurses assess the patients knowledge of
understanding of proposed surgery. This include brief over view of GI tract,
structure and functioning of ostomy.
Emotional preparation for patients undergoes ostomy surgery is extremely
important to verbalizes the patients feeling regarding change in body image.

16. CONT.…
Prepare the patients as per general abdominal surgery.
Supports the patients and family with many psychological considerations of
ostomy surgery.
3. Post operative nursing care:
Administer general abdominal surgery care same as other surgeries.
Examine the stoma in every shifts for color and recent changes finding.
 Normal color: Pink, red.
Dusky : Dark red, purplish have (ischemic sign).

18. CONT.…
Necrotic : Brown or black, may be dry.
Apply the pouch to the stoma correctly.
Check the skin around the stoma and be sure without irritation.
Clean the peristomal skin with mild soap and water and dried well before new
pouch is applied.
The pouch should be changed 4-5 days and when leakage occurs.
Empty the pouch about 2/3rd full and clean out pouch.

19. GENERAL PROCEDURE FOR CHANGING AN OSTOMY
POUCH:
1.Articles /equipment's: Chart paper

20. CONT.…
2. ASSESSMENT:
Identify the type of ostomy the patients has and its location (bowel urinary
diversion).
Assess the skin integrity around the stoma and general appearance.
Note the amount and characters of any fecal material or urine in the pouch.
Determine whether the patients is being taught self care at the moment.

21. CONT.…
3. INTERVENTION:
Wash your hands.
Gather the equipment's needed in changing a pouch or dressing:
• Cleaning supplies including tissues warm water, mild soap, wash cloth and a
towel.
• Use tape to prevent leakage.
• Clean belt.
• Dressing materials.
• Receptable for the soiled pouch or dressing(bedpan, paper bag/newspaper for
wrapping).

22. CONT.….
• Clean gloves.
Determine whether the patients is to participates actively.
Choose the appropriate location in performing the procedure (bath room/ bed
side).
Identify the patient.
Explain the procedure to the patients.
Put on clean gloves for infection.
Assist the patients to the bathroom or provide privacy.

23. Remove the soiled dressing
Use warm water and a mild soap, cleanse the skin around the stoma thoroughly.
Inspect the skin for redness or irritation.
Cover the stoma with a tissue to prevent feces or urine from contacting.
Change tissue as necessary during the procedure.
Dry the skin around the stoma carefully, patting gently.
Apply a skin to dry thoroughly so the pouch will adhere firmly.
Remove the tissue from the stoma and apply the clean pouch or dressing .
Remove gloves and wash hands.

24. CONT.
4. Evaluation : Evaluation using a following criteria;
Pouch or dressing secure.
Area clean.
Odor free.
Patient comfortable.
If the patients is being taught the procedure, add the following criteria:
• Patients is able to change the pouch using correct technique.
• Patients verbalizes understating of key points in care.

25. CONT..
5. DOCUMENTATION:
Record the following information:
• The amount, color, and consistency of the fecal materials or urine in the pouch.
• The application of the clean pouch and dressing change.
• The knowledge and ability of the patients to participate in the procedure or ability
to change independently.

27. SUMMARY

29. ASSIGNMENT
• Write down the patients health teaching about colostomy care.

31. PATIENT HEALTH TEACHING ABOUT OSTOMY CARE:
1. Teach stoma assessment : Size, color, odor and manifestations of irritation and
infection.
2. Prevent skin irritation: fit the stoma with pouch.
3. Treat the skin problems: Check the stoma, if there is fungal infection, candid or
antifungal creams powder is applied for skin treatments.
4. Reduce odor: Food such as egg, fish, onion, cabbage, causes stool odor. So
deodorants tablets should be placed in the pouch.
5. Discuss medication : Enteric coated medicines should not be prescribed.

32. CONT..
6. Emphasis in fluid intake: 1200-1500ml/day.
7. Explain dietary recommendation: Low residue and high protein, carbohydrate
and caloric diet is needed. Supplementary vitamin A, B, E, K and B12 should be
needed chew food well. Food must be high fibers.
8. Offer continue support to the patients and family.
9. Offer counseling as necessary and encourage the patients too use normal support
system. Such as family and spouse. So encourage spouse and family to view the
stoma.

33. CONT..
10. Describe about resuming activity of daily living as usual, like bathing, normally.
Encourage patients to maintain following up visits.

34. B