NURSING ISSUESCOLOSTOMY CARE

Alice Stella

OSTOMYOstomy is an artificial opening made in the abdominal wall Types 1) INPUT OSTOMY Tracheotomy ,Gastrostomy , Feeding illeostomy 2) OUTPUT OSTOMY Colostomy,Urostomy,Ileostomy

ColostomySurgical opening made from the large intestine through which faeces & flatus are excreted TYPES Temporary & Permanent * Single / Double barrel Wet & dry colostomy

INDICATIONS

Ulcerative colitis Crohns disease Cancer of colon Obstruction Congenital abnormalities Injury / Trauma Neurological conditions Fistula eg. RVF

COLOSTOMY CAREPre-operative counseling Stoma site marking Post operative care Irrigation

Pre Operative counselingTeam Work Individual care Explanation Ostomy Visitor Emotional support Site marking Prepare patient & family to accept a colostomy

SITES TO BE AVOIDUmbilical depression Bony prominence Drainage holes Natural waist level Operative incision & other scars Groin flexure Fatty bulges & deep creases Chr. Skin condition

Post operative carePatient involvement & family contribution Habit formation Diet Occupation Travel Sports Clothing Skin care

ASSESSMENT OF STOMA

Stomal colour Bleeding (Usually seen at the time of cleaning or changing the bag. Apply local pressure for 10 minutes and sucralfate powder ) Stomal edema Herniation Stoma prolapse (Stoma size is 1 to 1.5 cm above skin level in ) *

colostomy. In illieostomy 3 to 3.5 cm above skin level. If prolapse 10 cm needs surgical intervention

needed. Other wise surgical correction advised. Special attention to peristomal skin. )

Retraction (If no interference with bowel movement to intervention is Stenosis Peristomal skin

NURSING PROBLEMSIrregular bowel action Constipation / obstruction (Laxatives, enema, suppositories ) Diarrhea (Increase intake of fluid and hospitalization as early as possible ) Excoriation of Skin Flatus / foul smell Psychological problems Stricture of stoma

SKIN CAREWash with soap & water , Keep peristomal skin clean & dry Use correct size bag Empty the bag when it is full Use cotton clothes to clean Use antifungal powder in case of fungal infection Apply karaya powder with egg white if skin is excoriated Avoid powder or cream on peristomal skin

DIETcontrol gas forming foods Avoid chilly, spicy foods Control onion, cabbage,garly, meat ( smell ) Use same oil for cooking (diarrhoea) Use high fiber diet ,& increase fluid intake (constipation)

GAMESAvoidfootball,cricket,basket ball Rough contact sports (Kabbadi, Boxing..)

TRAVELLINGProtect stoma with a purse or hand bag Keep extra Collecting bag in case of long journey

Clothing

No Restriction

Sexual life Support Advice Encouragement Counseling

IRRIGATIONPURPOSETo establish a regular bowel habit To clean the colon of gas, mucus,& faeces To prevent skin excoriation To remove irritant food ingested by patient To teach the patient & family the care of colostomy

SOLUTIONS USEDPlain water Normal saline Soap water (in enema )

INSTRUCTIONSStart irrigation 3 months after surgery Do not irrigate if there is diarrhea Dont irrigate illeostomy Lubricate well the funnel Use 1-1.5 L water Dont irrigate more than once a day Do not use force to introduce funnel Clamp & remove tube from stoma after running of fluid Wait for return flow ( 30-45 )

Instruction contIrrigation needs to be continued LIFE LONG Habit formation only after 21 days Irrigate daily at a fixed time

Bag careUse correct size bag Empty bag when it is full Use soap & water to clean the bag Put charcoal in bag to prevent foul smell Clean with dettol water once in a week Dry the bag in shadow Avoid rough brushing or stone wash

COMPLICATIONSInfection Diarrhea Constipation Stenosis of colon Allergies , skin problems Prolapse & retraction

When to call a doctorWhen there is continous blood ooze When there is prolapse, retraction & hernia When there is colicky pain lasting more than 6 hours When there is diarrhea,dehydration, constipation,& abdominal distension Illestomy not functioning more than 24 hours Any peristomal skin problem

Tracheostomy Stoma made in the trachea for breathing.

AIM Encourage patient self-management.

RATIONAL To maintain independence.

ROUTINE CARE Cleaning Inner tube through cleaning of the tube inside and outside with soap and water sterilization of the tube in boiling water for 10 minutes or in betadine/ hydrogen peroxide solution.

Outer tube not to remove. Clean the tube plates with saline soaked gauze thoroughly.

Skin care Clean the skin around the tracheostomy tube with saline soaked gauze. Protect the skin with a gauze pad, cut in the middle of the gauze place in between the outer tube and skin (Vaseline gauze can be used).

Suction Careful suction to be done not greater than 5 second.

Humidification of air place a wet sterilize gauze on the top of the tracheostomy tube, this helps in humidifying the inhaling air and filters the dust

Changing tie It is applied to fix tube imposition. Change when it is dirty. Preferably black tie. It should not be too tight or loose. One finger gap. Changing the tie self attempt not to be made by the patient.y

Train the patient to clean the tube self with the help of mirror.

y Speech therapy and communication. To take deep breathe. Close the stoma with finger and then to speak.

THANK YOUAlice Stella