NURSING ISSUES

COLOSTOMY CARE

Alice Stella

OSTOMY Ostomy 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 CARE

Pre-operative counselingStoma site markingPost operative care Irrigation

Pre Operative counseling Team Work Individual care Explanation Ostomy Visitor Emotional support Site marking Prepare patient & family

to accept a colostomy

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

Post operative care Patient 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 <5 cm is normal and can mange by manual reduction >10 cm needs surgical

intervention ) * Retraction (If no interference with bowel movement to intervention is needed.

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

NURSING PROBLEMS Irregular 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 CARE Wash with soap & water , Keep peristomal skin clean & dry Use correct size bag Empty the bag when it is ¾ 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 foodsAvoid chilly, spicy foods Control onion, cabbage,garly, meat

( smell )Use same oil for cooking (diarrhoea)Use high fiber diet ,& increase fluid

intake (constipation)

GAMESAvoid

football,cricket,basket ball

Rough contact sports (Kabbadi, Boxing..)

TRAVELLING

Protect stoma with a purse or hand bag

Keep extra Collecting bag in case of long journey

Clothing

NoRestriction

Sexual life

SupportAdviceEncouragementCounseling

IRRIGATIONPURPOSE

To establish a regular bowel habitTo clean the colon of gas, mucus,&

faecesTo prevent skin excoriation To remove irritant food ingested by

patient To teach the patient & family the care

of colostomy

SOLUTIONS USED

Plain water

Normal saline

Soap water (in enema )

INSTRUCTIONS Start irrigation 3 months after surgery Do not irrigate if there is diarrhea Don’t irrigate illeostomy Lubricate well the funnel Use 1-1.5 L water Don’t 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 cont… Irrigation needs to be continued

LIFE LONG

Habit formation only after 21 days

Irrigate daily at a fixed time

Bag careUse correct size bagEmpty bag when it is ¾ fullUse soap & water to clean the bagPut charcoal in bag to prevent foul smellClean with dettol water once in a weekDry the bag in shadowAvoid rough brushing or stone wash

COMPLICATIONS InfectionDiarrheaConstipationStenosis of colonAllergies , skin problems Prolapse & retraction

When to call a doctor When 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.

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

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

THANK YOU

Alice Stella