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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