A colostomy consists of an artificial opening created in the large intestine and brought to the surface of the abdomen for the purpose of evacuating the bowels.
Indications
- Anorectal malformations
- Spina bifida
- Ulcerative colitis
- Hirschsprung’s disease
- Acquired indications- rectovaginal fistula, perineal injury, and colonic injury
Complications
- Skin excoriations
- Prolapse
- Hemorrhage
- Sepsis/wound infection
- Poor parental acceptance
- Para-colostomy hernia
- Stoma stenosis
- Persistent odor
Purposes of Colostomy Care
- To prevent the excoriation of the skin around the stoma
- To establish regularity of evacuation
- To stop any leakage of feces
- To teach the patient and parents/relatives regarding the care of colostomy
Equipment Needed
A clean tray containing:
- Pair of gloves
- Mackintosh and sheet
- Bowl with cotton swabs and gauze pieces
- Soap and water
- Wash cloth
- Bedpan
- Disposable colostomy bag with clamp
- Zinc oxide ointment
- Towel
- Tissue paper
Preparation
- Explain the procedure to the parents and the child as appropriate.
- Keep all the equipment near the patient site.
- Maintain privacy of the patient.
- Maintain comfortable position, for example, Fowler’s, semi-Fowler’s, or sitting position.
Procedure
- Assess the location of the ostomy and the type of colostomy performed. Stoma location is an indicator of the section of the bowel in which it is located and a predictor of the type of fecal drainage to expect.
- Wash hands and don gloves.
- Remove the old appliances.
- Empty the appliances in bedpan.
- Remove the excess stool with tissue paper from the stoma.
- Clean the peristomal skin with soap and water or prescribed cleansing agent.
- Dry the area completely with a paper towel.
- Observe the color of the stoma normal stoma looks reddish pink.
- Apply zinc oxide ointment and keep it for 1-2 minutes to absorb.
- Apply the skin barrier to the entire area that the appliance will cover.
- Apply the stoma paste around the stoma and the mucus fistula.
- Apply the stoma pouch over the barrier.
- Position a collection bag over the stoma.
Nurse’s Responsibility
- Empty a drainable pouch or replace the colostomy bag as needed or when it is not more than one-third full.
- Assess stoma appearance and surrounding skin condition frequently.
- Use Karaya paste and a skin barrier wafer as needed to maintain a secure ostomy pouch.
- Prior to discharge, provide written, verbal psychomotor instruction on colostomy care, pouch management, skin care, and irrigation for the client.
- Allow ample time for the caregiver and child (older) to practice changing the pouch either on the client or a model.
- Provide dietary teaching regarding the foods that cause stool odor and gas and foods that thicken the stools or cause loose stools.
- Foods that increase stool odor: asparagus, beans, cabbage, eggs, fish, garlic, onions, and some spices.
- Foods that increase intestinal gas: broccoli, cabbage, carbonated drinks, cauliflower, corn, cucumber, dairy products, dried beans, peas, radish, and spinach.
- Foods that thicken Stool: banana, cheese, yogurt, rice, tapioca, pasta, and creamy peanut butter.
- Foods that loosen the stools: chocolate, fried foods, greasy foods, lightly spiced foods, green leafy vegetables, raw fruits and juices, and raw vegetables.
- Foods that color stool: beetroot and red gelatin.
- The diet for a child with a colostomy is individualized and may require no alteration from that consumed preoperatively.
- If an abdominoperineal resection has been performed, emphasize the importance of using no rectal suppositories, rectal temperature, or enemas.
- If the child is school going, he/she should carry medical identification or a medical alert tag or bracelet.
These measures are important to prevent trauma to the tissues when the rectum has been removed
REFRENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
