QUESTION THREE

Madam Ama Serwah, aged 64 years, is admitted to the female surgical ward with intestinal
obstruction. She is scheduled to have an emergency laparotomy. Colostomy was done for her
subsequently.
i.

Mention FOUR indications for colostomy

(2 marks)
Cancer of colon or rectum
An injury to the small or large intestine
Inflammatory bowel diseases such as crohns diseases and ulcerative Collis that
causes irritation or sore in the GIT.
Obstruction- a blockage in the bowel that prevents the flow of fluid or solid.
Diviticulitis
Malformation present at birth
Facael inconvenience
mark * 4 points = 2 marks
What physiological preparation would be carried out prior to the surgery? (4 marks)
Laboratory investigations to rule out any abnormality
Cleansing enema
Nil per os
Administration of IV fluids
Skin preparation
Correcting of anemia
Serving prescribed medication
Administer replacement fluid, as ordered, before surgery due to possible

ii.

iii.

increased output during the postoperative phase

Provide low-residue diet before NPO status

discuss the nursing care that would be given to her within the first 48 hours under
a. Observations
(4 marks)
i. Stoma is observed for position of the bag, whether well fixed or not
ii. It is also observed for its nature, whether pinkish, pale or necrotic
iii. Stools are observed for color, consistency and rate of flow
iv. Watch for profuse bleeding
v. Inspect stoma and peristomal skin area with each pouch change.
Note irritation, bruises (dark, bluish color), rashes

vi. Observe wounds, note characteristics of drainage.

b. Care of the stoma and colostomy
(6marks)
i. After surgery, odour-proof pouch is placed over the patients ostomy.

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ii. The wafer is attached to the patient abdomen to be fitted over and around
the stoma to collect stool and gas.
iii. The wafer protects the skin around the stoma form getting irritated by
iv.
v.
vi.
vii.

stool leakage.
Best pouching system should be chosen for the patient.
Empty the pouch when its 1/3 or 1/2 full.
The pouch should not become over full.
Every bit of air should not be squeezed, as this can cause the sides to stick

together making it more difficult to collect stool

viii. Generally, appliance should be changed every 3-5days.
ix. If leakage occurs, change it immediately; this is to protect the skin around
the stoma from getting irritated from stool leakage.
c. what education would you give to Ama before discharge?

(4 marks)

i. Instruct the patient to inspect peristomal skin with each pouching system
change.
ii. Review techniques for treating peristomal skin problems.
iii. Recommend alternative products if patient develops allergic reaction to an
ostomy product.
iv. Teach the patient to notify health care provider when skin care problems
do not resolve by usual methods
v. Encourage pouch hygiene through rinsing, keeping pouch tail free of stool,
airing of reusable pouches, discarding odor-impregnated pouches.
vi. Recommend the use of pouch deodorants, room deodorizers, and oral
deodorizers, such as bismuth subgallate (Devrom) or parsley.
vii. Avoid use of pinholes in pouch
viii. Suggest avoidance of straws, excessive talking while eating, chewing
gum, and smoking to reduce swallowed air.
ix. Instruct about gas-forming foods, such as beans and cabbage, and
eliminate when appropriate. It takes about 6 hours for gas to travel from
mouth to colostomy.
x. Recommend using arm over stoma to muffle gas sounds when appropriate.
xi. Patient should be taught on dietary guidelines to follow after surgery.

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xii. Patient should be advised to stay well hydrated by drinking 8-10 glasses
of liquids daily, limit intake of caffeine and alcohol as they can
dehydrates, limit foods high in fibre and simple sugar, they also
dehydrates.
xiii. Advice patient to identify and remove any food that makes him feel pain
after eating from his diet.
xiv. Regulate the intake of gas forming diet such as; cabbage, carbonate
beverages, drinking through straw, chewing gum etc.
1 mark * 4 points = 4 marks

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