COLOSTOMY

It is a surgical procedure in which an opening formed by drawing the healthy end of large
intestine or colon through the incision in the anterior abdominal wall and suturing it in to the
place.
INDICATION
 colon cancer
 In preparation for surgery(pelvic tumors)
 Fecal incontinenece

TYPES
ACCORDING TO THE LOCATION

ACCORDING TO THE TYPE OF STOMA

END STOMA OR SINGLE BARELLED

It is constructed by dividing bowel and bringing out proximal end as a single stoma. It can be
temporary or permanent
If the stoma is permanent-distal bowel is removed
If it is temporary-the distal bowel is over sewn and left in aabdominal cavity and it is known
as HARTMANN’S POUCH
LOOP STOMA
It is a temporary stoma constructed by bringing the loop of bowel in to the abdominal surface
and opening the anterior wall of bowel to provide a fecal diversion. The loop is held in place
by a plastic rod for 7-10 days after surgery to prevent it from slipping back in to abdominal
cavity.
DOUBLE BARELLED STOMA
When the bowel is divided, both the proximal and distal end are brought to the abdominal
wall as two separate stoma. The proximal one is the functioning stoma and the distal non-
functioning stoma is referred to as a mucus fistula and it is temporary
OSTOMY CARE
Ostomy is an artificial opening created from ileum or colon that brought to the surface of
abdomen for the purpose of bowel elimination
IT CAN BE;

One piece-drainable or non drainable

Two piece-drainable or non drainable
Also
Disposable and reusable

CARE OF OSTOMY
 ASSESMENT OF STOMA

Assess the colour and size of stoma, drainage and signs of irritation
SIZE-it extend 1-2 cm beyond the abdominal wall and swollen at first. After 3-4 months
of surgery, swelling subside and stoma gets shrinked to permanenet small size.
COLOUR-every eight hour colour of stoma should be assessed
Pink to brick red-normal
Pale-anaemia
Dark red-necrosis
DRAINAGE
Semi solid or formed with weak odour-colostomy
Liquid stool-ileostomy

 IRRITATION

Look for signs of irritation like redness, ulceration and weeping dermatitis

 APPLICATION OF BAG AND PREVENTION OF SKIN IRRITATION

Select the bag of appropriate size of stoma otherwise skin irritation may occur as a result
of alkalinity of effluent
Remove hair around the stoma
Clean the area around the stoma with mild soap and water
Towel dray or air dry
Create a circle of 1/8 or ¼ inches larger than the size of the stoma on the back of
appliances
Apply skin barrier which protect the skin from skin irritation
Apply pouch to treated skin
Position the bag in a dependent position
Empty the bag when it is 1/3 or ½ is full
Usually the bag can keep in place for 5-7 days
Change the bag as soon as it is loose or leakage occur

 TREAT SKIN IRRITATION

If the skin irritation present check the fitness of bag

If leakage occur re apply ostomy bag and ensure proper fit and seal
Skin barrier can be applied before the application of bag to protect skin
Skin irritation can be treated with candid, an anti fungal powder. It should be rubbed over
the affected skin and barrier can be applied over the skin
 REDUCE ODOUR
Food such as egg, fish, onion, cabbage etc can cause stool odour. Advise the patient to avoid
these foods or encourage the use of deoderizing agents or tablets, that can be placed in the
pouch

 DISCUSS MEDICATION
Entric coated tablets such as ion preparation, vitamins and hormones may not be absorbed in
small intestine. Client should note for the presence of medicines in the drainage pouch. If so
physician can prescribe an alternative medication.
 EMPHASIS FLUID INTAKE
The approximate out put from ileostomy is 1200-1500ml/day. The client should monitor the
output for any increase that will lead to severe fluid electrolyte imbalance. So en ourage fluid
intake it should be minimum 2000ml/day

 DIETRY RECOMMENDATION

A low residue diet that is high in protein, CHO and calorie are recommended
Any food that cause diarrhea and discomfort should be avided
Client should chew the food well
High fibre diet should be avoided because it may cause obstruction
Suppliments of vitamin like ADEK and B12 is necessary

 PREVENTION OF UROLITHIASIS
The patient with ileostomy are always at risk due to fluid loss. Pharmacological management
include -allopourinol
Allcolostomy
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