Colostomy

nursing care of colostomy

1. RN Rawan akram Colostomy and nursing care

2. by DOCUMENT

3. INDICATIONS FOR OSTOMY

4. Some of the most common conditions that might necessitate a stoma are : Imperforate anus: where there is no exit for the bowel or its contents. Hirschsprungs disease: where nerves called the ganglion nerves are missing and waste matter cannot easily pass. Inflammatory bowel disease: this includes Crohns Disease and Ulcerative Colitis, both inflammatory diseases of the intestines.

5. Neonatal necrotising enterocolitis : this occurs when a portion of the bowel is dead and cannot function and is most common in premature babies who weight less than 3 pounds at birth. In this case a stoma can mean life to a baby. Spina bifida: where part of the spine fails to develop properly and in more severe forms of the disease, the spinal nerves that control the muscles of the legs, bladder and bowels may be affected and a stoma needed.

6. Ileostomy In an ileostomy the opening is made in the small intestine – the ileum. An end or loop of the small intestine is brought through the skin’s surface on your child’s abdomen and the output then passes out through the stoma. The ileostomy will resemble a ‘spout’ because the waste is more liquid. Due to the fact that ileostomy output contains digestive enzymes, this can be harmful to the skin and so requires extra care when pouching.

7. What types of products are used for colostomies? Pouch : There are a variety of sizes and styles of colostomy pouches. Pouches are lightweight and odor-proof. Pouches have a special covering that prevents the pouch from sticking to the body. Some pouches also have charcoal filters which release gas slowly and help to decrease gas odor. The following is general information about types of colostomy pouches: Open-ended pouch:  This type of pouch allows you to open the bottom of the pouch to drain the output. The open end is usually closed with a clamp. The open-ended pouch is usually used by people with ascending or transverse colostomies. The output from these colostomies is looser and is unpredictable (does not drain at regular times).

8. Close-ended pouch : This type of pouch is removed and thrown away when the pouch is filled. Close-ended pouches are usually used by people with a descending or sigmoid colostomy. The output from these types of colostomies is firm and does not need to be drained . One-piece : A one-piece pouch contains the pouch and adhesive skin barrier together as one unit. The adhesive skin barrier is the part of the pouch system that is placed around the stoma and attached to skin. When the pouch is removed and replaced with a new one, the new pouch must be reattached to the skin.

9. Two-piece:  The two-piece pouch has two parts: an adhesive flange and pouch. The adhesive flange stays in place while the pouch is removed and new pouch is attached to the flange. The pouch does not need to be reattached to the skin each time. The two-piece system can be helpful for patients with sensitive skin. Pre-cut or cut-to-fit pouches:  Some pouches have pre-cut holes so you do not have to cut the opening yourself. Other pouches can be cut to fit the size and shape of your stoma. Cut-to-fit pouches are especially useful right after your surgery because your stoma decreases in size for about eight weeks.

10. You will need a plastic irrigating container with a long tube and a cone to introduce water into the colostomy. You will also need an irrigation sleeve that will direct the output into the toilet. You will need an adjustable belt to attach the irrigation sleeve and a tail closure for the end of the sleeve. Choose the same time each day when you will not be interrupted to irrigate your colostomy. Fill the irrigating container with about 16 to 50 ounces (500 to 1500 mL ) of lukewarm water. The water should not be cold or hot. The amount of water each person needs to put in the irrigating container varies. Ask your caregiver how much water you will need to irrigate. Hang the irrigation container at a height in which the bottom of the container is level with your shoulder. Sit up straight on the toilet or on a chair next to the toilet.

11. HOW TO CHANGE POUCH

12. Clean the skin around the stoma with warm water. You may also use soap but do not use soaps that have oil or perfumes. Pat your skin dry . Use a pouch that has an opening that is one-eighth of an inch larger than the stoma. Use skin protection products if you have irritated skin around the stoma. The skin can be treated with these products to protect your skin and create a dry surface. Center the pouch over the stoma and press it firmly into place on clean, dry skin. It may be helpful to hold your hand over the newly applied pouch for 30 seconds. The warmth of your hand can help to mold the adhesive skin barrier into place. Place the old pouch in another plastic bag to be thrown away if the pouch is disposable. If you use a reusable pouch, talk to your caregiver about how to clean the reusable pouch.

13. Thanks for your attention