COLOSTOMY CARE

 DEFINITION:-

·        Colostomy is an operation in which an artificial opening is made in to the colon on the anterior abdominal wall to permit the escape of faeces.

PURPOSES:-

·        To permit escape of faeces and flatus when there nis an obstruction of large bowel or a known lesion that will eventually cause obstruction.

·        To permit healing of the bowel distal to the colostomy opening since it diverts the faecal contents from the affected area.

·        To provide a permanent means of bowel evacuation when the rectum and anus are non-functional as a result of disease, birth defect or a traumatic condition.

TYPES OF COLOSTOMY:-

A.    TEMPORARY AND PERMANENT COLOSTOMY:-

·        If the colostomy was done to relieve the obstruction which can be corrected by resection of the bowel or to divert the faecal stream to permit healing of the portion of the bowel, it will be a temporary colostomy.

·        A permanent colostomy is usually performed in conjuction with an abdominal-perineal resection. After the sigmoid colon is resected, the proximal end is brought out abdominal wall and sutured to it to form a permanent opening for the elimination of faeces.

B.    DOUBLE BARRELED & SINGLE BARRELED

·        A double barreled colostomy is one in which both loops- the distal and the proximal are opened to the abdominal wall. It has 2 openings, the one on the right side which is the outlet for stool and one on the left side which leads to non-functioning lower bowel. Double barreled colostomy may be temporary or permanent, depending upon the diseases present.

·        An end colostomy or a single barreled colostomy has only one stoma. It is a permanent colostomy because the bowel distal to it has resected.

C.     WET COLOSTOMY AND DRY COLOSTOMY:-

·        The term wet and dry colostomies are used to distinguish the sites of the openings. Dry colostomy refers to an opening of the left side of the colon where the fecal content is usually soft and formed. 

Wet colostomy refers to an opening of the right side where the fecal content is liquid. In addition the term wet colostomy is used for those colostomies through which both urine and faeces are excreted because of the transplantation of ureters in to the colon.

 

CARE OF THE PATIENT WITH COLOSTOMIES:-

PURPOSES OF COLOSTOMY IRRIGATION:-

·        To establish regularity of evacuation.

·        To cleanse the intestinal tract of gas, mucus and faeces.

·        To prevent excoriation of the skin around the stoma.

·        To remove any irritant foods ingested by the patient.

·        To teach the patient and his relatives about the care of colostomy.

SOLUTIONS USED FOR COLOSTOMY:-

·        Normal saline

·        Plain water

·        Soapy solution (as in enema)

GENERAL INSTRUCTIONS:-

·        Explain the steps of procedure to the patient and encourage him to cooperate in the procedure.

·        In the immediate post-operative period, the nurse carries out the procedure herself. But as soon the patient becomes ambulatory, the nurse helps the patient to carry out the procedure.

·        Use 500-1000ml of irrigating solution at the temperature of 37.8 C TO 40.6 c (100-105). The time taken for irrigation should be reduced to prevent the patient developing fatigue.

·        Use soft catheter. Always lubricate the catheter with a water soluble jelly and not with Vaseline.

·        Do not insert a catheter more than 4 inches.

·        As far as possible, avoid avoid colostomy irrigations. Do not irrigate more than once a day.

·        When irrigations are done, choose a time convenient for the patient. It should fit in the routine of patient. The establishment of habits will be appreciated by the patient.

·        Do not irrigate if there is diarrhoea.

·        Never use force to introduce the catheter into the stoma.Force exerted may cause perforation of the gut.If any resistance is encountered,some solution should be instilled to distend the bowl ahead of the tube and thus ease its insertion.

·        In immediate post operative period, “aseptic  techniques”are used as there is a surgical wound that is to be healed.Later on a “clean technique” is sufficient.

·        Since the faecal contents are highly contaminated with bacteria ,care should be taken to keep the discharges away from the surgical wound.

·        The height of the irrigating can should not be more than 12 to 18 inches above the colostomy opening or it should not be more than 12-18 inches above the colostomy opening or it should not be raised above the shoulder level if the patient is sitting. The rate of flow and force of fluid depends upon the height. If the fluid is not introduced rapidly it may cause abdominal cramps. It may also be lost inj the transverse colon and may spurt after 12-24 hours.

·        Avoiding introducing air in to the colon by:

a.      Expelling the air from the tubing

b.      Removing froth from the solution

c.       By not allowing the fluid on run completely out of the tube

·        Before introducing the fluid in to the colon, make sure that which is the proximal and distal loop of the colon.

·        Wet colostomies are never irrigated, because of the danger of forcing the contaminated material in to the ureters causing infection.

·        If the patient complains of cramps during colostomy irrigation, reduce the force of fluid either by clamping the tube or by lowering the irrigating can.

PREPARATION OF THE PATIENT:-

·        There is no any preparation for the investigation.

·        Explain the procedure to the patient and relatives.

·        Provide privacy

·        There should not be any ornaments during ECG on the body or the leads should not come contact with the ornaments.

·        Apply jelly to the skin where electrode is to be attached to have good contact between the skin and the electrode.

·        Give flat and relaxed position to the patient because any movements or twitching recorded by the machine may alter the tracing.

·        Clean the jelly of the electrode sites before leaving the patient.

PREPROCEDURAL CARE:-

·        Check and arrange the ECG machine, cables, and electrodes and needed articles ready in advance.

·        Explain the procedure clearly to the patient and family.

·        Check the doctor’s order for the ECG.

·        Identify he patient name, age, Id no., and diagnosis.

·        Inform the patient not to move during procedure.

PROCEDURE:-

·        Position the patient relaxed and flat.

·        Inform the by standers to keep away, to prevent them touching the patient during procedure.

·        Enter the identification data of patient.

·        Expose the needed area for connecting electrode.

·        Stay with the patient till it gets over.

AFTER CARE OF THE PATIENT AND ARTICLES:-

·        Clean the patient’s electrode site with gauze or tissue paper.

·        Ambulate and transfer the patient, send the ECG record to the doctor for interpretation.

·        Replace the ECG machine and articles to the proper place.

·        Record and report in the nurse’s note

NURSES RESPONSIBILITY:-

·        Nurses working in coronary care unit (CCU) and intensive care unit (ICU) should know to operate the ECG machine.

·        Nurses should able to interpret and identify the dysrhythmia.

·        Nurses should understand about the dysfunctions and loose connections.

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