PREPARED BY : JYOTHIS JOSEPH MEEQAT GENERAL HOSPITAL. MADINAH, KSA

2. COLOSTOMY,
NURSING CARE
PREPARED BY :
JYOTHIS JOSEPH

3. WHAT IS STOMA
It is an artificial
opening from the
intestine on the
abdominal wall
usually created by
a surgeon.

4. COLOSTOMY
Colostomy refers to a surgical procedure where a portion of the
large intestine is brought through the abdominal wall .to carry
stool out of the body .It may be permanent or temporary

5. INDICATION
A colostomy is created as a means to treat
various disorders of the large ,intestine
including ,cancer ,obstruction ,inflammatory
bowel disease ischemia (compromised
blood ),supply .or traumatic injury In a baby
or child it may be due to an imperforate
anus which is the absence of an .anal
opening It also may be due to ,
Hirschsprung’s Disease or it may be due to
other malformations that are present at
birth.

6. COMPLICATION
Potential complications of
colostomy surgery include :
1- EXCESSIVE BLEEDING
2- SURGICAL WOUND
3- INFECTION
thrombophlebitis
(inflammation and
blood clot to veins in the
legs)

7. STOMA COMPLICATIONS TO BE
MONITORED INCLUDE :
DEATH
(necrosis) of stoma tissue. Caused by
inadequate blood supply, this complication is
usually visible 12-24 hours after the
operation and may require additional
surgery

8. Retraction (stoma is flush with the -2 )
abdomen surface or has moved below it
Prolapse (stoma increases length above
the surface-3 of the abdomen (.Stenosis
(narrowing at the opening of the stoma-
3 Often associated with infection around
the stoma or scarring

9. There are four main types of colostomies .
named after the portion of the bowel where the
colostomy is located
An Ascending colostomy is
located within the
ascending colon .
A Transverse colostomy is
located within the
transverse colon .
A Descending Colostomy is
located within the
descending colon .

10. A Descending Colostomy is located
within the descending colon .
A Sigmoid Colostomy is
located within the sigmoid
colon .

11. PREPARATION:
1-The patient will be required to sign a consent form . after the procedure is explained
thoroughly ,
2- Blood and urine studies.
3- x-rays and an electrocardiograph (EKG), may be ordered as the doctor deems
necessary.
4- In order to empty and cleanse the bowel, the patient may be placed on a
for several days prior to surgery. A liquid diet may be ordered for at least .the day before
surgery, with nothing by mouth after midnight .
5- A series of enemas may be ordered to empty the bowel of stool .
6- Oral anti-infective (neomycin, erythromycin, may be ordered to decrease bacteria in the
intestine and help prevent post-operative infection.
7- A nasogastric tube is inserted from the nose to the stomach on the day
of surgery or during surgery to remove gastric secretions and prevent nausea and vomiting
8- A urinary catheter (a thin plastic tube) may also be inserted to keep the
bladder empty during surgery, giving more space in the surgical field and .decreasing
chances of accidental injury

12. AFTERCARE :
- Monitoring of blood pressure, pulse, respirations, and temperature The patient is instructed how to
support the operative site during deep - .breathing and coughing, and given pain medication as
necessary.
- Fluid intake and output is measured, and the operative site is observed for color and amount of wound
drainage
- The nasogastric tube will remain in place, attached to low intermittent - .suction until bowel activity resumes
For the first 24-48 hours after surgery, the colostomy will drain bloody - . mucus
Fluids and electrolytes are infused intravenously until the patient's diet is - . can gradually be resumed, beginning
with liquids.
Usually within 72 hours, passage of gas and stool through the stoma - begins. Initially the stool is liquid,
gradually thickening as the patient .begins to take solid foods
The patient is usually out of bed in 8-24 hours after surgery and discharged in 2-4 days.
A colostomy pouch will generally have been placed on the patient's - .abdomen, around the stoma during
surgery
During the hospital stay, the patient and his or her caregivers will be - . educated on how to care for the
colostomy .
- Regular assessment to the skin surrounding the stoma is important .

13. How do I empty my pouch?
- Wash your hands. Put on medical gloves.
- Empty the pouch when it is ⅓ to ½ full and before you change the system. Do not wait
until the pouch is completely full. This could put pressure on the seal and cause it to leak or
spill.
- Hold the pouch up by the bottom end. If the pouch has a clamp system, remove the
clamp. You may need to roll the end back to keep it from getting soiled.
- Drain the pouch. Place toilet paper into the toilet before you empty the pouch to reduce
splash back. Drain the pouch by squeezing the contents into the toilet.
- Clean the end of the pouch. Use toilet paper or a moist paper towel. You may also rinse
the pouch but it is not necessary. Keep the end of the pouch clean.
- Close the end of the pouch. Unroll the end of the pouch. Replace the clamp or close the
end of the pouch as directed.

14. Pouching systems are classified as
ONE-ONE PIECE POUCH WITH FILTER DRIENAINABLE
TWO-PEECE STANDARD CLOSED-END POUCH WITH FILTER

15. MANAGEMENT OF STOMA
Requirement :
- A new appliance.
- warm water.
- soft tissues or gauze
wipes.
- disposable bag .

16. CHANGING THE APPLIANCE:
- wash your hands.
- remove the old appliance carefully from the top down
and avoid dragging the skin.
- wash the stoma and surrounding skin,
- gently removing all waste.
- place prepared appliance over stoma.
- spend a few minutes moulding flang to skin.
- do not forget to attach the clip (drainable bag) place
the empty old appliance in the disposal bag.
- wash your hand.

17. Types of foods can I eat after a colostomy
- People with colostomies can eat a regular diet. Choose
healthy foods from all the food groups
- To avoid constipation, eat foods such as oatmeal, whole-
grain breads and cereals, fruits and vegetables
- You may want to avoid foods that cause gas and odor. Some
foods that may cause gas and odor are vegetables such as
broccoli, cabbage, and cauliflower. Other foods include beans,
eggs, and fish .
- You can also reduce gas by eating slowly and not using
straws to drink liquids.
- Foods that may help to control odor and gas in some
people are fresh parsley , yogurt and buttermilk

18. THANKS FOR YOUR
ATTENTION