Colostomy and illeostomy nursing management

1. ADVANCED NURSING II
GROUP PRESENTATION I ON COLOSTOMY/ILEOSTOMY
GROUP FIVE

2. COLOSTOMY/ILEOSTOMY

3. COLOSTOMY
A colostomy is a surgical procedure in the abdomen that creates an opening in the
abdomen to divert the colon’s function allowing stool to pass into a pouch or bag
attached to the skin .

4.  THE ANATOMICAL POSITION OF THE COLON.

The colon is located in the abdominal cavity, extending from the ileum(small
intestine) to the rectum. The colon consist of several parts including the ascending
colon, transverse colon, descending colon and the sigmoid colon.

5. FUNCTIONS OF THE COLON
The colon absorbs water, electrolytes such as potassium and chloride, absorbs
vitamins and forms and pushes feces to the rectum for excretion

6. COLOSTOMY
colostomy is a surgical procedure in the abdomen that creates an opening in
the abdomen to divert the colon’s function allowing stool to pass into a pouch
or bag attached to the skin .

7. TYPES OF COLOSTOMY
Types of Colostomy on:
*Location:*
1. Right sided colostomy (ascending colon)
2. Transverse colostomy (transverse colon)
3. Left sided colostomy (descending colon)
4. Sigmoid colostomy (sigmoid colon)
*Construction:*
1. End colostomy: Colon end brought to skin surface.
2.Loop colostomy: Loop of colon brought to skin surface.
3. Double-barrel colostomy: Two separate openings for stool and mucus.
*Temporary vs. Permanent:*
1. Temporary colostomy: Intended for future reversal.
2. Permanent colostomy: Irreversible, due to disease or injury.
*Other Types:*
1. Hartmann’s procedure: Colostomy with rectal stump closure.
2. Mastectomy colostomy: Removal of rectal mucosa.
3. Continent colostomy: Internal pouch creation

8. INDICATIONS
•Colon cancer
•Diverticulitis
•Inflammatory bowel disease(IBD)
•Bowel obstructions
•Birth defects

9. CONTRAINDICATIONS
•Pregnancy
•Active infections(e.g pneumonia)
•Obesity
•Diabetes mellitus
•Coagulopathy
•Uncontrolled hypertension
•Chronic kidney disease
•Severe electrolyte imbalances

10. ILEOSTOMY
An ileostomy is a surgical procedure that creates an opening in the abdominal wall to
divert the small intestine’s(ileum)waste output into an external pouch

11. ANATOMICAL POSITION OF THE ILEUM.
The ileum is the final and longest section of the small intestine, located between
the jejunum and the large intestine (colon).

12. INDICATIONS
•Inflammation bowel disease
•Ulcerative colitis
•Crohn’s Disease
•Bowel cancer
•Trauma
CONTRAINDICATIONS
•Infection
•Dehydration
•Electrolyte imbalance
•Stenosis
•Skin irritation
•Bowel obstruction

13. Differences between colostomy and
ileostomy
An ileostomy is a surgical procedure that attaches part of the small intestine to
an opening in the abdominal wall so waste can exit. A colostomy is a surgical
procedure that reroutes the large intestine to an external opening.

14. EQUIPMENT NEEDED FOR
COLOSTOMY/ILEOSTOMY CARE
•A clean tray containing :
*Mackintosh with draw sheet
*Kidney tray/paper bag
*Pair of clean gloves
*Colostomy bag
*Normal saline/basin with warm tap water
*Gauze pieces
*Gauze pad/tissue paper
*Skin barrier
*Stoma measuring guide
*Pen or Pencil and Scissors
*Bed pan

15. PROCEDURE
•STEP1
Arrange all necessary supplies.
*Reason*
To save time and energy .
•STEP 2
Identify the patient and explain the procedure to the patient . Encourage patient to
participate or observe.
*Reason*
-helps to relieve anxiety and gain confidence and cooperation.
-helps patient to adjust to having an ostomy
STEP3
Provide privacy and assist patient to comfortable position .
*Reasons*
For smooth performance of procedure

16. PROCEDURE
STEP 4
Perform hand hygiene
*Reasons*
This prevents the spread of microorganisms.
STEP 5
Spread mackintosh and draw sheet
*Reasons*
To protect bed linen from getting stained
STEP 6
Remove ostomy bag, and measure and empty contents. Place old pouching system in
garbage bag
*Reason*
To minimize the order and growth of microbes
STEP 7
Remove flange by gently pulling it toward the stoma. Support the skin with your other hand.
An adhesive remover may be used. Ifa rod is in situ, do not remove.
*Reason*
Gentle removal helps prevent skin tears. An adhesive remover may be used to decrease
skin and hair stripping.
*A rod may be used during the formation of a stoma. It can only be removed by a physician
or wound care nurse. If a rod is in place, It can be slid to allow the pouch to be removed.
STEP 8
Clean stoma gently by wiping with warm water. Do not use soap.

17. PROCEDURE
STEP 9
Assess stoma and peristomal skin
*Reasons*
A stoma should be pink to red in color, raised above skin level, and moist.
Skin surrounding the stoma should be intact and free from wounds, rashes, or skin
breakdown.
STEP 10
Measure the stoma diameter using the measuring guide (tracing template) and cut out
stoma hole.
Trace diameter of the measuring guide onto the flange, and cut on the outside of the pen
marking.
*Reason*
Ensures accuracy in determining correct pouch size needed
STEP 11
Prepare skin and apply accessory products. Accessory products may include stomahesive
paste, stomahesive powder, or products used to create a skin sealant to adhere pouching
system to skin to prevent leaking.
*Reasons*
Wet skin will prevent the flange from adhering to the skin.

18. STEP 12
Remove inner backing on flange and apply flange over stoma. Leave the border tape on.
Apply pressure. Hold in place for 1 minute to warm the flange to meld to patient’s body.
Then remove outer border backing and press gently to create seal.
*If rod is in situ, carefully move rod back and forth but do not pull up on rod.
*Reason*
To prevent irritation to skin
STEP 13
Apply the ostomy bag. Attach the clip to the bottom of the bag.
*Reason*
This step prevents the effluent from soiling the patient or bed.
STEP 14
Hold palm of hand over ostomy pouch for 2 minutes to assist with appliance adhering to
skin.
*Reason*
The flange is heat activated.
STEP 15
Clean up supplies, and place patient in a comfortable position. Remove garbage from patient’s
room.
*Reason*
Removing garbage helps decrease odor.
STEP 16
Perform hand hygiene.
*Reason*
This minimizes the transmission of microorganism

19. DOCUMENTATION.
Document appearance of stoma and peristomal skin, products used, and patient’s
ability
to tolerate procedure and assistance with procedure.
EDUCATION
•Educate patient on eating well balanced diet including fresh fruits and vegetables.
•Encourage patient to take in more fluids
•Avoid eating foods which may produce odor to prevent/reduce a strong odor when
emptying pouch
•Eat foods which are less in producing gas
•The stoma and peristomal area should be gently cleaned with water, dabbed rather
than scrubbed without soap
•Colostomy bag should be changed every 5-7 days.

20. GROUP MEMBERS
 1.CHARITY EDJEODJI-NMCTSRGN230137
2.DZIKUNU JOAN –NMCTSRGN230093
3.FORDJOUR BONSU FRANCESCA-NMCTSRGN230133
4.KERENHAPUCH MARTEY-NMCTSRGN230039
5.BOATENG AFIA GRACE-NMCTSRGN230103
6.KEMAVOR GRACE-NMCTSRGN23075
7.DOMEH BRIDGET-NMCTSRGN230110
8.PANFORD PEACE-NMCTSRGN230023
9.ANSONG HILDA-NMCTSRGN230032
10.FRIMPONG NADIA –NMCTSRGN230055
11.BAAH BARBARA-NMCTSRGN230052