This topic will help health worker to know what colostomy is and it will help them to have knowledge on the management of the patient with this condition

1. BY Mrs. M. Mwila
2012

2.  A colostomy may be performed from any
section of the large bowel.
 Colostomies may be permanent or temporary
and either an end or terminal or a
defunctioning or loop colostomy.

3.  A colostomy is a surgical procedure in which
a stoma is formed by drawing the healthy
end of the large intestine or colon through an
incision in the anterior abdominal wall and
suturing it into place (wikipedia,2012).
 This opening, in conjunction with the
attached stoma appliance, provides an
alternative channel for feces to leave the
body

4.  A colostomy is an opening between the colon
and the abdominal wall. The proximal end of
the colon is sutured to the skin (Lewis et
al,2004).

5.  Ulcerative colitis
 Crohns disease
 Cancer of colon
 Obstruction
 Congenital abnormalities

6.  Injury / Trauma
 Neurological conditions
 Fistula eg. RVF

7. • Loop colostomy: This type of colostomy is
usually used in emergencies and is a
temporary and large stoma. A loop of the
bowel is pulled out onto the abdomen and
held in place with an external device. The
bowel is then sutured to the abdomen and
two openings are created in the one stoma:
one for stool and the other for mucus.
• End colostomy: A stoma is created from one
end of the bowel. The other portion of the
bowel is either removed or sewn shut
(Hartmann's pouch).

11.  Double barrel colostomy: The bowel is
severed and both ends are brought out onto
the abdomen. Only the proximal stoma is
functioning

12. • Pre-operative counseling
• Stoma site marking
• Post operative care
• Irrigation

13. • Team Work
• Individual care
• Explanation
• Ostomy Visitor
• Emotional support
• Site marking
• Prepare patient & family to accept a colostomy

14. • Umbilical depression
• Bony prominence
• Drainage holes
• Natural waist level

15. • Operative incision & other
scars
• Groin flexure
• Fatty bulges & deep creases
• Chronic Skin condition

16. • Patient involvement & family
contribution
• Habit formation
• Diet
• Occupation
• Travel

17.  Sports
 Clothing
 Skin care

18. • Stomal colour
• Bleeding (
• Usually seen at the time of cleaning or changing the
bag. Apply local pressure for 10 minutes and
sucralfate powder
• )
• Stomal edema
• Herniation
• Stoma prolapse (

19. • Stoma size is 1 to 1.5 cm above skin level in
colostomy.
• If prolapse <5 cm is normal and can mange by
manual reduction >10 cm needssurgical
intervention
• ) *
• Retraction (If no interference with bowel
movement to intervention isneeded. Other wise
surgical correction advised. Special attention to
peristomalskin.

20.  Stenosis
 Peristomal skin

21.  Irregular bowel action
 Constipation / obstruction (
 Laxatives, enema,suppositories)
 Diarrhea (
 Increase intake of fluid and hospitalization as
early as possible

22.  Excoriation of Skin
 Flatus / foul smell
 Psychological problems
 Stricture of stoma

23.  Wash with soap & water ,
 Keep peristomal skin clean & dry
 Use correct size bag
 Empty the bag when it is ¾ full

24.  Use cotton clothes to clean
 Use antifungal powder in case of fungal
infection
 Avoid powder or cream on peristomal skin

25. • control gas forming foods
• Avoid chilly, spicy foods
• Control onion, cabbage,garly, meat( smell )
• Use same oil for cooking (diarrhoea)
• Use high fiber diet ,& increase fluid
intake(constipation)

26.  Avoid
 football,cricket,basket ball
 Rough contact sports

27.  Protect stoma with a purse or hand bag
 Keep extra Collecting bag in case of long
journey

28.  Support
 Advice
 Encouragement
 Counseling

29. • PURPOSE
• To establish a regular bowel habit
• To clean the colon of gas, mucus,& faeces
• To prevent skin excoriation
• To remove irritant food ingested bypatient
• To teach the patient & family the care of colostomy

30.  Plain water
 Normal saline
 Soap water (in enema )

31. • Start irrigation 3 months after surgery
• Do not irrigate if there is diarrhear
• Lubricate well the funnel
• Use 1-1.5 L water
• Dont irrigate more than once a day

32.  Do not use force to introduce funnel
 Clamp & remove tube from stoma after
running of fluid
 Wait for return flow ( 30-45 ¶)

33.  Irrigation needs to be continued LIFELONG
 Habit formation only after 21 days
 Irrigate daily at a fixed time

34. • Use correct size bag
• Empty bag when it is ¾ full
• Use soap & water to clean the bag
• Put charcoal in bag to prevent foul smell

35.  Clean with dettol water once in a week
 Dry the bag in shadow
 Avoid rough brushing or stone wash

36. • Infection
• Diarrhea
• Constipation
• Stenosis of colon
• Allergies , skin problems
• Prolapse & retraction

37. • When there is continuous blood ooze
• When there is prolapse, retraction & hernia
• When there is colicky pain lasting more than
6hours
• When there is
diarrhea,dehydration,constipation,& abdominal
distension
• Any peristomal skin problem

38.  Double barrel colostomy: The bowel is
severed and both ends are brought out onto
the abdomen. Only the proximal stoma is
functioning.

39. • Imbalanced nutrition , less than body
requirements , related to nausea and
anorexia.
• Risk for deficient volume related vomiting
and dehydration.
• Anxiety related to impending surgery and
the diagnosis of cancer.
• Risk for ineffective therapeutic regimen
management related to knowledge deficit
concerning the diagnosis, the surgical
procedure, and self care after discharge.

40.  Intraperitoneal infection
 Complete large bowel obstruction
 GI bleeding
 Bowel perforation
 Peritonitis
 Abscess and sepsis

41.  The patient awaiting surgery for colorectal
cancer has many concerns, needs and fears.
He or she may be physically debilitated and
emotionally distraught with concerns about
lifestyle changes after surgery, prognosis,
ability to perform in established roles and
finances.

42. • Involves building patients stamina in days
preceding surgery and cleansing and
sterilizing the bowel the day before surgery.
• A full liquid diet may be prescribed for 24-
48hours before surgery to decrease the bulk.
• Antibiotics such as kanamycin (kantrex),
neomycin (Mycifradin), and cephalexin
(Keflex) are administered orally the day
before surgery to reduce intestinal bacteria.

43.  The bowel is cleansed with laxatives ,
enemas, or colonic irrigations the evening
before and morning of surgery.
 Measure intake and out put, including
vomitus, to provide an accurate record of
fluid balance.
 NG tube inserted to drain accumulated fluids
and prevent abdominal distension.

44.  Monitor the abdomen for increasing
distension, loss of bowel sounds, pain or
rigidity, which may indicate obstruction or
perforation.
 Assess patients knowledge about the
diagnosis, surgical procedure and expected
outcomes.

45.  Patients anticipating colostomy will be very
anxious.
 Assess patient’s anxiety level and copying
mechanisms and suggest methods for
reducing anxiety.
 Present factual information about the
surgical procedure and the management of
the ostomy

46.  Arrange a visit by a person who is
successfully managing a colostomy.
 Obtain a signed consent form to legalize the
operation.

47.  Similar to nursing care for any abdominal
surgery, including pain management during
immediate post operative period.
Maintaining optimal nutrition- the patient
should avoid foods that cause a excesive
odour and gas including foods in the cabbage
family, eggs, fish, beans and high cellulose
products such as peanuts.

48.  Irritating foods should be replaced with non
irritating ones.
 The patient should identify foods that cause
diarrhea, e.g. fruits, high fibre foods, soda,
coffee, tea or carbonated drinks.
 Patients should be taking at least two liters
of fluids per day

49.  Examine the swelling, color discharge and
bleeding
 Perform dressing with a mild solution

50.  Report rectal bleeding
 Observe signs of pulmonary complications.
 Any abrupt change in abdominal pain is
reported promptly.


51.  The colostomy begins to function 3 to 6days
after surgery .
 Teach skin care and how to apply , empty
and remove the drainage pouch
 Continuously clean the peristomal skin to
prevent excoriation or ulceration.

52.  The purpose of irrigating a colostomy is to
empty the colon of gas , mucus, and faeces
so that the patient can go about social and
business activities without fear of feacal
drainage.
 The time for irrigating the colostomy should
be