Colostomy care, nursing procedure

1. DEMONSTRATION
ON
NURSING CARE OF CHILD WITH
COLOSTOMY
PRESENTED BY:
SIVASAKTHI.K
M.SC NURSING
II ND YEAR
CON-PIMS

2. Definition
A colostomy consists of an artificial
opening created in the large intestine and
brought to the surface of the abdomen for the
purpose of evacuating the bowels.

3. Indications
Anorectal malformation
Ulcerative colitis
Hirschsprung's disease
Acquired indications: Rectovaginal fistula,Perineal
injury, colonic injury.

4. Purpose
To prevent the excoriation of the skin around the stoma
To establish regularity of evacuation
To stop any leakage of feces
To teach the patient and parents/ relatives regarding the care
of colostomy.

5. Equipment Needed
A clean tray containing:
•Pair of gloves
•Mackintosh and sheet
•Bowl with cotton and gauze pieces
•Sterile water or normal saline
•Bed pan
•Disposable colostomy bag
•Zinc oxide ointment
•Towel
•Tissue paper.

7. Preparations
•Explain the procedure to the parents and child as appropriate
•Keep all the equipments near the patient site
•Maintain privacy of the patient
•Maintain comfortable position.

8. S.NO NURSING INTERVENTION RATIONALE
1. Explain the procedure to the parents and care
giver.
Helps in obtaining cooperation of the
patient.
2. Assemble the necessary equipment nearby. Organization facilitates performance
of the task.
3. Wash hands and wear gloves Prevents spread of microorganisms.
4. Provide privacy and assist child to a
comfortable position.(Fowlers, semi fowlers,
standing or sitting position)
Positioning allows child to view the
procedure in preparation for learning.
5. Empty the partially filled appliance into the
bedpan if it is a drainable pouch.
Emptying the contents befor removal
of the pouch prevents accidental
spillage of fecal material.

9. 6. Remove the appliance slowly beginning at the
top while keeping the abdominal skin taut. If
any resistance is felt, use warm water or
adhesive solvent to facilitate removal.
Careful removal protects the
underlying skin from damage and
minimizes discomfort for the patient.
7. Use tissue paper to remove any excess stool
from the stoma. Cover stoma with a gauze pad.
Gauze absorbs any drainage from the
stoma while the skin is being prepared.
8. Gently wash and pat dry the peristomal skin.
Mild soap and cleaning agent may be used
according to agency policy.

10. 9. Assess the appearance of peristomal skin and
stoma. A moist-reddish –pink stoma is
considered normal.
Change in normal appearance may
indicate anemia, altered circulation,
and it should be informed to
physician.
10. Apply paste type skin barrier if required and
allow the paste to dry for 1-2 minutes.
Establishes a smooth surface for
application of skin barrier and pouch.
11. Apply the skin barrier and appliance together.
a. Select size of stoma opening by using the
measurement guide.
b. Trace same size circle on the back at the
center of the skin barrier.
c. Use scissors to cut an opening ¼ or 1/8 inch
larger than stoma.
d. Remove the backing to expose sticky side.
e. Remove gauze pad covering stoma.

11. 12. Place barrier and pouch over the stoma and
gently press onto skin while smoothing out
creases or wrinkles.
Placing both the skin barrier and
application easier for the child.
13. Instill deodorant in bag if required.
14. Close the pouch if it is drainable by folding
the end upward and using a clamp or clip
according to manufacturer’s direction.
A tightly sealed appliance will not
leak and cause embarrassment and
discomfort for the patient.
15. Dispose off used equipment, discard gloves
and wash hands.
Prevents spread of microorganisms.
16. Document appearance of stoma, condition of
peristomal skin, and child’s reaction to
procedure.
Facilitated continuity of care.

12. Nurse's Responsibility
Empty a drainable pouch or replace the colostomy bag as needed or when it
is no more than one-third full
Assess stoma appearance and surrounding skin condition frequently.
 Prior to discharge, provide written, verbal psychomotor instruction on
colostomy care, pouch management, skin care and irrigation for the client.

13. Cont.,
Allow ample time for the caregiver and child (older) to practice changing the pouch
either on the client or a model
Provide dietary teaching regarding the food that cause stool odor and gas and food that
thicken and loosen stools
-Foods that increase stool odor: Asparagus, beans, cabbage, eggs, fish, garlic, onions,
some spices
-Foods that increase intestinal gas: Broccoli, cabbage, carbonated drinks,
cauliflower, corn, cucumber, dairy products, dried beans, peas, radish, dried spinach.

14. cont.,
-Foods that thicken stools: Banana, cheese, yogurt, rice, tapioca, pasta,
creamy peanut butter
-Foods that loosen stools: Chocolate, fried foods, greasy foods, lightly spicer
foods, green leafy vegetables, raw fruits and juices, raw vegetables
-Foods that color stools: Beet root, red gelatin.
The diet for a child with a colostomy is individualized and may require no
alteration from that consumed preoperatively.

15. Cont.,
If the child is school going, he/she should carry medical identification or a
medical alert tag or bracelet.
These measures are important to prevent trauma.

16. Complications
Skin excoriations
Prolapse
Hemorrhage
Sepsis/wound infection
Poor parental acceptance
Para colostomy hernia
Stoma stenosis

17. BIBLIOGRAPHY
1. Annamma Jacob, Rekha R Text book of clinical nursing
procedures the art of nursing practice, Japeebrothers publication,
pg no:221-228
2.Cicillia Correia, Text book of clinical nursing pediatric
procedure manual, pg no:117-119