36TH CASE SCENARIO (NURSING) COLOSTOMY.

Colostomy is a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall,so as to bypass part of the bad colon. Colostomy can be temporary or permanent.(Most cancer patients with colostomy tend to be permanent )It is done after bowel injury or surgery. It is an opening between the abdominal wall and the colon for the evacuation of feces.

PRE- OPERATIVELY patient is on low residue or liquid diet,Cathartics,antibiotics, enemas.

POST – OPERATION Nursing Responsibilities:

Gastric suction until returns of peristalsis bowel sounds, passage of flatus.Check stoma for Ischemia ( Stoma should be red and moist )antiembolitic stockings, leg exercises, heparin. It takes 6 – 8weeks for the colon to get trained.

TEACHING :should include:

Check stomach’s appearance, empty pouch when 1/2 full ,clean skin around stoma and apply the karaya powder.

For colonoscopy irrigation, there must be doctor’s orders to follow.

Colostomy irrigation 500 to 1000ml of warm water instilled from bag held 18inches above stoma.

PROCEDURE : Clear air from the tubing, insert tube 2- 4inches. If difficulty inserting catheter, let some solution flow in and rotate or lubricate with finger and gently dislodge feces.If cramping, stop solutions take deep breaths because taking a deep breath will relax the abdominal muscles, restart solution.

STEPS FOR COLOSTOMY IRRIGATION.

This is to remove stool from the colon.Stimulates the colon to empty stools.It is better to do it at least one hour after meal.

(1) Gather information from your healthcare provider.

(2) Gather your supplies. Your supplies ready before you start.

(3) Choose and maintain same time every day for irrigation. That is create the schedule that will work for you.

(4) Know amount of liquid to use for irrigation ( 500ml to 1000ml) is amount recommended. Close clamp on irrigation and fill the irrigation bag.

(5)The irrigation sleeve should be attached to the stoma.

(6)Air bubbles released from tubing

(7) Hang the bag up height above shoulder if seating down.

(8) The end of the cone moisten.

(9)Place the tip of the cone gently into the stoma.Open the clamp for water to run to the cone.Close flow control.

(10) Remove the cone and dry existing pouch or stoma cap.

NOTE : This procedure is used for descending or Sigmoid colostomy.

Not for ileostomy patients because their stools are liquids already.

Also irrigation is not needed when you are getting Chemotherapy or Radiation therapy.

Questions:

A man has undergone an abdominoperineal resection for treatment of a bowel obstruction. His wife asks the nurse if she can bring the patient some home cooked food now that he is back from surgery?.The nurse explains to her that the patient will not be able to eat until:

ANSWER: his bowel sounds have returned which will indicate return of peristalsis activity, you will start him with liquid diet then the low residue diet .

(2) A 52 years old man is admitted to the hospital for the treatment of severe diverticulitis. Because he has not responded well to medical interventions, surgical intervention for a colostomy is scheduled. The nurse plans to teach the patient ostomy self care.What will be the greatest success on the teaching?.

Answer: The patient acceptance of the colostomy and the ability to manage it.

(3) A 63years old man is being prepared for discharge after an abdominal resection. The dietary instructions are given to the patient by the nurse. He is advised to avoid food that produces excessive gas.Which foods if selected by the patient will indicate that patient understand his dietary needs.

Answer : Low residue diet.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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