Changing Fecal Pouching Colostomy)

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COLOSTOMY CARE PREPARED BY: MR. CHALMER L. MANUELA, RN

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COLOSTOMY CARE

PREPARED BY:

MR. CHALMER L. MANUELA, RN

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What is COLOSTOMY

A colostomy is an opening that is

made in the colon with surgery. After

the opening is made, the colon isbrought to the surface of the

abdomen to allow stools to leave

your body.

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Indication:

Cancer

Chrohn·s disease

Trauma

Injury

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2 kinds of Colostomy

Temporary Colostomy - maybe placed

for a weeks, months or years.

Permanent Colostomy ² when part ofcolon is removed pr cannot be used.

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Where is the colon located?

The colon is part of the digestive system. The

digestive system consists of the parts of the body

that are involved in the digestion (breakdown) of

food. Food moves from your stomach to the small

intestine where food is digested and nutrients are

absorbed. The food then goes to the colon (part of

the large intestine). The colon absorbs water fromdigested food and turns the digested food into stool.

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DIFFERENT TYPES OF COLOSTOMY 

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Ascending colostomy:

This colostomy has a stoma (opening) that is

located on the right side of the abdomen. Theoutput (stool) that drains from this stoma is in

liquid form.

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Transverse colostomy:

This colostomy has a stoma that is located

in the upper abdomen towards the middle or

right side. The output that drains from this

stoma may be loose or soft.

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CHANGING A TWO PIECE

DRAINABLE FECAL POUCHING

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EQUIPMENT

Duplicate wafer and pouch

Tail closure

Washcloth and towel Mild non oily soap (optional)

Accessory products prescribed for patients

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PROCEDURE

NURSING ACTION

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PREPARATORY PHASE

1. Have patient assume a relaxed position

and provide privacy. The best position

maybe sitting, reclining, or standing.Rationale

Patient must see to learn care

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c. Discard soiled pouch and wafer in odorproof

plastic bag

Rationale

Removes room odor and maintains universal

precaution

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2. To cleanse skin:

a. Use toilet tissue to remove feces from stoma and

skin if needed.Rationale

Stoma may function during the change.

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b. Cleanse stoma and peristomal skin with soft cloth

and water, soap optional.

Rationale

Minimizes skin breakdown and promotes hygiene.

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3. To apply wafer:

a. Use measuring guide or pattern to determine stoma

size.

Rationale

This step is omitted when stoma shrinkage is

complete, about 2 months postop.

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b. The correct size onto back of wafer and cut to

stoma size. It is acceptable to cut 1/16 ² 1/8 inch

larger than stoma.Rationale

Avoids wafer rubbing stoma; omit this step if the

wafer is precut

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d. Remove paper backing (s) from the wafer, center

opening over stoma, and press wafer down onto

peristomal skin.

Rationale

Ensure adherence.

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4. Snap pouch onto the flange of the wafer according

to maufacturer·s directios.

Rationale

If attaced properly, there will be no leakage or

odor.

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5. Apply tail closure to pouch tail.

Rationale

Proper closure will controls odor.

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FOLLOW UP PHASE

1. Dispose of plastic bag with waste materials.

Rationale Complies with universal precautions.

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2. Clean durable pouch with soap and water, if

appropriate. Drainable pouches maybe reused

severable times.

Rationale

Controls odor; reduces cost.

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3. A commercial deodorant can be placed in the

pouch to reduce odor.

4. Gas can be released by the pouch by releasing the

tail closure or by snapping off an area on the

pouch flange. Never make a pinhole in the pouch to

release gas.

Rationale

Destroys the odorproof seal.

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IRRIGATING A COLOSTOMY

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EQUIPMENT

Reservoir for irrigating fluids; irrigator bag or

enema bag if irrigator bag not available.

Irrigating fluid: 500 ² 1,500 mL lukewarm water or

other solution prescribed by health care provider

(volume is tiltrated based on patient tolerance and

results; average amount is 1,000mL.)

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Irrigating tip: Cone tip or soft rubber catheter #22 

or #24 with shield to prevent backflow of irrigating

solution (use only if cone not available. The cone is

the preferred method to avoid possibility of bowelperforation.)

Irrigating sleeve (long large ² capacity bag with

opening at the top with to insert cone or catheter

into stoma); available in different styles: Snap ² on,

self ² adhering to skin, or held in place by belt

Large tail closure

Water ² soluble lubricant

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PROCEDURE

NURSING ACTION

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PREPARATORY PHASE

1. Explain the details of the procedure to the

patient and answer any questions.

Rationale

Relieves anxiety and promotes compliance.

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2. Select a consistent time, free from distractions. If the

patient is learning to irrigate for bowel control,

choose the time of day that will best fit into the

patient·s lifestyle.

Rationale

Establishes regularity.

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3. Have the patient sit in front of the commode itself,

providing privacy and comfort.

4. hang irrigator reservoir with prescribed solution so

the bottom of the reservoir is approximately at the

level of the patient·s shoulder and above the stoma.

Rationale

Height of irrigation bag regulates pressure ofirrigant.

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Note:

Colostomy irrigation may also be performed to

empty the colon of its contents (feces, gas, mucus)

before a diagnostic procedure or surgery and to

cleanse the colon after fecal impaction removal or

with constipation.

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PERFORMANCE PHASE

1. Remove pouch or covering from stoma, and apply

irrigation sleeve, directing the open tail into the

commode.

Rationale

Allows water and feces to follow directly into

commode.

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3. Lubricate the tip of the cone/catheter, and gently

insert into the stoma. Insert catheter no more than 3 

inches. Hold cone/shield gently, but firmly, against

stoma to prevent backflow of water.

Rationale

Prevents intestinal perforation and irritation of

mucous membranes.

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4. If catheter does not advance easily, allow to flow

slowly while advancing catheter. NEVER FORCE

CATHETER. Dilating the stoma with lubricated,

gloved pinky finger maybe necessary to directcone/catheter properly.

Rationale

Slow rate relaxes bowel to facilitate passage ofcatheter.

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5. Allow water to enter colon slowly over 5 to 10 

minute period. If cramping occurs, slowly flow rate

or clamp tubing to allow cramping to subside, if

cramping does not subside, remove cone/catheterto release contents.

Rationale

Cramping may occur from too rapid flow, coldwater, excess solution, or colon ready to function.

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6. Hold cone/shield in place 10 seconds after water is

instilled, then gently remove cone /catheter from

stoma.

Rationale

Discourages premature evacuation of fluid.

7. As feces and water flow down sleeve, periodically

rinse sleeve with water. Allow 10 to 15 minutes formost of the returns, then dry sleeve tail and apply

tail closure.

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8. Leave sleeve in place for approximately 20 more

minutes while patient gets up and moves around.

Rationale

Ambulation stimulates peristalsis and completion ofirrigation return.

9. When returns are complete, clean stomal area with

mild soap and water; pat dry; reapply pouch or

covering over stoma.

Rationale

Cleanliness and dryness promote comfort.

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FOLLOW UP PHASE

1.Clean equipment with soap and water; dry and

store in well ² ventilated area.

Rationale

This will control odor and mildew, prolonging the life

of equipment.

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2. If applicable, the patient should use a pouch until

the colostomy is sufficiently controlled.

Rationale

It may take several months to establish control. The

patient can then use minipouch, stoma cap, or gauze

covering are desired.

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END

THANK YOU!!!

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