Colostomy Care

1. Definition of "colostomy."

1. A colostomy is the surgical connection of large intestine and the abdominal wall.

2. A small portion of the intestine is sewed to the surface of the abdomen creating a "stoma."

3. The purpose of the colostomy is to bypass the diseased rectum and colon to rid the body of solid wastes.

2. Basic anatomy and physiology of the large intestine.

1. The large intestine consists of the ascending, transverse, and descending portions.

2. Its primary purpose is to absorb water and store feces.

3. Peristalsis is the involuntary process that propels food in waves through the esophagus, stomach, and intestines.

3. Type of colostomy performed and the expected formation of stool.

1. Ascending (stools are liquid).

2. Transverse (stools are semi-formed).

3. Descending (stools are formed).

4. Sigmoid (stools are formed).

4. How to change a pouching system.

1. Assemble all the equipment (water, washcloth and towel, toilet paper, skin barrier, wafer and pouch, tape, scissors).

2. Use seran wrap or paper towel to trace a pattern around the stoma, being sure to label the top of the pattern.

3. Trace the stomal pattern on the paper side of wafer.

4. Cut the pattern out to the wafer and label the top.

5. Remove the pouch being worn.

6. Wash the skin thoroughly with soap and water, rinse, and dry well. (Urihesive remover may be necessary if body cement was used.)

7. Assess the stoma for any change in size or color.

8. Assess the skin for signs of irritation, and apply skin barrier as needed.

9. Apply wafer and pouch as directed.

10. "Window frame" the wafer with tape.

11. Add liquid deodorant, if desired, to decrease odor.

5. Procedure to manage skin irritation.

1. Mild irritation.

1. Wash skin with soap and water.

2. Apply sween cream, and massage well.

3. Apply skin prep before applying wafer.

2. Severe irritation.

1. Wash skin with soap and water.

2. Apply sween and massage.

3. Apply amphogel, and dry.

4. Apply skin prep and karaya powder.

6. Foods that may affect bowels. (Foods may affect each person differently, so foods should be tried gradually to determine tolerance.)

1. Foods associated with foul odor are fish, eggs, asparagus, onions, garlic, and some spices.

2. Foods that decrease odor are cranberry juice, yogurt, and buttermilk.

3. Foods associated with gas are brussels sprouts, cabbage, beans, peas, mushrooms, carbonated drinks, onions, cucumbers, and beer.

4. Low-residue foods that are helpful in managing diarrhea are strained bananas, peanut butter, and applesauce.

5. Increase fluids and high-fiber foods, including fresh fruits and vegetables, are helpful to manage constipation.(Provide "Fiber in Diet" handout.)

7. Support groups and assistance available.

1. The United Ostomy Association can visit for emotional help and information.

2. Visiting nurse may assist in the home until comfortable with procedure.

3. Counseling from clergy or other professionals may be helpful in adjustment required.