A colostomy is a surgical opening from the colon through the abdominal wall to the outside of the body. The purpose is for waste products (stool) to leave the body. A colostomy is performed for a variety of reasons including cancer, infections and certain diseases. Occasionally, the colostomy is only temporary until the colon heals and then it is reversed, but most of the time a colostomy is permanent.
1. Empty the colostomy drainage bag several times each day. It's best to empty the bag before it gets too full to prevent leaks and spills. 2. Remove the old colostomy bag by detaching it carefully from the skin every four to six days and discard it. 3. Thoroughly clean the skin around the stoma and dry thoroughly. The skin around the stoma where the bag is attached is very tender and must be kept clean and dry. 4. Apply antibiotic powder as directed to the skin around the stoma to help prevent irritation and yeast infection. 5. Replace the skin barrier disk or paste to the tender skin around the stoma. 6. Attach a new colostomy bag carefully over the stoma.
7. Order ostomy supplies to be delivered as needed.
Colostomies are performed for various reasons, including trauma, blockage and infection. The procedure is quite intense and requires a commitment to colostomy aftercare by the patient, nursing staff and doctors. Caring for a colostomy patient requires you to have knowledge and compassion. Conditions such as diverticulitis, inflammatory bowel disease, cancer or trauma sometimes require a colostomy. In general, the surgery lasts two to four hours. The most common type of colostomy procedure is the Hartmann colostomy, a procedure in which the colon is cut in half. The end of the colon that leads to the stomach is fed through the abdomen wall and attached to the skin. This area is the stoma. After surgery, the end of the colon near the rectum grows dormant. Most colostomies performed can be reversed after the affected tissues of the colon heal. In the days following surgery, you should check the stoma’s appearance to ensure that it remains red and moist. If there is any change in color, especially a darkening to a purple or black tone, you should immediately share this information with the surgeon. Check the abdomen for distention or bleeding near the incision site. Intake and output must be monitored to reduce the patient’s risk of dehydration or electrolyte imbalance. Within six to eight weeks, the swelling will reduce, and the stoma will shrink to its normal size. The stoma and surrounding skin should be assessed on a routine basis. Note the color and height of the stoma, and look for skin damage such as blisters, ulcers or rashes. Patients with certain types of colostomies — descending or sigmoid — might choose not to wear a pouch and opt for irrigation instead. To prepare for irrigation, the colostomy patient should take a seat on the toilet. Insert a flexible catheter coated in water-soluble jelly no more than 3 inches (7.6 cm) into the stoma. Stop at the first sign of resistance. If necessary, use a gloved and lubricated finger to dilate the stoma. After the catheter is in place, 16.9 to 33.8 ounces (500 to 1,000 cc) of warm fluid fills the colon. If the colostomy patient experiences cramping, the fluid flow should be stopped until cramping subsides and then continued slowly. The fluid remains in the colon for a few minutes before being drained into the toilet. Sometimes side-to-side or back-and-forth movement will encourage the fluid return rate to increase if slowed. The colostomy patient should note the amount and fluid type returned after irrigation. Any obstruction or prolapse of the stoma must be reported immediately. Patients who must use a pouching system can choose between disposable or reusable and one-piece or two-piece. In the one-piece system, the wafer and pouch are connected and attach to the stoma site. The wafer and pouch are separate in the two-piece system. The wafer attaches to the skin...
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