Colostomy Care Power Point

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Colostomy Care:

Colostomy Care Objectives Describe the indications for colostomy surgery and illustrate the types of colostomies and their methods of care Contact hours:2

Colostomy:

Colostomy A colostomy is a lifesaving surgery that enables a person to enjoy a full range of activities and work even through they have a stoma and may wear a pouching system Colostomy surgery is performed for many different diseases and conditions. Some are done because of cancer , and in children because of birth defects. They can be temporary. Some are on the left side of the abdomen, some are on the right, and some in the middle. Think of a colostomy's function as you think of a natural bowel movement. Individuals who have undergone a colostomy still have the same bowel, just less of it . The real change is having a bowel movement from an opening made in the abdomen.

Facts:

Facts An ostomy is a surgical opening, usually on the abdominal wall, for the drainage of the body wastes. In ostomies involving the digestive tract, portions of the bowel are diverted from their regular course to allow drainage to occur. A colostomy is a diversion of the colon or large bowel. An ileostomy is a diversion of the ileum or small bowel. A colostomy is created when a portion of the large intestine colon) or the rectum is removed or bypassed. The remaining portion of the large intestine is brought through the abdominal wall, creating a stoma.

New Colostomy:

New Colostomy

Temporary Colostomy:

Temporary Colostomy When conditions such as injury or inflammatory bowel disease are present in the lower colon, it may be necessary to give the affected portion of the colon a rest. A transverse colostomy may be created for a period of time to prevent stool from passing through the area of the colon that is inflamed , infected, diseased or newly operated on, thus allowing healing to occur. Such a colostomy is usually temporary. Depending on the recovery process, the colostomy may be necessary for a couple of weeks, months or even years. Eventually given good health, the colostomy is likely to be closed and normal bowel continuity restored.

Permanent Colostomy:

Permanent Colostomy When the end portion of the colon or the rectum becomes diseased, construction of a permanent colostomy becomes necessary. This may also be the case if other health problems make it unwise for the patient to have further surgery. The diseased potion must be totally removed or permanently bypassed.

The Stoma:

The Stoma A stoma is the actual end of the small or large bowel that can be seen protruding through the abdominal wall. It often protrudes like a nipple. When you look at a stoma, you are actually looking at the lining of the bowel, which resembles the lining of you cheek. Question: Should the stoma have a healthy look to it? It has a good blood supply so it appears pink to red in color. The bowel is lined with mucous membrane so the stoma is moist and shiny and secretes small quantities of mucus. There is no feeling or pain when it is touched because their are no nerves in the bowel lining. The stoma has no shutoff valve , for this reason willful control of the passage is not possible.

Healthy Stoma:

Healthy Stoma

Normal Digestive System:

Normal Digestive System With Colostomy

Normal Digestive System:

Normal Digestive System The small intestine is approximately 20 feet long, consisting of the following: Duodenum (first part) 19 -12 inches long, consisting of the following Jejunum (second part) about 8 -8 feet Ileum (third part) about 12 feet and is connected to the large intestine at the cecum.

Upper Colon:

Upper Colon Since nutrients are absorbed in the small intestine, a colostomy does not affect the body's ability to be nourished. When a colostomy interrupts the passage of stool, storage becomes more difficult. The higher up in the colon the colostomy is made, the less time the bowel has to absorb water and the more liquidly the stool is likely to be. Therefore, a colostomy in the transverse colon will discharge a softer and more voluminous stool and will require the use of a collection pouch.

Lower Colon:

Lower Colon A colostomy far down in the colon, near the rectum will discharge stool that has been in the intestine a longer time and barring the effects of illness, medications or other forms of treatment, may produce a more formed stool. Some patient find that they are able to pass a stool at regulated times. Question: Would this stool be firm or watery ?

Ascending and Transverse Colostomies:

Ascending and Transverse Colostomies The ascending colostomy is located on the right side of the abdomen. The discharge is very liquid. A drainable pouch is worn for colostomies of this type. The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. This type of colostomy allows the stool to exit from the colon before it reaches the descending colon

Indications :

Indications The indications for a transverse colostomy include the following Diverticulitis Trauma Inflammatory Bowel obstruction Question: Do you know what common medications doctors prescribe for Diverticulitis?

Indications:

Indications The indications for a descending or sigmoid colostomy include the following Diverticulitis Trauma Inflammatory bowel disease Bowel obstruction Birth defects Paralysis Cancer of the sigmoid colon or rectum

Management:

Management While many descending and sigmoid colostomies can be managed to move regularly, others cannot. Satisfactory management, with or without stimulation, is likely to happen only in those people who have had regular bowel movements before they became ill. It is often said that a person must have a bowel movement every day. Actually this varies from person to person. Some people have two or three movements a day, others have one every two or three days or even less often. You must judge by what is usual for you not what is usual for others.

Management:

Management The management of the descending or sigmoid colostomy consists of the following Natural evacuation or irrigation Protective stoma cover (stoma cap) or closed-end pouch if regulated Open-end drainable pouch if not regulated Care of the posterior wound if rectum and anus are removed

Irrigation:

Irrigation Irrigating ( an enema through the stoma ) to have regulated bowel movements is up to the individual. This is done to clean stool directly out of the colon through the stoma. Following irrigation, patients can use a stoma cap which covers and protects the stoma. Irrigating is usually done to avoid the need to wear a pouch. Management involves skin protection and emptying the drainable pouch several times a day. A closed-end pouch can be used for convenience

Pouching Systems:

Pouching Systems Selecting a pouching system that fits properly and is easily emptied and/or changed is a major step patients take in transitioning to their new way of life. A successful pouching system should provide the following: Leak-proof seal (4-7 days) for optimum security Odor resistant pouch Skin protection Inconspicuous and unnoticeable appearance Easy application and removal

Emptying the pouch:

Emptying the pouch Emptying the pouch when it is 1/3 full will prevent bulging and leaking. Comfort and convenience also should be considered To empty the following steps should be followed: Sit on the toilet Place a small strip of toilet paper in the toilet to minimize splashing Hold the bottom of the pouch up and open the pouch at the tail Slowly unroll the tail over the toilet Gently empty contents Clean the outside and inside of the pouch tail with toilet paper Close the pouch at the tail

Types:

Types The types of colostomies include the ascending, transverse and the descending or sigmoid. The ascending is rarely used since an ileostomy is better. The transverse colostomy may be temporary or permanent. In a loop transverse colostomy the entire loop of bowel is brought to the surface and a distal end (mucus fistula) and a functioning proximal end are created. In the double barrel the barrel is divided into two stomas. Management involves skin protection and emptying the drainable pouch several times a day

Pouch Seal Duration:

Pouch Seal Duration A good pouching system will have a leak-proof seal that will last for three to seven days. In addition to type of seal, there are several factors that can influence how long the pouch will stay sealed. These include proper fit, weather, skin conditions, scars, weights change, diet and activity, body contours near the sit and the nature of the stool.

Pouching Systems:

Pouching Systems A- Two- piece ostomy pouching system B- One –piece ostomy pouches

Problems:

Problems A hernia around the stoma site is the most common problem after a colostomy. Several skin problems may be treated with prescribed topical medication but if deep pressure ulcers caused by a very tight belt occurs or there is no activity for 4 to 6 hours and is accompanied by cramps and/or nausea, treatment is needed immediately.

Hernia What would you do?:

Hernia What would you do?

After Repair:

After Repair