Colostomy Nursing Care Plan & Management
Definition of Colostomy
- Colostomy is a surgical procedure that brought formation of an opening into the colon, brought out onto the abdominal wall as a stoma. The opening can be either permanent or temporary.
Specific Technique for Colostomy
- Bowel technique
Discussion
- This procedure is usually performed for lesions in the large intestine caused by cancer, diverticulitis, or obstruction of the large intestine in an area close to the rectum.
- Types of colostomy:
- Temporary colostomy: A temporary colostomy is performed to divert the fecal stream from the distal colon, which may be obstructed by tumor inflammation, or requires being “put-to-test” because of anastomosis or a pouch procedure. A temporary colostomy may be created in the transverse colon or sigmoid colon.
- Permanent colostomy: A permanent colostomy is performed to treat malignancies of the colon. Other indications may include irrevocable rectal strictures, incontinence of bowel, or inflammatory bowel disease. A permanent colostomy can be fashioned similar to a temporary colostomy but most often is an end colostomy.
Position
- Supine, with arms extended on arm boards.
Incision Site
- Dependent on the segment of colon to be used.
Packs/ Drapes
- Laparotomy pack
- Four folded towels
- Transverse Lap sheet
- Minor pack
Instrumentation
- Major Lap tray
- Intestinal tray
- Closing tray
- Internal surgical staples
Supplies/ Equipments
- Basin set
- Blades
- Needle counter
- Penrose drain
- Internal stapling instruments
- Glass rod and tubing with colostomy pouch
- Solutions – saline, water
- Sutures
- Medications
- Dressings
Procedure
- The abdomen is opened in the usual manner and the segment of colon is mobilized.
- The colon can be brought out through the main incision, or through an adjacent site from which a disk of skin and subcutaneous tissue has been excised.
- The underlying rectus fascia muscle and peritoneal layers are incised to accommodate the colon. The appropriate segment is excised between two atraumatic (intestinal) clamps or the internal stapling instrument, which is used to prepare and create the stoma.
- In a loop colostomy, a rod or bridge may be placed under the colon to avoid retraction.
- The abdomen is irrigated with warm saline and closed layers in a routine fashion.
- A colostomy poucj is applied over the stoma.
Perioperative Nursing Considerations
- The colostomy pouch may or may not be applied in surgery.
- A Vaseline gauze may encircle the stoma with a “fluff” type dressing applied.
- If the institution has an “Ostomy Nurse”, the application of the colostomy pouch may be delayed until the clinical specialist can work with the patient and family.
Exam
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Nursing Care Plan
Nursing Diagnosis
- Fluid Volume, risk for deficient
Risk factors may include
- Excessive losses through normal routes, e.g., preoperative emesis and diarrhea; high-volume ileostomy output
- Losses through abnormal routes, e.g., NG/intestinal tube, perineal wound drainage tubes
- Medically restricted intake
- Altered absorption of fluid, e.g., loss of colon function
- Hypermetabolic states, e.g., inflammation, healing process
