Download - Changing Fecal Pouching Colostomy)
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 1/48
COLOSTOMY CARE
PREPARED BY:
MR. CHALMER L. MANUELA, RN
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 2/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 3/48
Indication:
Cancer
Chrohn·s disease
Trauma
Injury
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 4/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 5/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 6/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 7/48
DIFFERENT TYPES OF COLOSTOMY
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 8/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 9/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 10/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 11/48
CHANGING A TWO PIECE
DRAINABLE FECAL POUCHING
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 12/48
EQUIPMENT
Duplicate wafer and pouch
Tail closure
Washcloth and towel Mild non oily soap (optional)
Accessory products prescribed for patients
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 13/48
PROCEDURE
NURSING ACTION
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 14/48
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
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 15/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 16/48
c. Discard soiled pouch and wafer in odorproof
plastic bag
Rationale
Removes room odor and maintains universal
precaution
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 17/48
2. To cleanse skin:
a. Use toilet tissue to remove feces from stoma and
skin if needed.Rationale
Stoma may function during the change.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 18/48
b. Cleanse stoma and peristomal skin with soft cloth
and water, soap optional.
Rationale
Minimizes skin breakdown and promotes hygiene.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 19/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 20/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 21/48
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
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 22/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 23/48
d. Remove paper backing (s) from the wafer, center
opening over stoma, and press wafer down onto
peristomal skin.
Rationale
Ensure adherence.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 24/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 25/48
5. Apply tail closure to pouch tail.
Rationale
Proper closure will controls odor.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 26/48
FOLLOW UP PHASE
1. Dispose of plastic bag with waste materials.
Rationale Complies with universal precautions.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 27/48
2. Clean durable pouch with soap and water, if
appropriate. Drainable pouches maybe reused
severable times.
Rationale
Controls odor; reduces cost.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 28/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 29/48
IRRIGATING A COLOSTOMY
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 30/48
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.)
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 31/48
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
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 32/48
PROCEDURE
NURSING ACTION
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 33/48
PREPARATORY PHASE
1. Explain the details of the procedure to the
patient and answer any questions.
Rationale
Relieves anxiety and promotes compliance.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 34/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 35/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 36/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 37/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 38/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 39/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 40/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 41/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 42/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 43/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 44/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 45/48
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.
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 46/48
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 47/48
END
THANK YOU!!!
8/3/2019 Changing Fecal Pouching Colostomy)
http://slidepdf.com/reader/full/changing-fecal-pouching-colostomy 48/48