1. The client/caregiver can define colostomy.
    1. A colostomy is a surgical opening between the large intestine and the surface of the abdomen.
    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.
    4. The large intestine consists of the ascending, transverse, and descending portions.
    5. Its primary purpose is to absorb water and store feces.
  2. The client/caregiver can list three types of colostomies.
    1. Ascending colostomy has a stoma that is located on the right side of the abdomen. The output that drains is in liquid form.
    2. Transverse colostomy has a stoma that is located in the upper abdomen toward the middle or right side. The output that drains is loose or soft.
    3. Descending or sigmoid colostomy has a stoma that is located on the lower left side of the abdomen. The output that drains is firm.
  3. The client/caregiver can list different types of colostomy pouches.
    1. An open-ended pouch is open at the bottom to drain output. The open end of this pouch is usually closed with a plastic clamp. This type of pouch is used by people with ascending or transverse colostomies.
    2. Closed-ended pouch is removed and thrown away when the pouch is filled. This type of pouch is usually used by people with a descending or sigmoid colostomy.
    3. A one-piece pouch has the pouch and the adhesive skin barrier as one piece. When the pouch requires changing, the new pouch must be reattached to the skin.
    4. The two-piece pouch has two parts, including the adhesive flange and the pouch. The adhesive part remains when the pouch is cleaned or replaced.
  4. The client/caregiver can demonstrate emptying the pouch.
    1. Empty when one-third full.
    2. Sit on the toilet or place on a chair with the pouch opening placed in the toilet.
    3. Put toilet paper on the surface of the toilet water to avoid splashing.
    4. Remove clamp and let contents empty into the toilet.
    5. Squeeze the remaining contents out of the pouch.
    6. While holding up the end of the pouch, pour a cup of water into the pouch, swish, and empty. Do not get the stoma or adhesive seal wet.
    7. Use toilet paper to clean around the opening of the pouch and clamp the pouch shut.
  5. The client/caregiver can demonstrate the procedure for changing the pouching system.
    1. Change pouch every 5 to 7 days or as needed.
    2. Assemble all of the equipment.
    3. Hold skin taut, and peel off the pouch being worn.
    4. Wash the skin thoroughly with soap and water, rinse, and pat dry.
    5. Inspect the stoma for any change in size or color.
    6. Inspect the skin for signs of irritation and apply a skin barrier.
    7. Apply pouch over the stoma, being sure it is the appropriate size and fits closely around the stoma.
  6. The client/caregiver can list dietary measures for the management of colostomy.
    1. Eat a healthy balanced diet. Eat slowly and chew well.
    2. Avoid the use of straws to reduce gas.
    3. Foods that may help to control odor and gas in some people are fresh parsley, yogurt, and buttermilk.
    4. Drink 8 to 10 glasses of water or liquids each day. Healthy choices are water, juices, and milk. Limit the intake of caffeine and soda.
    5. Foods that may cause gas and odor are
      • Broccoli, cabbage, cucumbers, Brussels sprouts, or cauliflower
      • Beans, eggs, and fish
      • Cheese, onions, garlic, or alcohol
    6. Provide information concerning sexual activity, such as
      1. Resume sexual activity when the stoma is healed.
      2. Empty pouch before intercourse.
      3. Get counseling if needed.
  7. The client/caregiver can list general measures for management of colostomy.
    1. Avoid contact sports and weight lifting.
    2. Avoid tight, constrictive clothing.
    3. Bathing, showering, and swimming can be done with appliances on.
    4. Keep extra colostomy supplies on hand.
    5. Report to the physician any change in size or color of the stoma, persistent diarrhea or severe constipation, frank bleeding from the stoma, purulent drainage or pain at the stoma, and fever.
    6. Provide information concerning sexual activity, such as
      1. Resume sexual activity when the stoma is healed.
      2. Empty pouch before intercourse.
      3. Get counseling if needed.

Resources

United Ostomy Associations of America, Inc.www.uoaa.org
Wound, Ostomy, Continence Nurseswww.wocn.org

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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