Colostomy
Colostomy Nursing Care
Plan and 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.
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:
1. 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.
2. 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.
Packs/ Drapes
▪ Laparotomy pack
Colostomy Nursing Care Plan and Management
,▪ Four folded towels
▪ Transverse Lap sheet
▪ Minor pack
Procedure
1. The abdomen is opened in the usual manner and the segment
of colon is mobilized.
2. 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.
3. 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.
4. In a loop colostomy, a rod or bridge may be placed under the
colon to avoid retraction.
5. The abdomen is irrigated with warm saline and closed layers
in a routine fashion.
6. A colostomy pouch is applied over the stoma.
Perioperative Nursing Considerations
1. The colostomy pouch may or may not be applied in surgery.
2. A Vaseline gauze may encircle the stoma with a “fluff” type
dressing applied.
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
Colostomy Nursing Care Plan and Management
, Colostomy
Desired Outcomes
▪ Maintain adequate hydration as evidenced by moist mucous
membranes, good skin turgor and capillary refill, stable vital
signs, and individually appropriate urinary output.
Nursing Interventions
▪ Monitor intake and output (I&O) carefully, measure liquid stool.
Weigh regularly.
▪ Rationale: Provides direct indicators of fluid balance.
Greatest fluid losses occur with ileostomy, but they generally
do not exceed 500–800 mL/day.
▪ Monitor vital signs, noting postural hypotension, tachycardia.
Evaluate skin turgor, capillary refill, and mucous membranes.
▪ Rationale: Reflects hydration status and/or possible need for
increased fluid replacement.
▪ Limit intake of ice chips during period of gastric intubation.
▪ Rationale: Ice chips can stimulate gastric secretions and
wash out electrolytes.
▪ Monitor laboratory results, e.g., Hct and electrolytes
▪ Rationale: Detects homeostasis or imbalance, and aids in
determining replacement needs
▪ Administer IV fluid and electrolytes as indicated.
Colostomy Nursing Care Plan and Management
Colostomy Nursing Care
Plan and 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.
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:
1. 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.
2. 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.
Packs/ Drapes
▪ Laparotomy pack
Colostomy Nursing Care Plan and Management
,▪ Four folded towels
▪ Transverse Lap sheet
▪ Minor pack
Procedure
1. The abdomen is opened in the usual manner and the segment
of colon is mobilized.
2. 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.
3. 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.
4. In a loop colostomy, a rod or bridge may be placed under the
colon to avoid retraction.
5. The abdomen is irrigated with warm saline and closed layers
in a routine fashion.
6. A colostomy pouch is applied over the stoma.
Perioperative Nursing Considerations
1. The colostomy pouch may or may not be applied in surgery.
2. A Vaseline gauze may encircle the stoma with a “fluff” type
dressing applied.
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
Colostomy Nursing Care Plan and Management
, Colostomy
Desired Outcomes
▪ Maintain adequate hydration as evidenced by moist mucous
membranes, good skin turgor and capillary refill, stable vital
signs, and individually appropriate urinary output.
Nursing Interventions
▪ Monitor intake and output (I&O) carefully, measure liquid stool.
Weigh regularly.
▪ Rationale: Provides direct indicators of fluid balance.
Greatest fluid losses occur with ileostomy, but they generally
do not exceed 500–800 mL/day.
▪ Monitor vital signs, noting postural hypotension, tachycardia.
Evaluate skin turgor, capillary refill, and mucous membranes.
▪ Rationale: Reflects hydration status and/or possible need for
increased fluid replacement.
▪ Limit intake of ice chips during period of gastric intubation.
▪ Rationale: Ice chips can stimulate gastric secretions and
wash out electrolytes.
▪ Monitor laboratory results, e.g., Hct and electrolytes
▪ Rationale: Detects homeostasis or imbalance, and aids in
determining replacement needs
▪ Administer IV fluid and electrolytes as indicated.
Colostomy Nursing Care Plan and Management
