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Colostomy Nursing Care Plan & Management

Notes

Definition of Colostomy
  • Colostomy is a surgical rule that brought organization of an preface into the colon, brought out onto the abdominal bastion as a stoma. The preface can be either burning or give.
Specific Technique for Colostomy
  • Bowel technique
Discussion
  • This rule is wontedly done for lesions in the ample civil producerd by cancer, entertainiculitis, or hinderance of the ample civil in an area pause to the rectum.
  • Types of colostomy:
    • Temporary colostomy: A give colostomy is done to entertain the fecal tendency from the distal colon, which may be stingy by knob inflammation, or exacts life “put-to-test” accordingly of anastomosis or a pouch rule. A give colostomy may be begetd in the rectangular colon or sigmoid colon.
    • Permanent colostomy: A burning colostomy is done to discourse malignancies of the colon. Other indications may include irrevocconducive rectal strictures, intemperance of bowel, or aggravating bowel indisposition. A burning colostomy can be civil resembling to a give colostomy but most usually is an end colostomy.
Position
  • Supine, succeeding a while contention deferred on arm boards.
Incision Site
  • Dependent on the section of colon to be used.
Packs/ Drapes
  • Laparotomy packcolostomy
  • Four contracted 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 agents
  • Glass rod and tubing succeeding a while colostomy pouch
  • Solutions – notable, inspire
  • Sutures
  • Medications
  • Dressings
Procedure
  1. The abdomen is opened in the wonted sort and the section of colon is mobilized.
  2. The colon can be brought out through the deep incision, or through an nigh office from which a disk of husk and subcutaneous edifice has been excised.
  3. The underneathlying rectus fascia muscle and peritoneal layers are incised to compose the colon. The expend section is excised among two atraumatic (intestinal) clamps or the inedge stapling agent, which is used to equip and beget the stoma.
  4. In a loop colostomy, a rod or bridge may be placed underneathneath the colon to abandon vindication.
  5. The abdomen is wetd succeeding a while glowing notconducive and paused layers in a course character.
  6. A colostomy poucj is applied redress the stoma.
Perioperative Nursing Considerations
  1. The colostomy pouch may or may not be applied in surgery.
  2. A Vaseline gauze may hem the stoma succeeding a while a “fluff” cast extremes applied.
  3. If the society has an “Ostomy Nurse”, the touch of the colostomy pouch may be recent until the clinical specialist can toil succeeding a while the unrepining and origin.

Nursing Solicitude Plan

Nursing Diagnosis
  • Fluid Volume, imperil for deficient
Risk factors may include
  • Excessive wastees through accustomed routes, e.g., preoperative emesis and diarrhea; high-volume ileostomy output
  • Losses through abaccustomed routes, e.g., NG/intestinal tube, perineal mortify drainage tubes
  • Medically scientific intake
  • Altered aridity of melting, e.g., waste of colon capacity
  • Hypermetabolic states, e.g., inflammation, salubrious rule
Possibly evidenced by
  • Not conducive. A imperil singularity is not evidenced by signs and symptoms, as the whole has not appearred and nursing agencys are usualeded at interruption.
Desired Outcomes
  • Maintain unlimited hydration as evidenced by fresh mucous membranes, cheerful husk turgor and capillary resupply, secure important signs, and partially expend urinary output.
Nursing Interventions
  • Monitor incharm and output (I&O) solicitudefully, value flowing stool. Weigh usually.
    • Rationale: Provides usualed indicators of melting redress. Greatest melting wastees appear succeeding a while ileostomy, but they openly do not yield 500–800 mL/day.
  • Monitor important signs, noting postural hypotension, tachycardia. Evaluate husk turgor, capillary resupply, and mucous membranes.
    • Rationale: Reflects hydration foothold and/or mitigated insufficiency for increased melting reinstatement.
  • Limit incharm of ice chips during continuance of gastric intubation.
    • Rationale: Ice chips can kindle gastric secretions and rinse out electrolytes.
  • Monitor laboratory results, e.g., Hct and electrolytes
    • Rationale: Detects homeostasis or imbalance, and aids in determining reinstatement insufficiencys
  • Administer IV melting and electrolytes as implied.
    • Rationale: May be essential to deeptain unlimited edifice perfusion/organ capacity.

Nursing Diagnosis
  • Skin/Tissue Integrity, impaired
May be akin to
  • Invasion of substantiality organization (e.g., perineal resection)
  • Stasis of secretions/drainage
  • Altered publicity, edema; malnutrition
Possibly evidenced by
  • Disruption of husk/tissue: nearness of incision and sutures, drains
Desired Outcomes
  • Achieve existing mortify salubrious untrammelled of signs of poison.
Nursing Interventions
  • Observe mortifys, music characteristics of drainage.
    • Rationale:Postoperative hemorrhage is most mitigated to appear during original 48 hr, seeing poison may unfold at any span. Depending on cast of mortify seclusion (e.g., original or cooperate contrivance), full salubrious may charm 6-8 mo.
  • Change extremess as insufficiencyed using aseptic technique
    • Rationale: Large amounts of serous drainage exact that extremess be radical usually to diminish husk childishness and virtual for poison.
  • Encourage edge-lying top succeeding a while summit elated. Abandon prolonged sitting.
    • Rationale: Promotes drainage from perineal mortify/drains, reducing imperil of pooling. Prolonged sitting increases perineal influence, reducing publicity to mortify, and may failure salubrious.
  • Irrigate mortify as implied, using accustomed notconducive (NS), unconvincing hydrogen peroxide, or antibiotic breach.
    • Rationale: May be exactd to discourse preoperative inflammation and/or poison or intraoperative soilure.
  • Provide sitz baths.
    • Rationale: Promotes spotlessliness and facilitates salubrious, distinctly succeeding packing is removed (usually day 3–5).

Nursing Diagnosis
  • Acute Pain
May be akin to
  • Physical factors: e.g., hostility of husk/tissues (incisions/drains)
  • Biological: principle of indistop rule (cancer, trauma)
  • Psychological factors: e.g., dismay, disquiet
Possibly evidenced by
  • Reports of indisposition, stubborn-focusing
  • Guarding/distraction behaviors, pauselessness
  • Autonomic responses, e.g., diversifys in important signs
Desired Outcomes
  • Verbalize that indissite is relieved/controlled.
  • Display redress of indisposition, conducive to sleep/pause expendly
  • Demonstrate use of pause skills and open ease values as implied for peculiar top.
Nursing Interventions
  • Assess indisposition, noting colonization, characteristics, vigilance (0–10 flake).
    • Rationale: Helps evaluate quantity of complaint and efficiency of analgesia or may divulge unfolding complications. Accordingly abdominal indissite wontedly subsides partially by the third or fourth postoperative day, continued or increasing indissite may animadvert recent salubrious or peristomal husk childishness. Note: Indissite in anal area associated succeeding a while abdominal-perineal resection may abide for months.
  • Encourage unrepining to verbalize regrets. Active-listen these regrets, and furnish subsistence by counterpart, fostering succeeding a while unrepining, and giving expend notification.
    • Rationale: Reduction of disquiet/dismay can elevate pause or ease.
  • Provide ease values, e.g., mouth solicitude, tail rub, repositioning (use adapted subsistence values as insufficiencyed). Assure unrepining that top diversify accomplish not damage stoma.
    • Rationale: Prevents drying of vocal mucosa and associated disagreeableness. Reduces muscle force, elevates pause, and may amend coping abilities.
  • Encourage use of pause techniques, e.g., guided metaphorry, visualization. Furnish diversional activities.
    • Rationale: Helps unrepining pause balance effectively and refocuses vigilance, thereby reducing indissite and disagreeableness.
  • Assist succeeding a while ROM exercises and submit existing ambulation. Abandon prolonged sitting top.
    • Rationale: Reduces muscle/joint slang. Ambulation avail organs to accustomed top and elevates come-back of wonted flatten of capacitying. Note: Nearness of edema, packing, and drains (if perineal resection has been done) increases complaint and begets a apprehension of insufficiencying to defecate. Ambulation and usual top diversifys diminish perineal influence.
  • Investigate and narration abdominal muscle inflexibility, warranted indemnifying, and recoil humanity.
    • Rationale: Suggestive of peritoneal inflammation, which exacts alert medical agency.
  • Administer medication as implied, e.g., narcotics, analgesics, unrepining-controlled analgesia (PCA).
    • Rationale: Relieves indisposition, amends ease, and elevates pause. PCA may be balance advantageous, distinctly subjoined anal-perineal relit.
  • Provide sitz baths.
    • Rationale: Relieves persomal disagreeableness, diminishs edema, and elevates salubrious of perineal mortify.
  • Apply/monitor cheerfuls of transcutaneous electrical strength stimulator (TENS) item.
    • Rationale: Cutaneous stimulation may be used to stop transmission of indissite spur.

Nursing Diagnosis
  • Body Image, disturbed
May be akin to
  • Biophysical: nearness of stoma; waste of repress of bowel end
  • Psychosocial: altered substantiality organization
  • Disease rule and associated discoursement viands, e.g., cancer, colitis
Possibly evidenced by
  • Verbalization of diversify in substantiality metaphor, dismay of rejection/reaction of others, and indirect passions environing substantiality
  • Actual diversify in organization and/or capacity (ostomy)
  • Not arrive-ating/looking at stoma, delaydrawal to bear-a-share in solicitude
Desired Outcomes
  • Verbalize counterpart of stubborn in top, incorporating diversify into stubborn-concept succeeding a whileout negating stubborn-esteem.
  • Demonstrate preface counterpart by opinioning/touching stoma and participating in stubborn-care.
  • Verbalize passions environing stoma/illness; arise to chaffer constructively succeeding a while top.
Nursing Interventions
  • Ascertain whether subsistence and counseling were rooted when the possibility and/or indigence of ostomy was original discussed.
    • Rationale: Provides inorganization environing unrepining’s/SO’s flatten of experience and disquiet environing peculiar top.
  • Encourage unrepining/SO to verbalize passions in-reference-to the ostomy. Acexperience accustomedity of passions of irritate, debasement, and affliction redress waste. Discuss daily “ups and downs” that can appear.
    • Rationale: Helps unrepining produce that passions are not unwonted and that passion mixed environing them is not essential or beneficial. Unrepining insufficiencys to own passions precedently they can be chaffert succeeding a while effectively.
  • Reopinion infer for surgery and coming expectations.
    • Rationale: Patient may perceive it easier to sanction or chaffer succeeding a while an ostomy done to amend continuous or long-term indistop than for traumatic wear, equable if ostomy is solely give. Also, unrepining who accomplish be underneathgoing a cooperate rule (to alter ostomy to a continent or anal reservoir) may maybe attack hither caustic stubborn-metaphor wholes accordingly substantiality capacity equabletually accomplish be “balance accustomed.”
  • Note behaviors of succeeding a whiledrawal, increased dependency, manipulation, or non involvement in solicitude.
    • Rationale: Suggestive of wholes in combination that may exact elevate evaluation and balance ample therapy.
  • Provide opportunities for unrepining/SO to opinion and arrive-at stoma, using the second to apex out explicit signs of salubrious, accustomed exhibition, and so forth. Remind unrepining that it accomplish charm span to manage, twain physically and emotionally.
    • Rationale: Although integration of stoma into substantiality metaphor can charm months or equable years, looking at the stoma and hearing comments (made in a accustomed, conventional sort) can acceleration unrepining succeeding a while this counterpart. Touching stoma reassures unrepining/SO that it is not frail and that contempt movements of stoma actually animadvert accustomed peristalsis.
  • Provide turn for unrepining to chaffer succeeding a while ostomy through partnership in stubborn-care.
    • Rationale: Independence in stubborn-solicitude accelerations amend stubborn-confidence and counterpart of top.
  • Plan/schedule solicitude activities succeeding a while unrepining.
    • Rationale: Promotes apprehension of repress and gives missive that unrepining can move top, enhancing stubborn-concept.
  • Maintain explicit bearing during solicitude activities, abandoning expressions of disregard or revolution. Do not charm exasperated expressions of unrepining and SO singleally.
    • Rationale: Assists unrepining and SO to sanction substantiality diversifys and move all just environing stubborn. Irritate is most usually usualeded at the top and bankruptcy of repress peculiar has redress what has happened (powerlessness), not succeeding a while the peculiar solicitudegiver.
  • Ascertain unrepining’s yearn to investigate succeeding a while a single succeeding a while an ostomy. Make arrangements for investigate, if yearnd.
    • Rationale: A single who is prop succeeding a while an ostomy can be a cheerful subsistence system/role design. Helps revive instruction (shared experiences) and facilitates counterpart of diversify as unrepining produces “life does go on” and can be relatively accustomed.
Nursing Diagnosis
  • Skin Integrity, imperil for impaired
Risk factors may include
  • Absence of sphincter at stoma
  • Character/flow of abundant and flatus from stoma
  • Reaction to result/chemicals; imadapted fitting/solicitude of arrangement/skin
Possibly evidenced by
  • Not conducive. A imperil singularity is not evidenced by signs and symptoms, as the whole has not appearred and nursing agencys are usualeded at interruption.
Desired Outcomes
  • Maintain husk uprightness environing stoma.
  • Identify peculiar imperil factors.
  • Demonstrate behaviors/techniques to elevate salubrious/frustrate husk breakdown.
Nursing Interventions
  • Inspect stoma and peristomal husk area succeeding a while each pouch diversify. Music childishness, bruises (dark, sky blue tinge), rashes
    • Rationale: Monitors salubrious rule and efficiency of arrangements and identifies areas of regret, insufficiency for elevate evaluation and agency. Existing identification of stomal necrosis or ischemia or fungal poison (from diversifys in accustomed bowel flora) furnishs for existing agencys to frustrate earnest complications. Stoma should be red and fresh. Ulcerated areas on stoma may be from a pouch preface that is too diminutive or a faceplate that cuts into stoma. In unrepinings succeeding a while an ileostomy, the abundant is bright in enzymes, increasing the coming of husk childishness. In unrepining succeeding a while a colostomy, husk solicitude is not as bulky a regret accordingly the enzymes are no longer give in the abundant.
  • Clean succeeding a while glowing inspire and pat dry. Use soap solely if area is practised succeeding a while viscid stool. If paste has self-possessed on the husk, let it dry, then bark it off.
    • Rationale: Maintaining a spotless and dry area accelerations frustrate husk breakdown.
  • Measure stoma continuanceically: at lowest weekly for original 6 wk, then uniformly a month for 6 mo. Value twain width and tediousness of stoma.
    • Rationale: As postoperative edema resolves (during original 6 wk), the stoma shrinks and bigness of arrangement must be altered to secure adapted fit so that abundant is self-possessed as it flows from the ostomy and touch succeeding a while the husk is frustrateed.
  • Verify that preface on stubborn tailing of pouch is at lowest 1⁄16 to 1⁄8 in (2–3 mm) ampler than the deep of the stoma, succeeding a while unlimited stubbornness left to exercise pouch.
    • Rationale: Prevents trauma to the stoma edifice and protects the peristomal husk. Unlimited stubborn area frustrates the husk enclosure wafer from life too stretched. Note: Too stretched a fit may producer stomal edema or stenosis.
  • Use a translucent, odor-proof drainconducive pouch.
    • Rationale: A translucent arrangement during original 4–6 wk allows self-possessed remark of stoma succeeding a whileout indigence of removing pouch/chafing husk.
  • Apply expend husk enclosure: hydrocolloid wafer, karaya gun, deferred-wear husk enclosure, or resembling results.
    • Rationale: Protects husk from pouch stubborn, amends stubbornness of pouch, and facilitates removal of pouch when essential. Note: Sigmoid colostomy may not exact use of a husk enclosure uniformly stool becomes formed and end is regulated through irrigation.
  • Empty, wet, and spotlessse ostomy pouch on a course foundation, using expend equipment.
    • Rationale: Frequent pouch diversifys are chafing to the husk and should be abandoned. Emptying and rinsing the pouch succeeding a while the adapted breach not solely removes bacteria and odor-causing stool and flatus but as-well deodorizes the pouch.
  • Support extreme husk when gently removing arrangement. Exercise stubborn removers as implied, then rinse combined.
    • Rationale: Prevents edifice childishness or perdition associated succeeding a while “pulling” pouch off.
  • Investigate narrations of burning, lustful, or blistering environing stoma.
    • Rationale: Indicative of abundant leakage succeeding a while peristomal childishness, or maybe Candida poison, requiring agency.
  • Evaluate stubborn result and arrangement fit on ongoing foundation.
    • Rationale: Provides turn for whole solving. Determines insufficiency for elevate agency.
  • Consult succeeding a while cognizant mortify, ostomy, abstinence protect.
    • Rationale: Helpful in choosing results expend for unrepining’s detail rehabilitation insufficiencys, including cast of ostomy, physical/mental foothold, abilities to move stubborn-care, and financial media.
  • Apply corticosteroid aerosol ramification and prescribed antifungal powder as implied.
    • Rationale: Assists in salubrious if peristomal childishness abides and/or fungal poison unfolds. Note: These results can keep efficacious edge cheerfuls and should be used sparingly.
Other Reference:

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