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Registered Nurse (RN)
Fundamentals of Nursing
Bowel Elimination
Colostomy Care

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Colostomy Care

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Ileostomy Care

Colostomy Care

Colon-star-mouth Care
A colostomy is a surgical procedure that brings a portion of the colon through the abdominal wall and creates an opening called a stoma. Instead of elimination through the anus, intestinal contents empty through the stoma. Colostomies are indicated for patients unable to maintain the normal elimination route. Colostomy care is critical to prevent skin breakdown and infection. After washing the stoma with warm water, the appliance should be cut 1/8 inch wider than the stoma prior to application to decrease skin irritation. The bag should be emptied when it's 1/3 to 1/2 full and changed every 3-7 days. Considerations include low fiber diet, antibiotics, and daily irrigation.
Wash with Warm Water
Washing with Warm Water

Since intestinal contents may irritate the surrounding skin, the patient's stoma should be washed with warm water. A very mild soap should be used, since oil-based or fragrant soaps may cause skin irritation. The soap should be rinsed off the area thoroughly well to prevent skin irritation. Cold water is avoided because it may lead to cramping.

Cut 1/8 inch Around Stoma
1/8 Cut Around Star-mouth

The hole of the appliance surrounding the colostomy pouch should be cut 1/8 inch wider than the stoma. The additional room around the stoma prevents constriction of the skin opening.

Decreases Skin Irritation
Down-arrow Skin-suit-man Irritated

A colostomy in the ascending and transverse colon has semiliquid stools, while a colostomy in the sigmoid or descending colon has semi-formed or formed stools. Since drainage is frequent and extremely irritating to the skin, the stoma should protrude at least 1 cm to minimize seepage leading to altered skin integrity.

Empty When 1/3 to 1/2 Full
1/3 and 1/2 Full bags need to be Emptied

Full Leakage of intestinal contents will cause skin breakdown and infection. Empty the pouch when it becomes 1/3 to 1/2 full to prevent leakage.

Change 3-7 Days
Changing Bag in (3) Tree with Lucky (7)

Many patients with a colostomy are unable to establish regularity and must wear a pouch at all times. An open-ended pouch is recommended for easy drainage. The pouch is changed every 3-7 days. If the pouch leaks, it should be immediately removed and replaced with a new colostomy bag.

Avoid Odor Causing Foods
Avoid-sign with Odorous Foods

To minimize gas and body odors, instruct the patient to avoid odor causing foods. Foods that may cause odor include dried beans, asparagus, fish, cabbage, onions, cheese, and eggs. Certain vitamins and medications may also cause odor.

Irrigate at Same Time
Irrigation-ditches with Same Time

The patient's colostomy should be irrigated at the same time every day to help stimulate emptying of the colon. Irrigating and emptying the colon on a regular basis will prevent stool elimination in between irrigation sessions. Regularity may allow the patient to only need to wear a pad or small pouch over the stoma instead of a bag. A colostomy in the sigmoid or descending colon may be regulated using the irrigation method. However, a pouch should be readily available in case the patient develops diarrhea from food or illness.


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