Colostomy

Definition

A colostomy is the surgical creation of an opening (ie, stoma) into the colon. It can be created as a temporary or permanent fecal diversion. It allows the drainage or evacuation of colon contents to the outside of the body. The consistency of the drainage is related to the placement of the colostomy, which is dictated by the location of the tumor and the extent of invasion into surrounding tissues. With improved surgical techniques, colostomies are performed in fewer than one third of patients with colorectal cancer.

Providing Postoperative Care

Postoperative nursing care for patients undergoing colon resection or colostomy is similar to nursing care for any abdominal surgery patient, including pain management during the immediate postoperative period.

The nurse also monitors the patient for complications such as leakage from the site of the anastomosis, prolapse of the stoma, perforation, stoma retraction, fecal impaction, skin irritation, and pulmonary complications associated with abdominal surgery.

Providing Postoperative Care

The nurse assesses the abdomen for returning peristalsis and assesses the initial stool characteristics. It is important to help patients with a colostomy out of bed on the first postoperative day and encourage them to begin participating in managing the colostomy.

Providing Wound Care The nurse frequently examines the abdominal dressing

during the first 24 hours after surgery to detect signs of hemorrhage. It is important to help the patient splint the abdominal incision during coughing and deep breathing to lessen tension on the edges of the incision.

The nurse monitors temperature, pulse, and respiratory rate for elevations, which may indicate an infectious process. If the has a colostomy, the stoma is examined for swelling (slight edema from surgical manipulation is normal), color (a healthy stoma is pink or red), discharge (a small amount of oozing is normal), and bleeding (an abnormal sign).

Providing Wound Care

If the malignancy has been removed using the perineal route, the perineal wound is observed for signs of hemorrhage. This wound may contain a drain or packing, which is removed gradually. Bits of tissue may slough off for a week. This process is hastened by mechanical irrigation of the wound or with sitz baths performed two or three times each day initially. The condition of the perineal wound and any bleeding, infection, or necrosis are documented.

Monitoring and Managing Complications

The patient is observed for signs and symptoms of complications. It is important to frequently assess the abdomen, including decreasing or changing bowel sounds and increasing abdominal girth, to detect bowel obstruction.

The nurse monitors vital signs which may indicate an intra-abdominal infectious process. It is important to report rectal bleeding immediately because it indicates hemorrhage.

The nurse monitors hemoglobin and hematocrit levels and administers blood component therapy as prescribed.

Monitoring and Managing Complications

Any abrupt change in abdominal pain is reported promptly. Elevated white blood cell counts and temperature or symptoms of shock are reported because they may indicate sepsis. The nurse administers antibiotics as prescribed.

Pulmonary complications are always a concern with abdominal surgery; patients older than 50 years are at risk, especially if they are or have been receiving sedatives or are being maintained on bed rest for a prolonged period.

Two major pulmonary complications are pneumonia and atelectasis.

Monitoring and Managing Complications

Frequent activity (eg, turning the patient from side to side q 2h), deep breathing, coughing, and early ambulation can reduce the risk for these complications.

The incidence of complications related to the colostomy is about half that of an ileostomy. Some common complications are prolapse of the stoma (usually from obesity), perforation (from improper stoma irrigation), stoma retraction, fecal impaction, and skin irritation.

Leakage from an anastomotic site can occur if the remaining bowel segments are diseased or weakend. Leakage from an intestinal anastomosis causes peritonitis with abdominal distention and rigidity, temp elevation, and signs of shock. Surgical repair is necessary.

Irrigating the Colostomy

The purpose of irrigating a colostomy is to empty colon of gas, mucus, and feces so that the patient can go about social and business activities without fear of fecal drainage.

A stoma does not have voluntary muscular control and may empty at irregular intervals. Regulating the passage of fecal material is achieved by irrigating the colostomy or allowing the bowel to evacuate naturally without irrigations. The choice often depends on the person and the type of the colostomy.

Irrigating the Colostomy

By irrigating the stoma at a regular time, there is less gas and retention of the irrigant. The time for irrigating the colostomy should be consistent with the schedule the person will follow after leaving the hospital.