A Colostomy is an artificial opening that is created as a means for evacuation of bowel contents in the event that the large intestine, otherwise known as the colon, is incapable of performing this function. A colostomy can be created for a number of reasons and they may or may not be temporary.In cases of colo-rectal cancer however, these colostomies are almost always permanent as sometimes the entire colon is removed.
It is considered rare for the nurse in the Philippines to encounter colostomies in his everyday nursing life. The mere creation of one requires a feasible amount of money and the majority of the people in the country do not have the means of having one, even though it is necessary for survival. Hence, the nurse does not encounter this in his everyday life and not all nurses are equipped with the knowledge and skills in handling these. When the time does come, however, that the nurse handles clients with these, how can the nurse successfully render care? Ostomy care is a nursing procedure and it is NOT delegated to unlicensed assist personnel so the nurse must always be prepared to render appropriate care.
Here are some guidelines that you, as a nurse, without any experience in colostomy care, may use:
1. Gather equipment
Rationale: It ensures that you have everything necessary to render colostomy care. Ensure that you have all the materials that you need based on the type of colostomy your client has.
2. Encourage clients to look at the stoma
Rationale: This encourages participation in stoma care. A drastic change in self-physical perception may occur in clients. Keep an open mind and maintain therapeutic communication at all times. Engage the client in care but do not pressure them.
3. Explain the procedure to the client
Rationale: This brings into light concerning things that your clients may have. Remain factual and answer all their queries with prompt and direct answers. Guide them throughout the procedure especially if they will have permanent stomas.
4. Provide privacy
Rationale: Privacy is very important especially if your client is to receive his first ostomy care. Remember that the ostomy has created an imbalance in your client’s self-perception. Do not underestimate that. Always provide privacy. Ask your client if he is comfortable doing this with significant others, or if he will need time to adjust first. Be sensitive to your client’s needs. You may ask the client if he wishes to do it in the bathroom so that he may see how it is done at home.
5. Perform hand hygiene and wear gloves
Rationale: Protects you and the clients as well. Gloves need not be sterile as the ostomies are unsterile and cater to fecal material.
6. Inspect the ostomy and determine the need for change of appliance
Rationale: Inspection will allow you to make a judgment. You may change the ostomy pouch if it is one-thirds full, of more frequently if the client desires or complains of skin irritation, which is very common with colostomies. Note for any leakage. Avoid changing ostomies during meal times, before and after meal times, or during visiting hours.
7. Assist the client to stand or sit
Rationale: Promotes better evacuation of stool and avoids wrinkles on the colostomy. Unfasten belts if clients wear one.
8. Empty the pouch and remove the ostomy skin barrier.
Rationale: Always empty the pouch through the bottom to prevent spillage of contents into the client’s skin. When removing the skin barrier, gently peel from top to bottom while holding the client’s skin tout in order to minimize discomfort. Always inspect the contents for color.
9. Clean and dry the stoma and the peristomal skin
Rationale: Promotes hygiene ad comfort for the client. Use a tissue to remove excess stool. When cleaning the stoma, use warm water and a clean washcloth. The use of “strong” soaps is discouraged as they promote dryness and are irritating to the stoma. If you use soap however, avoid moisturizing soaps as they interfere with the adhesiveness of the new skin barrier that is to be applied. Dry the area by patting, not by rubbing as it causes abrasions.
10. Place a piece of cloth or tissue over the stoma as it is being cleaned.
Rationale: Absorbs any sippage as stoma care is being actively done.
11. Prepare the skin barrier, the peristomal seal
Rationale: Ensures cleanliness and proper adhesion and appliance of a new skin barrier. Use the guide to measure the appropriate stoma size. On the back of the skin barrier, trace the appropriate stoma size and cut it, making sure that there is 1/8 to 1/4 allowance on the size to allow the stoma to expand when functioning.
12. Remove the adhesive backing to expose the sticky side. Place the skin barrier over the client’s skin and press for 30 seconds.
Rationale: The pressure and the heat from the skin will activate the adhesives of the skin barrier, successfully patching it to the skin.
13. Remove the tissue from the stoma and snap the pouch onto the skin barrier wafer.
Rationale: Provides attachment and ensures drainage of stool using a new, and clean skin barrier. Promotes comfort and allays anxiety.
Rationale: Do not forget to document all the nursing care you have rendered. It does not necessarily mean that you must document the procedure in a step by step fashion. Be selective and use your judgment.
Ostomy care is a very rare opportunity that the Filipino nurse encounters. Nonetheless, when the nurse does encounter this, he must have the knowledge and the skills to carry out the procedure with safety and precision. Always ensure that you are competent enough to perform any procedure that requires you. Remember, you were educated as a generalist nurse and ostomy care is in fact, a part of the Fundamentals of Nursing Practice. You must posses this skill, at all times.
Reference and Photo credits:
- Fundamentals of Nursing by Kozier and Erb 7th edition