RUFAIDA COLLEGE OF NURSING

LESSON PLAN
ON

COLOSTOMY CARE

Submitted To Submitted By
MR. NASEEM. M MS. DEEPTI KUKRETI
NURSING TUTOR M.SC(N) 1ST YEAR
RUFAIDA COLLEGE OF NURSING RUFAIDA COLLEGE OF NURSING

Submitted On
19-11-18
GENERAL INFORMATION

Name of the student teacher : Ms. Deepti Kukreti

Topic : Colostomy care

Group : Peer group

Venue : Classroom

Time duration : 1 hour

Size of group : 13

Subject : Advance nursing practice

Method of teaching : Lecture cum discussion and demonstration

Av aids : Charts, PPT

Name of the supervisor : Mr. Naseem. M

Previous knowledge of the group : The group had studied colostomy care in their undergraduate studies.
GENERAL OBJECTIVES

 According to student point of view:

At the end of the class, the students will gain in-depth knowledge about the topic.

 According to student teacher point of view

At the end of class, the student teacher will gain confidence and improve her skills

while delivering lecture.

SPECIFIC OBJECTIVES

After the class students will be able to understand the topic and apply this in clinical area.
 LEARMING AND
TIME SPECIFIC CONTENT TEACHING EVALUATION
OBJECTIVE ACTIVITY

2min To Introduce the topic to Colostomy is an opening,

the group. called a stoma in the large
intestine brought to the
surface of the abdomen
for the purpose of
evacuation of bowel.
Stools moving through the
intestine drain through the
stoma into a bag attached
to the abdomen.

1/2min To announce the topic Today I am going to

discussed the topic on
colostomy care.

2min To define colostomy. DEFINITION OF COLOSTOMY

The student teacher Define colostomy ?
 Colostomy is a surgical procedure that brings one end of the defines colostomy.
large intestine out through an opening (stoma) made in the
abdominal wall.
5min To illustrate the types of TYPES OF COLOSTOMY The student teacher What are the types of
colostomy. illustrate the types of colostomy?
1. Temporary and permanent colostomy colostomy.
2. Wet colostomy and dry colostomy

Temporary and Permanent colostomy

Temporary colostomy is done to relieve an obstruction which can be
corrected by resection of the bowel or to divert the faecal stream to
permit healing of a portion of the bowel.

Permanent colostomy is usually performed in conjunction with an

abdomino-perineal resection. after the sigmoid colon is resected, the
proximal end is brought out through the abdominal wall and sutured
it to form a permanent opening for the elimination of the faeces.

Wet colostomy and Dry colostomy

Wet colostomy refers to an opening of the right side where the faecal
content is liquid.

Dry colostomy refers to an opening of the left side of the colon where
the faecal content is usually soft and formed.

According to stoma site:-

3. Transverse
 Loop
 Double Barrel

4. Ascending
5. Descending
6. Sigmoid

Transverse Colostomies
 The transverse colostomy is in the
upper abdomen, either in the middle or
toward the right side of the body.
 This type of colostomy allows the
stool to leave the body before it reaches the
descending colon.
Loop Colostomy
 The loop colostomy may look
like one very large stoma, but it has 2
openings.
 One opening puts out stool,
the other only puts out mucus.

Double-Barrel Colostomy
 In a double-barrel colostomy
the surgeon divides the bowel completely.
 Each opening is brought to the
surface as a separate stoma.
 The 2 stomas may or may not be
separated by skin.
 one opening puts out stool and
the other puts out only mucus (this smaller stoma is called a mucus
fistula).

Ascending Colostomy
 The ascending colostomy is
placed on the right side of the belly.
 Only a short portion of colon
remains active. This means that the
output is liquid and contains many
digestive enzymes.
 A drainable pouch must be
worn at all times, and the skin must be
protected from the output.
Descending And Sigmoid Colostomy
 In the descending colon, the
descending colostomy is placed on the
lower left side of the belly.
 Most often, the output is firm
and can be controlled.
 A sigmoid colostomy is the most
common type of colostomy.
 It’s made in the sigmoid colon,
And located just a few inches lower than
a descending colostomy.
 Because there’s more working colon, it may put out solid
stool on a more regular schedule.
 Both the descending and the sigmoid colostomies can have a
double-barrel or single-barrel opening.
 The single-barrel, or end colostomy, is more common.
 The stool of a descending or sigmoid colostomy is firmer
than the stool of the transverse colostomy.

TYPES OF COLOSTOMY POUCHES

1. Drainable poches

 Drainable pouches are generally use when the output will

need to be drained frequently, e.g. ileostomies.
 Special drainable pouches with outlet are used for urostomies.

2. One-piece pouches

 One-piece pouches, as the name suggests, are all in one

piece i.e. the whole thing is removed when the pouch is
changed.

3. Two-piece pouches
 Two-piece pouches available for all types of stoma have a
separate base plate flange to which a pouch is fitted.
 The base plate flange is left in place on the abdomen, with a
new pouch fitted when necessary. Every 2-4 days the base
plate flange will need to be changed too.
3min To discuss the indication INDICATION The student teacher What are the indication
for colostomy. 1. Colon Cancer discuss the indication for for colostomy.
2. Hirschsprung’s Disease colostomy.
3. Ulcerative Colitis
4. Polyps in Intestine
5. imperforate anus or other birth defects
6. irritable bowel syndrome
7. Diverticulitis
8. Colonic Polyps
9. Blockage or injury

2min To list down the purposes PURPOSES The student teacher list What are the purposes
of colostomy care. down the purposes of of colostomy care?
1. Skin protection & care colostomy care.
2. Receptacle for drainage
3. Patient acceptance & self care.

5min To enlist the articles ARTICLES FOR COLOSTOMY CARE The student teacher enlist Enlist the articles
required for colostomy the articles required for required for colostomy
care. A clean tray containing:- colostomy care. care?
• Mackintosh with draw sheet Gauze pad/tissue paper
• Skin barrier
• Pair of clean gloves
• Colostomy bag
• NS/Basin with warm tap water
• Gauze pieces
• STOMA measuring guide
• Pen or pencils & scissors
• Bed pan
• Kidney tray/paper BAG

2min To explain the assessment ASSESSMENT The student teacher What is the assessment
for colostomy care. explain the assessment for for colostomy care?
colostomy care.
1. Identify the type & location of ostomy in the patient.
2. Assess the skin integrity around the stoma and appearance.
3. Note the amount and character of faecal material in pouch.
4. Signs of healthy stoma.
15min To explain the procedure PROCEDURE The student teacher What is the procedure
of colostomy care. — Arrange the all necessary articles. explain the procedure for for colostomy care?
— Explain the procedure to the patient. colostomy care.
— Provide privacy and assist patient to a comfortable position.
— Wash hands & wear gloves to prevent infection.
— Spread Mackintosh & draw sheet to protect linen.
— Remove used pouch & skin barrier gently by pushing the skin
away from the barrier.
— Reduces trauma, jerking, irritates skin and can cause tear.
— Remove clamp and empty the contents into the bed pan.
Rinse the pouch with tepid water or normal saline to
minimize the odour & growth of microbes.
— Discard the disposable pouch in paper bag.
— Observe stoma for colour, swelling, trauma,& healing.
— Stoma should be moist and pink.
— Cover the stoma with a gauze piece to prevent the
faecal matters from contacting with skin.
— Clean stomal region gently with warm tap water
using gauze pad.
— Do not scrub the skin, dry completely by patting the skin with
gauze.
— Remove gauze and clean stoma with gauze and pat dry.
— Measure the stoma using measuring guide.
— Ensures accuracy in determining correct pouch size needed.
— Trace same circle behind the skin barrier, using scissors, cut
an opening 1/16th to 1/8th inch larger than stoma before
removing the wrapper over adhesive part.
— Put skin barrier and pouch over the stoma, and gently press
on to the skin, for 1-2 minutes.
— To prevent irritation to skin.
— Use the pouch if it is drainable using a clamp or clip
— Remove gloves and wash hands.
— Make the patient comfortable.
— Clean the area and replace all articles.

DOCUMENTATION
— Record the procedure with following details (with date &
time)
 Amount,
 colour,
  and consistency of the faecal matter in the pouch.

7min To explain the guidelines GUIDELINES FOR COLOSTOMY CARE The student teacher What are the guidelines
for colostomy care. explain the guidelines for for colostomy care?
— Keep odour as free of odours as possible. colostomy care.
— Ostomy bag should be emptied frequently.
— Check the stoma regularly, the colour should be dark pink to
red and moist.
— Pale colour indicates anaemia.
— Dark or purple blue indicates compromised circulation.
— Size of the stoma stabilizes 6-8 weeks.
— If dressing, check frequently for drainage and bleeding.
— Keep the skin around the stoma (peristomal area) site clean
and dry.
— If not it causes skin irritation and infection.
— Intake and output chart must be recorded for every 4 hours.
— Encourage the patient to participate in care and to look at the
ostomy.
— Can help the patient by listening, explaining, being available
and supportive.
— Encourage the patient to avoid fibre rich diets.
— Encourage the patient to drink fluids.
— Educate the patient about the various methods of odour
control measures.
— Chlorophyll rich diet will deodorise the faeces.
— Direct contact sports and heavy lifting must be avoided.

1/2min To summarize the topic. SUMMARY

Today I discussed about
cord prolapse and cord
presentation, its types,
incidence rate,
etiology/risk factors,
diagnostic evaluation,
management and further
complication of cord
prolapse.
1/2min To conclude the topic CONCLUSION
Cord prolapse is a
frightening and life-
threatening event that
occurs in labour. Rapid
identification and
immediate appropriate
response may well save
the life of a neonate.
Therefore, clinicians
should be knowledgeable
in its recognition and
management.

BIBLIOGRAPHY

 Sr. Nancy, Principle & Practice Of Nursing, Volume-2, 4th

edition, N.R Brothers,213-124.
 https://www.slideshare.net/katteysquare/colostomy care
 www.slideshare.net/fasikab/colostomy care
 www.wikipedia.com