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In a colostomy. y . After a colostomy. feces leave the patient's body through the abdomen. depending on the reasons for its use. which is drawn out through the incision and sutured to the skin. leaving the patient with an opening on the abdomen called a stoma. y Colostomy irrigation is the introduction and drainage of volume of fluid to and from the colostomy. A colostomy may be permanent or temporary. the stoma is formed from the end of the large intestine.Introduction A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall.
Human Digestive System .
y . y To cleanse the lower gastrointestinal tract in colostomy irrigation. y To establish a regular pattern of evacuation.Purpose To stimulate peristalsis. y To control odor from the colostomy. gas or mucus from the colon. y To evaluate feces.
Equipment and Supplies y y y y y y y y y y Irrigating can or enema bag Irrigation solution: 500-1000 ml Normal Saline Solution Connecting tube with clamp Rubber catheter fr. 22-24 Irrigating sleeve/sheath (colostomy bag) Water soluble lubricant Tissue wipes Emesis basin Bedpan Receptacle for soiled dressing and disposable pouch .
y Rationale To prevent spillage of feces and control odor.Procedure Suggested Actions 1. . To prevent introduction of air into the colon which could cause abdominal cramps. Apply irrigating sleeve or sheath to y stoma. Never force the catheter. Gently insert lubricated catheter y into stoma for 3-4 inches and hold firmly in place. 2. To prevent perforation of the colon. To help relax the colon and facilitate insertion of catheter. If catheter does not advance easily. y allow solution to flow while inserting the catheter. 3. Expel air from the tubing and catheter. 4. Insert well the lubricated gloved finger. commode or toilet bowl. Place end over the bedpan. To check for stoma structures and to dilate the stoma.
y maybe increase up to 1000 ml with subsequent irrigations 7. If patient y experiences cramps. 6. Hold the catheter in place. stop flow of solution for few minutes before progressing. Allow drainage of solution for 1015 minutes.Procedure Suggested Actions 5. y Rationale To prevent painful cramps. feces and flatus adequately. 8. To have effective result of the procedure. To expel water. Initial volume of solution is 500 ml. Allow fluid to flow for 5-10 minutes. Introduce solution slowly. . after instillation of solutions. and then remove slowly and gently.
Change colostomy bag. y Reaction of patient to the procedure y Rationale To protect the skin from irritation.Procedure Suggested Actions 9. . Discard contaminated articles aseptically. Encourage ambulation if possible. dry the area. Clean the skin around the stoma. y Character and amount of fecal drainage. y To further stimulate peristalsis and complete irrigation return. 12. 11. 10. Record the following: y Time the procedure was done.
the clients usual daily bowel movement. . Select a convenient time for the procedure. Utilize the treatment time of irrigating colostomy as the learning time for the patient to manage his colostomy independently. Warm the solution to body temperature to enhance peristalsis and prevent abdominal cramps.Special Consideration y y y y y Provide privacy and psychosocial support and comfort. Hang irrigating can 18-20 inches above the stoma (shoulder level when sitting).
y . y Place in upright position ² may sit on commode or toilet bowl. irrigate the colostomy more than once a day.Special Consideration Lubricate the catheter before insertion to prevent trauma. y The client should never use more than 1000 ml. may be placed in lateral position (depends on location of colostomy). or irrigate the colostomy if diarrhea is present. If unable to sit upright.
The skin around the stoma should be clear. y . y The pouch should be changed every 4-5 days or when leakage occurs. without evidence of irritation. y Teach the client the proper application of pouch to the stoma.Special Consideration Minimize flatus by using odor-proof pouches and pouches with charcoal filter and limit eating gas forming foods. A healthy stoma is red and slightly raised.
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