Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.
The colostomy may be short-term or permanent.
Colostomy is done while you are under general anesthesia (asleep and pain-free). It may either be done with a large surgical cut in the abdomen, or with a small camera and several small cuts (laparoscopy).
The type of approach used depends on what other procedure done needs to be done. In general, the surgical cut is made in the middle of the abdomen. The bowel resection or repair is done as needed.
Nursing Assessment for Colostomy
- Stoma color (normal reddish color)
- Signs of bleeding (bleeding wound)
- Signs of inflammation (Dolor – Latin term for “pain”, Calor – Latin term for “heat”, Rubor – roomates in Latin means “Redness”, Tumor – a Latin term for “swelling”, Functio laesa – roomates in Latin means “injured function”, roomates can also mean loss of function)
- Position of stoma
Is there changes in fecal elimination:
- Consistency, odor, color stool
- Is there constipation / diarrhea
- Is stool properly accommodated.
- Is the patient able to take care of their own feces
Is there pain disorders:
- No pain / no
- The things that cause pain
- Quality of pain
- When pain arises (continuous / repetitive)
- Is the patient agitated or not
Is rest and sleep needs are met
- Sleep well / not
- Is stoma disrupt sleep / no
- Is there environmental factors make it difficult to sleep
- Is there psychological factors complicate sleep
How does the concept of patient self
- How patients’ perception of: identity, self-esteem, ideal self, self-image and role
Is there any nutritional deficiencies:
- How appetite client
- Normal weight or not
- How the eating habits of patients
- Foods that cause diarhe
- Foods that cause constipation
Is a patient’s open?
- Will patients express the problem
- Can the patient adapt to the environment after learning his body parts removed
Assess client needs sexual needs:
- Ask about the sexual needs of the client
- Wife / husband to understand the state of the client
Nursing Diagnosis for Colostomy
1. Risk for Impaired Bowel Elimination (konstipasi atau diare) related to related to the possibility of an unbalanced diet.
2. Acute Pain related to the mechanism of skin disorder caused by surgery.
3. Disturbed Sleep Pattern related to the fear of the state of the stoma.
4. Risk for Americans through imbalanced Nutrition Less Than Body Requirements related to ignorance against the needs of food.
5. Self-concept disturbance related to not be able to adapt to the stoma and anatomical changes.
6. Risk for Impaired Skin Integrity related to skin contamination with feces.
7. Sexual dysfunction related to changes in body structure.
8. Risk for Infection related to the contamination of the wound with feces.
9. Anxiety related to fear of isolation from others.
10. Activity Intolerance related to clients feel scared to do the activity because of the stoma.
Nursing Interventions for Colostomy
1. Patients can defecate regularly:
Avoid eating foods laxative effect.
Avoid eating foods that cause constipation (hard food).
Collaboration with nutrition experts with regard to the food menu.
Control food brought from home.
Give drink enough (2-3 liters / day).
Regular diet (3 times daily).
2. The pain can be reduced by:
Record the medication administration during intra operative.
Evaluation of pain and its characteristics.
Give the client’s understanding that pain is accepted as a reasonable to a certain extent.
Give analgesics as an act of collaboration.
3. Clients can sleep / rest enough:
Explain, stoma will not open during sleep.
Observe environmental factors that make it difficult to sleep.
Observe the psychological factors that make it difficult to sleep.
4. Nutritional needs are met:
Working closely with a nutritionist for a food menu.
Provide adequate nutrition as needed.
Give motivation to not be afraid to spend their food.
5. No disruption of self-concept:
Give the spirit of encouragement.
Avoid foreign stance on the state of the patient’s illness.
Point your clients to care for themselves.
Give an explanation so that the client can accept the situation and adapt to the stoma.
Avoid behaviors that make patients offense (anger, disgust, etc.).
6. Sexuality needs can be met:
Give an explanation that the client may have sexual intercourse with the fair.
7. No disruption of skin integrity:
Perform better treatment techniques (net).
Protect your skin with a protective skin (vaseline / skin barrier) around the stoma.
Put the pad (gauze) which can absorb the flow of feces.
8. To avoid secondary infection:
Perform aseptic and antiseptic action on stoma
Teach clients about personal hygiene and stoma care
9. To avoid anxiety:
Give the belief that the client is able to adapt to the environment (society).
10. Clients are not afraid to do the activity
Provide a description of the problem should not be performed activities (sports soccer, ran).
When the stoma bag will do the activities given buffer (belts).