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[colon + -stomy]
The opening of a portion of the colon through the abdominal wall to its skin surface. A colostomy is established in cases of distal obstruction, inflammatory process, including perforation, and when the distal colon or rectum is surgically resected. A temporary colostomy is performed to divert the fecal stream from an inflamed or operative site.
COLOSTOMY SITES ; SEE: ostomy for colostomy care
Preoperative: When the possibility exists that a patient will need to have a colostomy created (even when surgery is performed in an emergency), the patient and family are advised about the nature of the colostomy, including temporary versus permanent stoma and general principles of aftercare. The patient is assured that he or she will be able to resume a normal lifestyle with a stoma. A stomal therapist works with patient and family throughout this experience. Except in an extreme emergency, e.g., perforation, penetrating trauma, etc., preparation for colon surgery with laxatives, enemas, and antibacterial agents is coordinated with the surgery's starting time. Intravenous hydration is instituted.
Postoperative: Routine care, including the use of various monitors, pneumatic hose, incentive spirometry, and pulmonary toilet measures, along with special attention given to inspecting the stoma for viability and the surrounding skin for irritation and excoriation. The stoma should be smooth and cherry red, and may be slightly edematous. Any discoloration or excessive swelling is documented and reported. The stoma and surrounding skin are gently cleansed and dried thoroughly. A drainage bag is applied by fitting a karaya adhesive ring (or other appliance) before the patient leaves the operating room to ensure a firm seal and to prevent leakage without constricting the stoma. Nonirritating skin barriers are used as appropriate.
Avoidance of dehydration and maintenance of electrolyte balance are emphasized until the patient is able to eat a normal diet. Stool consistency is observed. If colostomy irrigations are prescribed, the patient is advised that the procedure is similar to an enema. The patient is advised to return to a normal diet judiciously, adding new foods gradually while observing their effect. He or she should avoid gas-forming, odoriferous, spicy, and irritating foods. Colostomy requires a difficult adjustment by both patient and family; they are encouraged to verbalize their fears and concerns, and support is offered. The patient is reassured of the ability to regain continence with dietary control and bowel retraining. Usual physical activities should be gradually resumed, avoiding heavy lifting and activities that could cause injury to the stoma and surrounding tissues. Abdominal muscle strengthening should be part of a supervised exercise program. Both patient and partner are encouraged to discuss their feelings and concerns about body image changes and about resumption of sexual relations, and they should be assured that the appliance will not dislodge if empty. The patient should avoid food and fluids a few hours before sexual activity. Participation in a local “ostomates” support group help the patient and significant others to manage the stoma and associated concerns. Depression is not uncommon after ostomy surgery, and psychological counseling is recommended if depression persists.
SEE: Nursing Diagnoses Appendix