Transcript الشريحة 1

Colostomy
WHAT IS STOMA
It is an artificial
opening from the
intestine on the
abdominal wall
usually created by a
surgeon
colostomy
Colostomy refers to a surgical procedure where a portion
of the large intestine is brought through the abdominal wall
to carry stool out of the body.
It may be permanent or temporary.
Indication
A colostomy is created as a means
to treat various disorders of the large
intestine,
including
cancer,
obstruction,
inflammatory bowel disease,
ischemia (compromised blood
supply),
or traumatic injury.
In a baby or child
it may be due to an imperforate
anus which is the absence of an
anal opening.
It also may be due to
Hirschsprung’s Disease,
or it may be due to other
malformations that are present at
birth
complication
Potential complications
of colostomy surgery
include
1-excessive bleeding
2-surgical wound
infection
3-thrombophlebitis
(inflammation and
blood clot to veins in
)the legs
Stomal complications to be •
monitored include
Death (necrosis) of stomal •
tissue. Caused by
inadequate blood supply,
this complication is usually
visible 12-24 hours after
the operation and may
require additional surgery
2-Retraction (stoma is flush with the •
)abdomen surface or has moved below it
3-Prolapse (stoma increases length above the surface
of the abdomen
3-Stenosis (narrowing at the opening of the stoma).
Often associated with infection around the stoma or scarring
There are four main types of colostomies .
named after the portion of the bowel where
the colostomy is located.
An Ascending •
colostomy is located
within the ascending
colon.
A Transverse •
colostomy is located
within the transverse
colon.
A Descending •
Colostomy is located
within the descending
colon.
A Sigmoid Colostomy is •
located within the
sigmoid colon.
Preparation
1-The patient will be required to sign a consent form
after the procedure is explained thoroughly.
2-Blood and urine studies,
3-x rays and an electrocardiograph (EKG), may be ordered as the doctor
deems necessary.
4-In order to empty and cleanse the bowel, the patient may be placed on a
for several days prior to surgery. A liquid diet may be ordered for at least
the day before surgery, with nothing by mouth after midnight.
5-A series of enemas may be ordered to empty the bowel of stool.
6-Oral anti-infective (neomycin, erythromycin, may be ordered to
decrease bacteria in the intestine and help prevent post-operative
infection.
7-A nasogastric tube is inserted from the nose to the stomach on the day
of surgery or during surgery to remove gastric secretions and prevent
nausea and vomiting.
8-A urinary catheter (a thin plastic tube) may also be inserted to keep the
bladder empty during surgery, giving more space in the surgical field and
.decreasing chances of accidental injury
Aftercare •
-Monitoring of blood pressure, pulse, respirations, and temperature.
-The patient is instructed how to support the operative site during deep
breathing and coughing, and given pain medication as necessary.
-Fluid intake and output is measured, and the operative site is observed for
color and amount of wound drainage.
-The nasogastric tube will remain in place, attached to low intermittent
suction until bowel activity resumes.
-For the first 24-48 hours after surgery, the colostomy will drain bloody
mucus.
-Fluids and electrolytes are infused intravenously until the patient's diet is
can gradually be resumed, beginning with liquids.
-Usually within 72 hours, passage of gas and stool through the stoma
begins. Initially the stool is liquid, gradually thickening as the patient
begins to take solid foods.
-The patient is usually out of bed in 8-24 hours after surgery and
.discharged in 2-4 days
-A colostomy pouch will generally have been placed on the patient's
abdomen, around the stoma during surgery.
-During the hospital stay, the patient and his or her caregivers will be
educated on how to care for the colostomy.
Regular assessment to the skin surrounding the stoma is important.
Pouching systems are classified as
TWO-PEECE;
ONE-PIECE
STANDARD CLOSED-END POUCH
WITH FILTER
DRIENAINABLE POUCH WITH FILTER
Requirements:
A new appliance.
warm water.
soft tissues or gauze
wipes.
disposable bag.
Changing the appliance:
wash your hands.
remove the old appliance carefully from the top
down and avoid dragging the skin.
wash the stoma and surrounding skin, gently
removing all waste.
place prepared appliance over stoma.
spend a few minutes moulding flang to skin.
do not forget to attach the clip (drainable bag)
place the empty old appliance in the disposal
bag
wash your hands.
Types of foods can I eat after a colostomy
People with colostomies can eat a regular diet.
Choose healthy foods from all the food groups
To avoid constipation, eat foods such as oatmeal,
whole-grain breads and cereals, fruits and vegetables
You may want to avoid foods that cause gas and odor. Some foods that may
cause gas
and odor are vegetables such as broccoli, cabbage, and cauliflower.
Other foods include beans, eggs, and fish. You can also reduce gas by eatin
slowly and not using straws to drink liquids.
Foods that may help to control odor and gas in some people are fresh
parsley , yogurt and buttermilk