Question

Case study: Ostomy

A 55-year old man with a history of Crohn’s disease had a colostomy two weeks ago and is now in need of discharge teaching. The man lives alone and is concerned that he will not be able to care for the ostomy on his own. The nurse assesses the stoma and finds it is red at the stoma site, and the skin surrounding the stoma is pink-tinged. The man denies pain at the site, and other than being anxious about caring for himself, he appears in good spirits.

1. Identify the clinical problems in the case study.

2. Is the condition of the stoma of concern to the nurse?

3. The patient expresses that he will have to resign his membership to his local botanical gardens where he is a member of a walking club. He feels the long walks will delay his healing, and the odor from the ostomy will be embarrassing. He states he cannot risk the pouch falling off his skin, so he will only walk by himself now in his neighborhood. How should the nurse respond to the patient?

Answer 1

Colostomy

      A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is the opening in the skin where a pouch for collecting feces is attached.

Clinical problems

· Stoma site is red

· Skin surrounding the stoma is pink-tinged

· Pain at the site

· He is anxious

Is the condition of the stoma of concern to the nurse?

Yes. The nurse sees the patient before surgery to explain what will happen during the procedure, about the stoma and any changes to the body, and to educate the patient about practical care of the stoma.

How should the nurse respond to the patient?

The nurse should plan for discharge teaching. It includes;

· Take short walks on a level surface

· Wash the incision site with soap and water and pat it dry.

· Check the incision every day for redness, drainage, swelling, or separation of the skin.

· Take the medicines exactly as directed.

· Empty the pouch when it is ⅓ to ½ full. Do not wait until the pouch is completely full. This could put pressure on the seal and cause it to leak or spill.

· Ensure to drink plenty of fluids (6-8 glasses/day).

· Avoid gas forming foods. Learn which foods produce gas or odor, which cause diarrhea, and which produce constipation.

· Not to do heavy lifting or do strenuous activity for at least six weeks unless ordered by your surgeon. Walking is a good form of exercise and helps to tone up muscles.

· Once you have recovered your health, you may continue a normal daily routine as you did before the operation.