Preparing the Patient for Colostomy Care: A Lesson Well Learned
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E ducation can be defined as experience that results in a change of behavior in some desired direction. Adults are strongly motivated to learn only when they perceive a possible application in their own lives.1 Education is a vital role of the nurse, particularly regarding colostomy care. Providing instruction on proper technique for changing a pouch system, as well as some important things to look for during the procedure, will help prevent problems and make living with a colostomy a bit more manageable. One patient's experience offered the opportunity to acknowledge the key points for patient education in this situation.
At the age of 78, Mrs. J had a new colostomy and no one to help her manage it once she went home. She had been admitted from a local hospital to a skilled nursing facility. After some preliminary questions and answers regarding what she knew and how she felt about this new aspect of her life, she was given written material to review in preparation for learning self-care techniques.
A new ostomate such as Mrs. J has many educational needs. Initially, she was taught how a colostomy works, different types of colostomies, and how and when to empty the pouch. She will acquire knowledge about how certain foods may affect the function of her colostomy, how gas as seen as air in the pouch can be managed, and how her lifestyle may need to be altered somewhat regarding clothing, travel, and her social life.
Measuring the Stoma and Applying the Correct Wafer Size
To prevent skin problems and stool leakage from the pouch system, the wafer must fit properly onto the peristomal skin. In order to accomplish this, the opening in the wafer must be 1/8-inch larger than the stoma. Two types of wafers are available. The pre-cut wafer is already cut to the correct size for the opening around the stoma. Usually, this type is recommended once the stoma has stopped changing size (usually 6 to 8 weeks after surgery); it can be of great benefit for a person who is unable to cut the wafer (eg, due to arthritis or poor coordination). To use the pre-cut wafer, the patient or caregiver needs to measure the size of the stoma using the measuring guide found in most commercially prepared wafer products, keeping in mind the opening needs to be 1/8-inch larger than the stoma. The size is selected and applied without making any changes to the wafer.
The cut-to-fit wafer needs to be cut to the correct size before use. The person can size the wafer each time a new one is applied, allowing for more accuracy regarding the stoma opening with each application. To use this wafer, the patient needs to determine the size of the stoma using the measuring guide. The selected hole size of the measuring guide is centered on the wafer. The patient or caregiver traces the hole on the wafer in the center of the flange with a marking pen. The wafer is cut along the pen marking as the guide, adjusting for irregular areas of the stoma.
Another wafer option is the convex style. If the stoma is flush or retracted, the use of convexity will help achieve a better wafer adherence. The convex wafer presses into the tissue around the stoma, which increases the degree of stomal protrusion and reduces the risk of undermining. Disposable wafers are available with convexity that ranges from shallow to deep. Convex inserts (plastic rings that fit inside the flange of the wafer) are sized according to the stoma assessment.
Assessing the Stoma and Peristomal Skin
The stoma and peristomal skin need to be assessed for abnormalities and treated according to the findings. Assessment of these areas should note the following:
* Color and turgor of the stoma. The stoma should be red and moist. A pale pink may indicate low hemoglobin and a dark red may indicate bruising, or ischemia (especially immediate post-op) (see Figure 1).
1. Gillies DA. Nursing Management: A Systems Approach. Philadelphia, Pa: W.B. Saunders Co.; 1982.
2. Hampton B, Bryant R. Ostomies and Continent Diversions: Nursing Nanagement. Philadelphia, Pa:Mosby Year Book; 1992.
3. ConvaTec patient education guide for living with an ostomy. Princeton, NJ: ConvaTec; 1992. Additional Resources The First Step: A Book of Colostomy Patients and Families. Lincoln, Neb: Hospital Educators Resource Catalogue Inc; 1989. Managing Your Colostomy (Video). Libertyville, Ill.: Hollister, Inc.; 1993. Mullen B, McGinn K. The Ostomy Book: Living Comfortably with Colostomies, Ileotomies and Urostomies. Paolo Alto, Calif.: Bull Publishing Co.; 1992. Turnbull G. Ostomy products are not created equally. Ostomy/Wound Management. 2002;48(2):12.