Component Task: Nursing Management of Colostomy and Ileostomy

This is the process of caring for a child with a stoma created at the anterior abdominal wall making the skin exposed to effluent. This is as a result of birth defect, injury or diseases related to the colon. It is necessary for a paediatric nurse to provide basic physical and psychological care to child and caregiver.

Aims

·         Prevent excoriation around the stoma

·         Provide psychological support

·         Ensure stoma is intact

·         Ensure effective elimination

·         Promote personal hygiene

Requirements

a.      Colostomy bag

b.      Sterile gauze

c.      Examination gloves

d.      Normal saline

e.      Topical medication/hypoallergenic/skin barrier cream

f.        Diaper

g.      Stoma measuring guide

h.      Plastic bag

i.         Water

j.         Mackintosh cape with towel

k.       Bedpan

l.         Antimicrobial solution (savlon)

Steps

1.        Establish rapport (Refer to steps)

2.      Explain procedure to patient in simple plain language (refer to steps) and use illustrations if possible

3.      Provide privacy

4.      Perform five moments of hand hygiene

5.      Nurse child in a desirable bed/cot

6.      Check and record baseline vital signs (temperature, pulse, respiration, blood pressure, pain, SPO2)

7.       Prepare items and send to bedside

8.      Pour normal saline into a receiver for cleaning

9.      Wear examination gloves

10.    Expose dressing on stoma to initiate stoma care

11.      Clean in and around stoma till effluent appears clean

12.    Inspect stoma for colour, prolapse, collapse, and oedema

13.    Assess skin around stoma for redness, breakdown or dry skin

14.    Apply topical ointment to prevent skin excoriation

15.    Measure size of stoma and cut stoma bag hole 1/8 inch wider than measured (if necessary)

16.    Fix stoma bag on stoma depending on how mobile the child is

17.    Allow base of colostomy bag face down or side if child is mobile or unconscious respectively

18.    Monitor intake and output in ileostomy

19.    Encourage the mother of the child with ileostomy to feed frequently to prevent dehydration

20.  Allow child to wear one piece loose waist undergarment and outfit to prevent child from pulling off and exerting pressure on the pouch

21.    Occupy child with toys during pouch change

22.  Start toilet training for bladder control at appropriate time as for any other child

23.  Encourage caregiver to change pouch always when halfway full

24.  Inform caregiver to provide child with adequate nutrition and avoid feeds likely to cause diarrhoea

25.  Involve child and caregiver completely in stoma care

26.  Teach caregiver home management of stoma

27.  Encourage caregiver to report if bleeding, prolapse, oedema of stoma is detected

28.  Provide child and caregiver continuous psychological support

29.  Express appreciation to child and caregiver

30.  Dispose off, decontaminate and clean used items

31.    Remove examination gloves

32.  Document findings manually/electronically


0 Comments

Search This Blog