COLOSTOMY

By:
Maria Silvana Dhawo
 Learning Objectives
At the end of the session, the students should be able to:
• Understanding the tenses’ structure by answering the
exercise 1
• Understanding the text about colostomy by determining
correct phrases in exercise 2
• Determining the nursing care plan for the patient in
exercise 3
 Exercise 1
A colostomy is an operation which allows .............. (faecal, a
faeces, faeces) to exit the body either after the rectum
.......................... (has been removed, is removing, removal) or if
the rectum has to be bypassed. The surgeon makes an
operating ...................... (in, on, at) the abdomen and ..............
(attachment, attaches, attaching) the colon to it. A temporary
colostomy may be ................. (made,did,do) to allow the rectum
time .................. (to heal, healing, heal) from injury or surgery.
 Exercise 1
Before .................. (making, doing, taking) surgery on the
rectum a bowel or rectal wash-out is usually done. This is
when fluid is introduced .............. (on, via, at) a tube ................
(into, by, with) the rectum. The fluid is then .............. (siphon, to
siphon, siphoned) off in order to help empty the rectum. A
bowel wash-out is also ................ (do,did,done) before special
radiological examinations and in certain cases of impacted
faeces.
PATIENT CARE PLAN

Patient: Mrs Pauline Greene

DOB: 7.5.48
Problems: Prepare for theatre

Mrs Pauline Greene was admitted to the

surgical ward on 15 February (15/2) and
scheduled for a colostomy on 18 February
(18/2). This is her patient care Plan:
 PATIENTS CARE PLAN
Eating and Drinking:
Potential probs of
dehydration due to above
Work and Play: Anxious
about effect of stoma on
home and social life. To
involve family member in
care.
Objectives/Goals:
• Minimise risk of post-op,
wound infection from
bowel contents.
• Allow surgeons clear
access to operation site,
i.e. Free from faeces.
• Complete pre-op care
schedule.
• Encourage patient to
voice worries.
 PATIENT CARE PLAN
Nursing Intervention:
• Rectal wash-out before bedtime for three days (daily).
• Purgatives as prescribed.
• Low-residue light diet 15/2.
• Fluids only including soup and ice cream 16/2
• Clear fluid only 17/2.
• Nil by mouth from 00.00 hours 18/2
• Standard pre-op, procedure.
• Ensure variety of acceptable drinks
• Mrs Potter (ex-ostomy patient) to visit 16/2
• Staff nurse to see Mr and Mrs Greene 17/2 to discuss potential practical
probs at home.
 Exercise 2
Identified Needs/Problems
• Mrs Greene is suffering from dehydration.
• Mrs Greene is dangerously close to becoming dehydration.
• There is a danger that Mrs Greene will become dehydrated.
• Her preparation for theatre is a cause of dehydration.
• Mrs Greene is worried about life after the operation.
• Mrs Greene is anxious about living through the operation.
• Mrs Greene is anxious about the effect of the stoma on her ability to do
sports.
• Her family should help out with nursing during her stay in hospital.
 Exercise 2
Objectives/Goals:
• The patient’s bowel may infect the wound.
• The patient has a bowel infection.
• The surgeon will clear the operation site of faeces.
• It is best not to upset the patient by discussing the
operation.
 Exercise 2
Nursing Intervention
• Before the operation, Mrs Greene will receive three rectal
wash-outs every day.
• On 15 February, Mrs Greene should have only fluids.
• She can have ice cream on the day of the operation.
• It is important to keep Mrs Greene away from exostomy
patients.
• Mrs Potter is a nurse.
• A member of the medical staff will give Mrs Greene advice after
the operation.
 Exercise 3
Mrs Foster went for an operation and when she returned to
the ward at 14:00 she was still recovering from the
anaesthetic and there was a potential problem of respiratory
obstruction. Nurses were instructed to make regular
observations of the patient’s TPR, to lie the patient in the left
lateral position and to take immediate action if her airwa
became obstructed. Shock could result from decreased
volume of circulating blood because of haemmorage and fluid
loss and it was important to maintain fluid volume.
 Exercise 3
IVI was in progress when she arrived on the ward. 500 ml of
dextrose 5% until 15:00 and then 500 ml normal saline
solution over the following four hours.
At 17:00, Mrs. Foster woke and said she was “in absolute
agony”. The first dose of Omnopon (15 mg) was given and the
patient repositioned to keep her as free from pain as possible.
Mrs Foster was prescribed 25 mg of Omnopon every 4 hours.
 Exercise 3
The patient was helped to sit on a bed-pan at 18:00. She was
experiencing some discomfort from retention of urine and
when this repeated an hour later she was catheterised,
producing 200 ml of urine.
 Time Problems/Needs Nursing Intervension
• 14:00
• 17:00
• 18:00
• 19:00
 REFERENCE

Lukito.2009.Build Up your English Reading Skill.

Yogyakarta:Kanisius