Question

Which skills does the nurse teach a patient with a new colostomy before discharge from the hospital? (Select all that apply.) a. How to change the pouch b. How to empty the pouch c. How to open and close the pouch d. How to irrigate the colostomy e. How to determine whether the ostomy is healing appropriately

Short answer

The nurse should teach the patient with a new colostomy how to change the pouch (a), how to empty the pouch (b), how to open and close the pouch (c), how to irrigate the colostomy (d), and how to determine whether the ostomy is healing appropriately (e).

Step-by-step solution

Understand the Patient’s Needs

Recognize that a patient with a new colostomy requires education on various aspects of managing their colostomy to ensure proper care and monitoring. This includes changing and emptying the pouch, as well as assessing the healing of the ostomy.

Identify Necessary Skills for Independence

Identify the skills that will enable the patient to be independent in caring for their colostomy post-discharge. This includes changing the pouch (a.), emptying the pouch (b.), and assessing the condition of their ostomy (e.).

Highlight Additional Skills for Optimal Management

Determine if there are any additional skills that are necessary for optimal colostomy management, such as irrigation of the colostomy (d.) and knowing how to open and close the pouch (c.), if this is applicable to the type of colostomy pouch system used.

Review Skills to Teach the Patient

Review and select the skills that a nurse should teach a patient with a new colostomy before discharge, according to standard care practices. In this case, all of the options listed (a to e) are relevant skills for patient education.

Key concepts

Changing Colostomy Pouch

Learning to change a colostomy pouch is essential for new colostomy patients to maintain hygiene and comfort. The process involves gently removing the old pouch, cleaning the skin around the stoma, and attaching a new pouch securely. This is usually done every 3-5 days or when there is leakage. In the first few weeks after surgery, the stoma size may change, hence, measuring the stoma before cutting the hole in the new pouch is important to ensure a snug fit.

During the changing process, it's crucial to inspect the stoma and surrounding skin for any signs of irritation or complications. Using proper supplies, such as skin barrier films and ostomy pastes, can help protect the skin. Educating patients on these steps aids in preventing skin issues and boosts their confidence in managing their colostomy.

Emptying Colostomy Pouch

Emptying the colostomy pouch regularly is necessary to avoid overfilling and potential leaks. Patients should be guided on how to empty the pouch when it's one-third to one-half full. The procedure includes bending over the toilet, opening the pouch's bottom, and allowing the contents to empty out.

To keep the process hygienic, it's important to clean the end of the pouch with toilet paper or a damp cloth before reclosing it. Demonstrating the emptying technique and allowing practice in a supervised setting can help the patient become more self-sufficient and avoid mishaps.

Assessing Ostomy Healing

Assessing ostomy healing is critical after colostomy placement. Patients need to be educated on what normal healing looks like, including expected changes in stoma appearance, such as initial swelling and color changes. They should also be informed about the signs of infection or complications, like increased redness, swelling, pain, or foul-smelling discharge.

Regular examination helps in early identification of issues for timely intervention. Educating patients on keeping records of stoma size and any symptoms promotes proactive care and communication with healthcare providers. A well-informed patient is better equipped to participate in their healing process.

Colostomy Irrigation

Colostomy irrigation is an advanced skill that some colostomy patients may choose to learn. It involves flushing the colon with water through the stoma to regulate bowel movements, similar to an enema. This procedure can provide more control over bowel function and potentially reduce the need for a colostomy pouch.

However, it's typically recommended for those with a sigmoid or descending colostomy and should be done under the guidance of a healthcare professional. Proper technique, frequency, and use of equipment are crucial for successful irrigation, making thorough patient education and practice under supervision key components of this self-care routine.