COLOSTOMY is defined as an artificial opening of the colon onto the

abdominal surface. It may originate from: The sigmoid colon, the

descending colon, the transverse colon or the ascending colon. A
colostomy is named according to where in the bowel it is formed: It
may be an ascending, transverse, descending, or sigmoid colostomy. The
type of effluent is dependent on the location of the bowel used. The type
of effluent in cecostomy (ascending colostomy) is liquid to mushy and
foul odor. The type of effluent in right transverse co- lostomy is mushy
to semiformed. The type of effluent in left transverse colostomy is
semiformed and soft. The type of effluent in descending or sigmoid
colostomy is soft to hard formed.
Hatton, [31 stated that stomas involving the bowel are most common
with an estimated 50,000 people in the UK with a colostomy each year.
In the last year (from 1 /1 /2011- 1 /1 /2012), approxi- mately 71 cases
carried out colostomy at General Surgery Department of Assiut
University Hospital (Assiut University Hospital Record, 2011-2012).

Basic competency for all acute care nurses providing care and
educational support for the new post operative ostomy patient should
include the following: Stoma assessment, pouch fitting, pouch emptying,
access to resources and supplies, and basic problem-solving skills.
Priorities for nursing care include preparing the patient physically for
surgery; providing infor- mation about post operative care, including
stoma care and supporting the patient and family emo- tionally. Patients
undergoing surgery for a tempo- rary colostomy may express fears and
concerns similar to those of a person with a permanent stoma. All
members of the health care team, in- cluding the wound ostomy and
continence nurse (WOCN), should be available for assistance and
support. The nurse's role is to assess the patient's anxiety level and
coping mechanisms and suggest methods for reducing anxiety, such as
deep breath- ing exercises and visualizing a successful recovery from
surgery.
Monitoring and managing complications: After the client returns from surgery,
assessments include taking vital signs, checking dressings, and moni-
toring nasogastric tubes and IV infusions. Review the client's chart for the
type of colostomy and the location of the stoma. If an abdomin
operineal resection was performed, check the drain or packing in the
perineal area and note the characteristics of the drainage. Also, check
the surgical dressing frequently in the early post operative period and
observe the characteristics of the stoma. Monitor urine output and the
volume of suctioned gastric secretions. If urine output is markedly
decreased or less than 500m1/day, inform the physician im- mediately
[6].

The nurse assesses the abdomen for returning peristalsis and

assesses the initial stool character- istics [7].
 Colostomy irrigation: Colostomy irrigation is a type of bowel
management. Before the wide- spread use of disposable, odor-proof
ostomy equip- ment, nearly all clients with colostomies used irrigation
for control of bowel movements [8].

Maintaining optimal nutrition: A complete nutritional assessment is

important for the patient with a colostomy. The patient avoids foods
that cause excessive odor and gas, including foods in the cabbage
family, eggs, asparagus, fish, beans, and high-cellulose products such
as peanuts [9].

During the postoperative period, a stoma should have a red, moist, shiny
appearance. Any deviation would warrant an immediate physician
consultation. Protrusion of the stoma should be assessed and
documented in the clinical record as flush, budded, or long. Flush stomas
open below skin level and increase the risk of peristomal skin irritation
due to inadequate appliance seal [10].

Sexual concerns regarding stoma formation are often psychosocial in

origin, especially in terms of body image 1111. Nurses should discuss
changes in body image with patients, and how any issues can be dealt
with, as this can bring to light issues about the impact on sexuality 1121.