During a follow-up visit for a patient with a colostomy, the nurse notes erythema around the peristomal skin. What is the most appropriate initial nursing intervention to address this finding?

A) Apply a skin barrier or protective powder

B) Increase the frequency of colostomy bag changes

C) Instruct the patient to increase fluid intake

D) Recommend a low-fiber diet to the patient

What is the most likely reason for the persistent erythema around the patient's colostomy site?

A) Allergic reaction to the new adhesive

C) Incorrect placement of the colostomy bag

D) Dietary changes increasing colostomy output

What is the most appropriate initial nursing action when a patient presents with persistent erythema around the colostomy site?

B) Suggest changing the colostomy bag adhesive

A) Apply a topical antibiotic cream

B) Suggest changing the colostomy bag adhesive

C) Increase the frequency of colostomy bag changes

D) Instruct the patient to apply a moisturizing lotion

What is the most likely cause of the erythema around the patient's peristomal skin?

A) Sensitivity to the new adhesive

What is the most appropriate nursing intervention to prevent further skin irritation around a colostomy site?

B) Use a protective skin barrier before applying the adhesive

A) Apply a thick layer of ointment under the adhesive

B) Use a protective skin barrier before applying the adhesive

C) Change the colostomy bag every two days

D) Clean the stoma site with alcohol wipes daily

What is the primary reason the nurse advises the patient with a colostomy to increase their fluid intake?

B) To prevent dehydration due to increased colostomy output

A) To enhance nutrient absorption

B) To prevent dehydration due to increased colostomy output

C) To reduce abdominal discomfort

Which intervention is most appropriate for a nurse to recommend to a patient experiencing increased colostomy output and mild dehydration?

A) Increase fluid intake to 8-10 glasses of water daily

B) Decrease fiber intake to reduce output volume

C) Apply an anti-diarrheal medication to the stoma

D) Limit fluid intake to prevent further dehydration

Which of the following actions should the nurse take to prevent dehydration in a patient with a colostomy?

A) Encourage the patient to drink 8-10 glasses of water daily

B) Advise the patient to limit fluid intake to prevent increased output

C) Suggest the patient avoid all caffeinated beverages

D) Recommend the patient consume only clear liquids

What is the primary reason for encouraging increased fluid intake for a patient with a colostomy?

C) To maintain proper stoma function and output consistency

B) To reduce the risk of urinary tract infections

C) To maintain proper stoma function and output consistency

D) To ensure adequate nutritional absorption

colostomy - Nursing Case Study

Pathophysiology

• Primary mechanism: A colostomy involves creating an opening in the abdominal wall to divert the colon's contents, often due to diseases like cancer or diverticulitis, allowing waste to exit the body through a stoma.

• Secondary mechanism: The procedure bypasses the affected or diseased part of the colon, reducing the risk of further disease progression and complications, and allowing the lower digestive tract to heal.

• Key complication: Minor complications can include skin irritation around the stoma due to contact with digestive waste, requiring careful stoma care and monitoring to prevent infection.

Patient Profile

Demographics:

58-year-old male, retired school teacher

History:

• Key past medical history: Diagnosed with early-stage colon cancer, underwent bowel resection

• Current medications: Multivitamin, acetaminophen 500 mg as needed

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Follow-up for colostomy management

• Key symptoms: Mild intermittent abdominal discomfort, well-functioning colostomy without complications

• Vital signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C)

Section 1

Initial Assessment Findings:

During the follow-up visit, the nurse conducts a thorough assessment of the colostomy site and surrounding skin to ensure proper function and identify any minor complications that may arise. The stoma appears pink and moist, which is a healthy sign indicating adequate blood supply. There is slight erythema around the peristomal skin, suggesting mild irritation likely due to contact with digestive waste. The patient mentions experiencing mild intermittent abdominal discomfort, which he describes as a 3 out of 10 on the pain scale. This discomfort typically occurs after meals and subsides with rest or after bowel movements through the colostomy.

The nurse also inspects the colostomy bag and its contents, noting that the output is within normal volume and consistency for a colostomy, indicating that digestion and waste elimination are functioning appropriately. The patient reports that he is changing the colostomy bag as instructed, every 3-5 days or when it's about one-third full, which helps prevent leakage and skin irritation. Vital signs remain stable with blood pressure at 120/80 mmHg, heart rate at 72 bpm, respiratory rate at 16 breaths per minute, and temperature at 98.6°F (37°C), indicating no signs of infection or systemic complications.

Education is reinforced regarding proper stoma care techniques, including the importance of maintaining a secure and clean seal around the stoma to prevent further skin irritation. The nurse advises using a skin barrier or protective powder to manage the mild erythema and suggests monitoring the area closely for any changes. The patient is encouraged to continue monitoring his symptoms and to report any increase in pain, changes in stoma appearance, or issues with colostomy output. The focus remains on maintaining skin integrity and ensuring the patient feels confident in managing his colostomy care at home.

Section 2

Two weeks later, the patient returns for a routine follow-up visit. During this appointment, the nurse performs a detailed reassessment of the colostomy site and surrounding skin. The stoma continues to appear pink and moist, maintaining its healthy condition. However, the mild erythema from the previous visit has persisted, and the nurse notes a slight increase in the redness of the peristomal skin. This suggests the irritation may not be solely due to contact with digestive waste, prompting the nurse to inquire further about the patient's colostomy care routine and any recent changes to products or techniques.

The patient explains that he recently switched to a different brand of colostomy bag adhesive, hoping for a more comfortable fit. The nurse suspects that the new adhesive may be contributing to the persistent erythema. Additionally, the patient mentions an increase in the frequency of mild abdominal discomfort, now rating it as a 4 out of 10 on the pain scale. Although still intermittent, the discomfort occurs more frequently and is sometimes accompanied by a slight increase in colostomy output volume.

The nurse educates the patient on the potential sensitivity to the new adhesive and suggests reverting to the previous brand to determine if the erythema improves. A protective skin barrier is recommended to provide an added layer of protection for the irritated skin. The nurse also reinforces the importance of monitoring the frequency and volume of colostomy output. Vital signs remain stable, with blood pressure at 118/76 mmHg, heart rate at 70 bpm, respiratory rate at 16 breaths per minute, and temperature at 98.4°F (36.9°C), indicating no systemic complications. The patient is advised to contact the healthcare provider if the erythema does not improve within the next week or if there are any significant changes in pain or colostomy output, ensuring timely intervention if needed.

Section 3

Response to Interventions

A week later, the patient returns for another follow-up visit, having reverted to the previous colostomy bag adhesive as recommended. The nurse performs a thorough assessment of the colostomy site. Encouragingly, the erythema around the peristomal skin has noticeably decreased, suggesting that the initial irritation was indeed related to the sensitivity to the new adhesive. The stoma remains pink and moist, indicating a healthy appearance, and the surrounding skin shows signs of recovery with reduced redness and no signs of further irritation.

The patient reports a modest improvement in abdominal discomfort, now rating it as a 3 out of 10 on the pain scale, though it still occurs intermittently. The patient also notes a slight reduction in colostomy output volume, which seems to be stabilizing. The nurse reviews the patient's diet and hydration status, reinforcing the importance of maintaining a balanced diet and adequate fluid intake to assist in regulating colostomy output and minimizing discomfort.

Vital signs continue to remain stable, with blood pressure at 116/74 mmHg, heart rate at 68 bpm, respiratory rate at 16 breaths per minute, and temperature at 98.2°F (36.8°C). The patient expresses relief at the improvement of skin irritation and commits to ongoing monitoring of any changes. The nurse encourages the patient to continue using the protective skin barrier and provides additional education on recognizing signs of potential complications. The patient is reassured and advised to maintain regular follow-up appointments to ensure continued progress and to promptly report any new symptoms or concerns.

Section 4

Two weeks following the last visit, the patient presents for another follow-up, this time reporting an unexpected increase in colostomy output volume over the past few days. The nurse notes that the output is now more liquid in consistency, which differs from the patient's usual pattern. Additionally, the patient mentions experiencing mild fatigue and a slight increase in abdominal discomfort, which they now rate as a 4 out of 10 on the pain scale. Despite these changes, the patient’s vital signs remain within normal limits: blood pressure is 118/76 mmHg, heart rate is 70 bpm, respiratory rate is 18 breaths per minute, and temperature is 98.4°F (36.9°C).

The nurse conducts a comprehensive assessment and observes that the stoma still appears healthy, maintaining a pink and moist appearance, and the peristomal skin shows no signs of irritation or infection. However, the nurse identifies mild dehydration as a potential concern, given the increased output and the patient's report of fatigue. The patient's recent dietary adjustments are reviewed, revealing that they may have inadvertently reduced their overall fluid intake, potentially contributing to the changes observed.

To address these issues, the nurse emphasizes the importance of increasing fluid consumption to compensate for the higher output volume and prevent dehydration. The patient is advised to monitor their fluid intake more closely and to aim for at least 8-10 glasses of water daily, unless otherwise directed by their healthcare provider. The nurse also provides education on dietary modifications that may help thicken the colostomy output, such as incorporating more fiber-rich foods, if appropriate for the patient's condition. The patient is encouraged to continue monitoring any changes in their symptoms and to follow up promptly if the increased output persists or if additional symptoms develop.

Section 5

Response to Interventions:

Following the nurse's recommendations, the patient diligently increases their fluid intake, ensuring they consume at least 8-10 glasses of water daily. Over the next few days, the patient notices a gradual improvement in their symptoms. The colostomy output begins to thicken slightly, returning closer to its usual consistency, and the overall volume decreases. The patient also reports a decrease in abdominal discomfort, now rating it as a 2 out of 10 on the pain scale. The mild fatigue they initially experienced has lessened, and they feel more energetic.

The patient returns for a follow-up appointment, where the nurse conducts another assessment. The stoma continues to appear healthy, with a pink and moist appearance, and there are still no signs of irritation or infection in the peristomal skin. The patient's vital signs remain stable, with a blood pressure of 116/74 mmHg, heart rate of 72 bpm, respiratory rate of 18 breaths per minute, and a temperature of 98.2°F (36.8°C). These findings suggest that the interventions have been effective in addressing the mild dehydration and increased output.

Encouraged by the positive response, the nurse reinforces the importance of maintaining adequate hydration and monitoring dietary habits to support optimal colostomy function. The patient is reminded to continue observing their symptoms and to reach out to their healthcare provider if they notice any significant changes or if the increased output returns. The nurse also schedules a follow-up visit in a few weeks to ensure continued progress and to reassess the patient's condition. This proactive approach helps prevent potential complications and supports the patient's ongoing recovery and adaptation to living with a colostomy.