# Situation: A 58-year-old man had a sigmoid resection with an end colostomy in the left lower quadrant (Hartmann procedure) for perforated diverticulitis. Six weeks later, the surgeon approves colostomy irrigation, and the nurse watches his first attempt at home. He sits on the toilet, fills the irrigator with 750 mL of lukewarm tap water, hangs it on a hook about 90 cm above the stoma, and inserts the lubricated cone. Within 2 minutes, half of the water has run in, and he reports cramping. What should the nurse tell him?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630490  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 58-year-old man had a sigmoid resection with an end colostomy in the left lower quadrant (Hartmann procedure) for perforated diverticulitis.

Six weeks later, the surgeon approves colostomy irrigation, and the nurse watches his first attempt at home. He sits on the toilet, fills the irrigator with 750 mL of lukewarm tap water, hangs it on a hook about 90 cm above the stoma, and inserts the lubricated cone. Within 2 minutes, half of the water has run in, and he reports cramping. What should the nurse tell him?

## 보기

1. Lie in left Sims' position for the rest of the flow
2. Continue, as cramping is expected with every irrigation
3. Use only 250 mL of water for each irrigation
4. Pause the flow, then lower the bag to about 45–50 cm **✔ 정답**

**정답: 4**

## 해설

Irrigation water is hung about 45–50 cm above the stoma (about shoulder height when seated) and instilled slowly over 5–10 minutes. At 90 cm the water runs in far too fast, causing cramping; the client stops or slows the flow until it passes, then continues with the bag at the correct height. His 750-mL volume is within the usual range.

## 심화 해설

What went wrong in his technique
Colostomy irrigation instills water into the colon through the stoma to stimulate emptying at a planned time. The water must flow slowly, so the irrigation bag is hung about 45–50 cm above the stoma, roughly shoulder height when the client is seated, and the water runs in over about 5–10 minutes. He hung the bag at about 90 cm, nearly twice the correct height, so the pressure was too high and half the water entered within 2 minutes. Rapid distension of the bowel causes cramping. Cramping during irrigation is a signal to stop or slow the flow, and here the cause is the height of the bag.

The correct response
The nurse tells him to pause the flow by clamping the tubing until the cramp passes, then to lower the bag to about 45–50 cm and continue slowly. Pausing lets the bowel relax; lowering the bag reduces the pressure so the rest of the water enters gradually. Too rapid a flow can also cause nausea, dizziness, and, rarely, bowel injury, which is why correct height and a lubricated cone are emphasized.

| Element | His practice | Correct practice |
| --- | --- | --- |
| Bag height | About 90 cm | About 45–50 cm (shoulder height when seated) |
| Flow time | Half in 2 minutes | Slowly over 5–10 minutes |
| Volume | 750 mL | Usually 500–1,000 mL |
| Position | Seated on the toilet | Seated on or beside the toilet |
| Water | Lukewarm tap water | Lukewarm water |

Why the other instructions are wrong
Lying in left Sims' position is used for an enema given through the rectum; irrigation is done seated on or beside the toilet so the returning stool drains through the irrigation sleeve. Telling him cramping is expected each time ignores a correctable error. Reducing the volume to 250 mL is unnecessary because 750 mL is within the usual range; the problem is the rate, not the amount. Watch out! When a stem gives several numbers, compare each with the standard to find the one that is out of range: here only the height is wrong.

Exam takeaway
Irrigation is used for clients with a descending or sigmoid colostomy who have formed stool and approval from the surgeon. The water is lukewarm, the cone is lubricated and inserted gently, and the flow is slow. Key point! If cramping occurs, stop the flow until it passes, then continue with the bag at about 45–50 cm above the stoma.

## 임상 시나리오

Colostomy Irrigation TechniqueManaging cramping during the flow
Hang the irrigation bag about 45–50 cm above the stoma (about shoulder height when seated) and let 500–1,000 mL of lukewarm water run in over 5–10 minutes.

At 90 cm the water runs in too fast and causes cramping. Pause the flow until the cramp passes, then lower the bag and continue slowly.

Irrigation is done seated on or beside the toilet with a lubricated cone; left Sims' position is used for enemas.

CautionRapid flow can cause cramping, nausea, dizziness, and, rarely, bowel injury.

## 핵심 개념

- **Colostomy irrigation** — Instillation of water through a colostomy to stimulate emptying of the bowel at a planned time.
- **Irrigation cone** — A tapered tip placed in the stoma that controls the water flow and prevents bowel perforation.
- **Irrigation sleeve** — A long plastic drainage sleeve that carries returning water and stool into the toilet.
- **Sims' position** — A side-lying position with the upper knee flexed, used for rectal procedures such as enemas.

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