OSTOMY
surgery to create an opening (stoma) from an area inside
the body to the outside.
It can be permanent or temporary
Types of Ostomy:
1. Ileostomy
2. Colostomy
3. Urostomy
Ostomy management
Closed Pouch Drainable Pouch
Stoma and skin care
▪ Place tissue or gauze over stoma and change
as needed until new appliance is in place
▪ Prepare and apply skin barrier
– Measure stoma with stoma guide
– Trace and cut skin barrier material to be no
more than ⅛ to inch larger than the stoma
Stoma and skin care
▪ Prepare and apply skin barrier
– Remove barrier backing
– Press adhesive side onto skin, avoiding wrinkles;
hold for 30 seconds
– For 2-piece, remove tissue and snap appliance onto
the flange or skin barrier wafer
– Apply closed drainable pouches per instructions
– Document care
Purposes
• To assess and care for the peristomal skin
• To collect stool for assessment of the amount and type of output
• To minimize odors for the client’s comfort and self-esteem
Assessment
• The type of ostomy and its placement on the abdomen. Surgeons
often draw diagrams when there are two stomas. If there is more
than one stoma, it is important to confirm which is the functioning
stoma.
• The type and size of appliance currently used and the special barrier
substance applied to the skin, according to the nursing care plan.
Assess for:
• Stoma color
• Stoma size and shape
• Stomal bleeding
• Status of peristomal skin
• Amount and type of feces
• Complaints
• Learning needs of the client and family members
• The client’s emotional status
Return to Presentation
Planning
• Review features of the appliance to ensure that all parts are present
and functioning correctly.
Equipment
• Clean gloves
• Bedpan
• Moisture-proof bag (for disposable pouches)
• Cleaning materials, including warm water, mild soap (optional), washcloth,
towel
• Tissue or gauze pad
• Skin barrier (optional)
• Stoma measuring guide
• Pen or pencil and scissors
• New ostomy pouch with optional belt
• Tail closure clamp
• Deodorant for pouch (optional)
Implementation
Preparation
1. Determine the need for an appliance change.
• Assess the used appliance for leakage of stool.
• Ask the client about any discomfort at or around the stoma.
• Assess the fullness of the pouch.
2. If there is pouch leakage or discomfort at or around the stoma,
change the appliance.
3. Select an appropriate time to change the appliance.
• Avoid times close to meal or visiting hours.
• Avoid times immediately after meals or the administration of any
medications that may stimulate bowel evacuation.
• The best time to change a pouching system is first thing in the
morning or 2 to 4 hours after meals, when the bowel is least active.
Implementation
Performance
1. Prior to performing the procedure, introduce self and verify the
client’s identity using agency protocol.
• Explain to the client what you are going to do, why it is necessary,
and how he or she can participate.
• Discuss how the results will be used in planning further care or
treatments.
• Changing an ostomy appliance should not cause discomfort, but it
may be distasteful to the client.
• Communicate acceptance and support to the client.
• It is important to change the appliance competently and quickly.
• Include support people as appropriate.
Implementation
Performance
2. Perform hand hygiene and observe other appropriate infection
prevention procedures.
3. Apply clean gloves.
4. Provide for client privacy preferably in the bathroom, where
clients can learn to deal with the ostomy as they would at home.
5. Assist the client to a comfortable sitting or lying position in bed or
preferably a sitting or standing position in the bathroom.
6. Unfasten the belt if the client is wearing one.
Implementation
Performance
7. Empty the pouch and remove the ostomy skin barrier.
• Empty the contents of a drainable pouch through the bottom
opening into a bedpan or toilet.
• If the pouch uses a clamp, do not throw it away because it can be
reused.
• Assess the consistency, color, and amount of stool.
• Peel the skin barrier off slowly, beginning at the top and working
downward, while holding the client’s skin taut.
• Discard the disposable pouch in a moisture-proof bag.
Implementation
Performance
8. Clean and dry the peristomal skin and stoma.
• Use toilet tissue to remove excess stool.
• Use warm water, mild soap (optional), and a washcloth to clean
the skin and stoma.
• Check agency practice on the use of soap.
• If soap is allowed, do not use deodorant or moisturizing soaps.
• Dry the area thoroughly by patting with a towel.
Implementation
Performance
9. Assess the stoma and peristomal skin.
• Inspect the stoma for color, size, shape, and bleeding.
• Inspect the peristomal skin for any redness, ulceration, or
irritation.
• Transient redness after the removal of adhesive is normal.
10. Place a piece of tissue or gauze over the stoma, and change it
as needed.
Implementation
Performance
11. Prepare and apply the skin barrier (peristomal seal).
• Use the guide to measure the size of the stoma.
• On the backing of the skin barrier, trace a circle the same size as
the stomal opening.
• Cut out the traced stoma pattern to make an opening in the skin
barrier.
• Make the opening no more than one eighth inch larger than the
stoma (Piras and Hurley, 2011).
• Remove the backing to expose the sticky adhesive side.
• The backing can be saved and used as a pattern when making
an opening for future skin barriers.
Colostomy irrigation
▪ Similar to enema
▪ Only for sigmoid or descending colostomy
▪ Used to stimulate evacuation, control time of elimination
so pouch will not need to be worn
▪ Fluid varies from 300 m L to 1 L
illi iter iter
▪ Cone may be used to retain fluid in bowel before
evacuation
▪ Long-term irrigation puts client at risk for peristomal
hernias, bowel perforation, electrolyte imbalance
Evaluating
• The goals established during planning phase are
evaluated according to specific desired outcomes.
• If outcomes are not achieved, nurse should explore the
reasons.
– Review fluid and diet, activity level, prescription
medications, and other factors
– Do client and family understand instructions?
– Was sufficient support provided?
The End
