Ostomy Paper 1
Ostomy Paper 1
Ostomy Paper 1
Caring for an ostomy includes assessing and cleaning the stoma, and changing and
emptying the ostomy appliance. When assessing the stoma, you should inspect the stoma and
the skin surrounding the stoma. The stoma should be pink to beefy red and appear moist, like the
lining on the inside of your mouth. The stoma contains no nerve endings, but many blood
vessels. It is normal to have a small amount of bleeding when cleaning the stoma. For the first
six to eight weeks after formation of the ostomy, the stoma will be shrinking in size as the edema
subsides after surgery. Clean the stoma with soap and water using soft cloths or gauze. Avoid
soaps that contain moisturizers, oils, or aloe, as these will interfere with adhesion of the skin
barrier wafer. You can clean the stoma whenever you change the ostomy pouch. This can be
done in the shower with the pouch removed. After cleaning the stoma be sure to thoroughly dry
the skin surrounding the stoma for optimal adhesion of the skin barrier wafer. An optional step
is to apply a skin protectant to the skin around the stoma and allow it to dry completely (about
Along with assessing and cleaning the stoma, you also need to empty and change the
ostomy pouch. The pouch is what is catching and collecting the stool produced. There are many
types of pouches including, closed, drainable, one piece, two piece, opaque, and transparent.
Drainable pouches are good for ileostomies and colostomies of the upper gastrointestinal region
where the stool is more liquid and frequently produced. The pouch is open at one end and can be
emptied, rinsed, and secured with a clip or Velcro closure. A drainable pouch needs to be
emptied when it is one third full. A closed pouch is a good option for colostomies of the lower
gastrointestinal region, where the stool is thicker and more formed. The pouch can be thrown
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away when half full. In a one-piece system the pouch is connected to the skin barrier wafer,
which provides fewer places for possible leakage. With a two-piece system, the wafer is applied
to the skin and then the pouch connects separately to the wafer. This helps prevent skin irritation
from changing wafers. There are also filtered pouches with vents and filters that release gas, but
not odors. This prevents ballooning and the need to burp the pouch.
Along with emptying the pouch when it gets to be a third to a half full, you will also need
to change the entire appliance every three to seven days or when there is leakage. The best time
to change the pouch is before eating or drinking in the morning, when the stoma is less active.
Or you can also do it after a shower, or at least two hours after a meal. It is best to have all your
supplies at hand and ready before removing the old pouch. You will remove the pouch and
wafer and discard. Then assess, clean, and measure the stoma using a supplied measuring tool.
You do not want to measure more than one eighth inch around the stoma. This will minimize the
amount of skin surrounding the stoma that comes in contact with stool, thus decreasing skin
irritation. When you decide on your desired stoma size, next trace this measurement onto the
wafer and cut out the opening. Once the opening of the wafer is cut, peel off the paper backing
and apply the adhesive side to the skin surrounding the stoma. Press down around the wafer
You may also need to use a skin barrier paste. The paste fills in gaps and creases. It
allows you to even out the skin surface surrounding the stoma to get a better seal, which prevents
leakage. The paste is applied to the wafer in a bead or a line shape and is not spread. Allow the
The group's choice of ostomy care for the home health care procedure presentation was
twofold. First, this was a subject that has touched every member of the group. Ciara's uncle had
one after a colectomy due to ulcerative colitis for a year. Liz's grandpa has had one since 1978.
Julia's younger brother had one when he was very young and her grandfather just recently had a
colectomy due to colon cancer and has a new, temporary ileostomy. Chloe works as an aide at St.
Second, ostomy care was something the group reviewed in Professional 1, but had not
had much experience with since then. The group felt that the presentation would be a good
review and a great opportunity to get more information on things that may not have been covered
in class. Things that weren't covered in class include: lifestyle post ostomy, differences in
equipment, and the range of all complications that could arise. This subject gave the group an
opportunity to speak with the Wound Care nurses at length about the procedure. The WC nurses
gave the group invaluable insight into past experiences and techniques for teaching and care.
While caring for an ostomy in an acute care setting, you will be using a transparent
pouch. This will allow you to easily visualize and assess your patients stoma and stool. You
want to assess the stoma to make sure that it is pink to beefy red and moist. A dusky or cyanotic
stoma could signify compromised circulation. In the acute care setting you will likely be caring
for your patient and their newly formed ostomy after surgery. You will need to document strict
intake and output on your patient during your shift. When you are measuring the output of the
ostomy you will want to use a graduated measuring device that will allow you to get an accurate
volume of the stool produced. After surgery they will have an abdominal surgical incision that
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you will be caring for as well. For six to eight weeks after formation of the ostomy, the stoma
will be shrinking as the edema decreases, so you will be using a cut-to-fit skin barrier wafer in
While caring for an ostomy in a home setting, your patient might be using an opaque
pouch. Many patients prefer the opaque pouches because they are more discreet, and then the
patient does not have to constantly see the stool being produced. The patient will likely be
emptying the pouch themselves straight into the commode. You can teach your patient to float
tissue paper in the commode to prevent splashing. The patient might be having you come out to
their home on the days that they need to change their ostomy appliance. They will be ordering
their own ostomy supplies through whatever company their insurance covers. You can assist
them with the ordering process if needed. Once their stomas shape and size has stabilized they
In both acute care and home settings you need to be very conscious of your non-verbal
communication. Always keep in mind that getting an ostomy is a huge life change for patients,
and it might take them awhile to become comfortable in caring for the ostomy themselves.
Provide ample patient teaching and encourage them to watch you whenever you provide ostomy
care, whether it is assessing and cleaning the stoma, emptying the pouch, or changing the entire
appliance. Every interaction in the hospital and at home is a great opportunity for teaching.
When a nurse is taking care of a patient with an ostomy there is a lot of information he or
she must assess and then document. The nurse should be aware of the baseline and/or most
recent documentation so the he or she knows when they are dealing with an abnormal finding.
If the patient is a fresh post-op, he or she will have a long abdominal incision in addition
to the stoma. The nurse should be assessing/documenting on both the incision and stoma
condition because if the incision were to get infected it could negatively affect the stoma.
Assessment of the stoma: color, size, if any bleeding is present on or around the stoma,
Assessment of the bag: condition of the bag (intact, leaking, needing changed, etc.),
consistency of the stool, amount in the bag (too little amount of contents could indicate
Assessment of the skin: document what the skin looks like both around the abdominal
incision and the stoma. Does it look red and irritated? Is there any drainage on the skin?
That could indicate an infection if around the surgical incision or a leakage in the bag if
What did nurse do for patient: whenever a bag is drained or changed, stoma cleaned,
Equipment used: its very important to document the supplies you used. Just in case the
patient happens to have a reaction to a new type of paste, wafer, powder, etc. you know
Patient teaching: document any teaching that was done and how patient is handling
having an ostomy. This procedure is life changing and is difficult both physically and
If a complication arose and the primary physician and/or WOC nurse was contacted.
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There are many companies including Convatec, Hollister, and Coloplast that are all
available for new and current ostomates to reach out to via phone number or through the internet
to receive free samples, home care packages, and insurance referrals can be made through a
Every area has home health care nursing available for ostomy care. This will be
prescribed through your physician and a plan of care will be reached together for what will work
best for the ostomate. The number of visits and frequency of visits may differ from case to case
but getting home care nursing is available and is a great tool to discuss with new ostomates and
their physicians. These home visits will include proper uses and care of the stoma, ostomy, and
all supplies. Our group utilized the wound and ostomy care nurses at North Side hospital who
went over application and removal of the devices and provided many different products to use
Youtube.com is a great source for ostomates to learn about their procedure before
undergoing surgery, and for after surgery for visual demonstrations on how to change and care
for their ostomy. This can be especially helpful for a new ostomate who may need to change
their pouch but may have some questions or concerns about the procedure and performing it on
their own. Step by step tutorials are available which can be great teaching tools. We utilized
youtube.com during our presentation to show a short video of an ostomy surgical procedure.
Ostomy.org is another great tool for ostomates to refer to for all things ostomy care. It is
the website for United Ostomy Associations of America, Inc. and they have everything from
general information, support groups, conferences, and events that are all available for ostomates.
This website is a wonderful resource for everyone and anyone who may have an ostomy or may
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have a friend or family member with an ostomy because of all the different information
available. We utilized this website to find information regarding living, eating, and working with
an ostomy. And we also utilized this website to find the travel cards available that are printable
wallet size cards explaining an ostomy that can be useful for airport security.
swimmable pouch covers, and they make support belts that can provide extra protection during
physical activity. They also sell lingerie for ostomates. All of these products are available to
order and are useful to help ostomates gain confidence and maintain normal living without
For the Youngstown OH area there is an ostomy support group located in Austintown and
is run by Anna Fitzgerald upcoming location, times, and meeting places can be established
through emailing Anna. Support groups are excellent resources for ostomates because they
provide an environment where they can be open about their feelings and get advice and support
from others that are currently or have previously been in the same situations.
The group felt that the presentation on ostomy care went very well. There was a lot of
valuable information provided that covered nearly every angle of ostomy care, from why an
ostomy would be needed to what sort of lifestyle modifications should be expected with an
ostomy. The group felt that the presentation covered most topics that would be important to a
new ostomate after speaking with the WC nurses and relatives with ostomies.
However, there were a few modifications that the group would consider. First, the length
of the presentation would likely be modified. The presentation was approximately 45 minutes
long, and that would be a very long time for a new ostomate to sit and a lot of information to
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absorb in one sitting. Modifications that could remedy this problem would be to condense the
information to major points that are essential for a first teaching and to leave time for the patient
to ask questions that concern them specifically. Perhaps there could follow up teaching sessions
to build upon that information. Ideally, the setup of the presentation would be customized to the
patient.
Another modification that the group identified was for the demonstration of the
application and removal of an ostomy bag. The ostomy was small and probably difficult for
everyone in the classroom to visualize. A video on the board may alleviate that problem. A
patient with an ostomy may also want to see a real ostomy with fecal matter being emptied. A
Finally, if the group were teaching a single patient and their family, the teaching would
ideally begin prior to the surgery. A common nursing diagnosis for a patient with a new ostomy
is "alteration in body image." The sooner the teaching begins, the more time the patient would
have to cope with this alteration in body image, and the sooner they could come to acceptance,
hopefully.
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References
Lynn, P. (2015). Bowel elimination- changing and emptying an ostomy appliance. In Taylor's
clinical nursing skills: A nursing process approach (Fourth ed., pp. 744-753).
United Ostomy Associations of America Inc. (2005, May 1). Retrieved November 13, 2015,
from http://www.ostomy.org/Home.html
UVA Ostomy Bag Change and Cleaning. (2015, February 15). Retrieved November 13, 2015,
from https://www.youtube.com/watch?v=2lxucf2Ikjg