Stoma Care (Colostomy bag)
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Outline
Overview
- Purpose
- Caring for a stoma involves assessing the following:
- Perfusion of the stoma
- Color
- Moisture
- Skin integrity around the stoma
- Function of the stoma itself
- Color, consistency of output
- Perfusion of the stoma
- Stoma barrier wafers and bags only NEED to be changed every 3-5 days or if there is leakage
- Can assess the stoma through a clear bag
- However – if the bag is opaque and you cannot see the stoma, you MUST remove it to assess the stoma itself.
- 1-piece – remove and replace the whole thing with the procedure below
- 2-piece – remove just the bag, leave the wafer intact
- Output type
- Colostomy – formed, firm, brown stool
- Ileostomy – loose brownish-green stool
- Urostomy – urine
- Caring for a stoma involves assessing the following:
Nursing Points
General
- Supplies needed
- Barrier cream/paste
- New barrier/wafer and stoma bag
- 1-piece or 2-piece
- Small scissors
- Skin prep
- Washcloth and warm soapy water
- Towel x 2
- May use incontinence pad
Nursing Concepts
- Steps and Nursing Considerations
- Explain procedure to patient
- Gather supplies
- Perform hand hygiene
- Don clean gloves
- Place a towel or incontinence pad below the patient on that side
- Inspect the output from the stoma for appropriate color and consistency
- Look in the existing bag
- If bag is opaque – empty the bag into a urinal or bedpan, then dispose in the toilet
- Carefully remove the stoma wafer by pressing it away from the skin
- Discard in appropriate waste container
- Use washcloth with warm soapy water to clean around the stoma and the stoma itself – do NOT scrub
- Pat the skin dry with a towel or dry cloth
- Inspect the stoma itself
- Should be dark pink and moist
- BAD = dark red, purple, dusky/cyanotic
- Measure the stoma for correct size of pouching system
- Cut the hole of the wafer approximately ⅛ inch larger than the stoma
- Apply skin prep around the stoma
- Remove paper backing from wafer, apply to skin around stoma, with stoma in the hole
- If any creases occur that you can’t smooth out, use barrier paste to fill in – let dry 1-2 minutes
- For 2-piece → apply the wafer, then snap on the bag
- Ensure the bottom opening of the bag closed and clamped appropriately
- Some have a separate clamp, some have velcro built in
- Follow manufacturer’s instructions
- The opening of the bag should face towards the patient’s knees if they were sitting
- NOTE – if your patient is bedridden, face the pouch to follow gravity (may be to the side)
- Discard used supplies appropriately
- Remove gloves
- Perform hand hygiene
- Document procedure and patient response / tolerance
Patient Education
- Patients should be taught how to self-care for their own stoma
- They can even do this in the hospital – just need to get them the right supplies
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Transcript
In this video, we’re going to talk about stoma care. Now, the wafer and bag for an ostomy only NEEDS to be changed every 3 days, or if it’s leaking. But, you still need to be able to assess the stoma itself. In this case we’re going to show you how to replace the bag and clean and assess the stoma. Start by putting a towel under the patient on the side of the stoma.
The first thing you want to do is assess the output from the stoma. If you have a clear bag, you can visualize it that way, otherwise you’ll need to empty the bag into a urinal so you can measure it, then discard in the toilet.
In order to clean and assess the stoma, we have to remove the bag. You’ll start by peeling the wafer and pushing the skin down away from it. You may need to use warm water or alcohol here if the adhesive is tough.
Now you want to clean the stoma and around it with a washcloth with warm soapy water. Use gentle strokes, don’t scrub.
Then you will pat the skin dry with a towel. Again, don’t rub.
Now that it’s clean, you can inspect the stoma itself. It should be light to dark pink and moist. What you don’t want to see is dark red, pale, purple, or blue-ish – none of those are good signs, they all represent problems with perfusion and should be reported right away. And of course, look for any skin breakdown.
Now you’re going to measure the stoma and cut the hole of the wafer to be about ⅛ inch larger than the stoma.
You’ll apply skin prep or barrier to the skin around the stoma, remove the paper backing from the wafer, and apply it to the skin with the stoma in the center of the hole.
If you get any spaces or creases you can’t smooth out, you can use barrier paste to fill them in.
If you’re using a 2-piece, you’ll apply the wafer first and then snap on the bag. Then make sure the bag is closed and sealed based on the type of bag you have.
Discard your supplies, wash your hands, and document your findings, including the output measurement.
So that’s it for stoma care – remember the little things might change depending on the type of stoma your patient has and what kind of device you’re using. But always look at the stoma and the skin around it.
Now, go out and be your best self today. And, as always, happy nursing!
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6 week
Concepts Covered:
- Gastrointestinal Disorders
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- Lower GI Disorders
- Integumentary Disorders
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- Urinary System
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Study Plan Lessons
Abdomen (Abdominal) Assessment
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acetaminophen (Tylenol) Nursing Considerations
Acute Bronchitis
Acute Otitis Media (AOM)
Airborne Precaution Diseases Nursing Mnemonic (MTV)
Albuterol (Ventolin) Nursing Considerations
Alveoli & Atelectasis
Amoxicillin (Amoxil) Nursing Considerations
Anti-Infective – Antivirals
Anti-Infective – Macrolides
Anti-Infective – Penicillins and Cephalosporins
Anti-Infective – Fluoroquinolones
Appendicitis
Appendicitis – Assessment Nursing Mnemonic (PAINS)
Appendicitis Case Study (Peds) (30 min)
Appendicitis for Certified Emergency Nursing (CEN)
Assessment of a Burn Nursing Mnemonic (SCALD)
Asthma
Asthma Concept Map
Asthma management Nursing Mnemonic (ASTHMA)
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Base Excess & Deficit
Bisacodyl (Dulcolax) Nursing Considerations
Blood Brain Barrier (BBB)
Blood Type O Nursing Mnemonic (Universally Odd)
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Bronchodilators
Bupropion (Wellbutrin) Nursing Considerations
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Cardiac Glycosides
Care of the Pediatric Patient
Casting & Splinting
Cefaclor (Ceclor) Nursing Considerations
Celiac Disease
Cerebral Palsy (CP)
Cimetidine (Tagamet) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Cleft Lip and Palate
Cleft Lip Repair – Post Op Care Nursing Mnemonic (CLEFT LIP)
Clubfoot
Congenital Heart Defects (CHD)
Conjunctivitis
Constipation and Encopresis (Incontinence)
Corticosteroids
Coumarins
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Cystic Fibrosis (CF)
Day in the Life of a NICU Nurse
Day in the Life of a Peds (Pediatric) Nurse
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Dehydration
Diarrhea – Treatment Nursing Mnemonic (BRAT)
Digoxin (Lanoxin) Nursing Considerations
Diphenhydramine (Benadryl) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Eczema
EENT Assessment
Enuresis
Epiglottitis
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Epispadias and Hypospadias
Famotidine (Pepcid) Nursing Considerations
Fever
Fever Case Study (Pediatric) (30 min)
Flu Symptoms Nursing Mnemonic (FACTS)
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Fluid Volume Deficit
Fluticasone (Flonase) Nursing Considerations
Gas Exchange
Gentamicin (Garamycin) Nursing Considerations
Glucose Lab Values
Gluten Free Diet Nursing Mnemonic (BROW)
Guaifenesin (Mucinex) Nursing Considerations
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
Hemoglobin (Hbg) Lab Values
Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
Integumentary (Skin) Assessment
Intussusception
Intussusception for Certified Emergency Nursing (CEN)
Iron Deficiency Anemia
Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
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Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)