Ostomy Care
With Samantha Rhea, MSN, RN
Learning Objectives
•
or permanent ostomy.
•
a colostomy, ileostomy, and urostomy.
•
assessment.
•
with an ostomy.
Learning Objectives
•
the ostomy waste pouch for mobile clients
and clients confined to a bed.
•
the appliance of both one-piece and two-
piece ostomies.
•
site and change of appliance.
•
clients living with an ostomy and changes
to body image.
Client Impact
Estimates of the number of people with ostomies in the U.S. range
from 750,000
to 1 million with approximately
100,000 new ostomy surgeries performed each year.
Many of these are temporary.
Source: https://www.ostomy.org/wp-content/uploads/2020/10/UOAA-New-Ostomy-Patient-Guide-2020-10.pdf
It is a surgical opening
to allow stool or urine
to leave the body.
What is an ostomy?
© by Lecturio
Indications for an ostomy:
• Colon or • Trauma
rectal cancer • Abscess
• Intestinal • Inflammation
blockage
• Infection
What is an ostomy?
© by Lecturio
Ostomy allows the
bowel to rest and
recover.
What is an ostomy?
© by Lecturio
Common Types of Ostomies
Named by their location:
Colostomy Ileostomy Urostomy
© by Lecturio
What is a stoma?
© by Lecturio
A stoma is an opening on the abdomen.
It looks like a small, pinkish, circular
piece of flesh sewn to your body. It may
lie fairly flat on the body or protrude out. Stoma and ostomy are
interchangeable words.
What is a stoma?
© by Lecturio
Nurses and Ostomy Care
Care includes:
• Assessing the stoma
• Skin care
• Emptying the waste
pouch
• Changing the appliance
© by Lecturio
Assessing the Stoma
Assess once per shift:
Skin irritation Leakage Necrosis
© by Lecturio
Assessing the Stoma
Assess once per shift:
Stoma blockage Stoma prolapse Stoma retraction
© by Lecturio
Nurses and Ostomy Care
Care includes:
• Assessing the stoma
• Skin care
• Emptying the waste
pouch
• Changing the appliance
© by Lecturio
Skin Care for Ostomies
1. Less is more for skin care! Water is
usually sufficient for cleaning the skin.
2. If soap is needed, use a mild one
without fragrance, lotions, or creams,
which would leave a residue!
3. Items NOT recommended for routine
peristomal skin care: creams, lotions,
powders, baby wipes, isopropyl alcohol,
steroidal medications, and ointments
4. Normally, there should not be any sign
of irritation. Abnormal assessment that
requires follow-up includes red, broken,
or irritated skin.
© by Lecturio
Skin Care for Ostomies
1. Less is more for skin care! Water is
usually sufficient for cleaning the skin.
2. If soap is needed, use a mild one
without fragrance, lotions, or creams,
which would leave a residue!
3. Items NOT recommended for routine
peristomal skin care: creams, lotions,
powders, baby wipes, isopropyl alcohol,
steroidal medications, and ointments
4. Normally, there should not be any sign
of irritation. Abnormal assessment that
requires follow-up includes red, broken,
or irritated skin.
© by Lecturio
Skin Care for Ostomies
1. Less is more for skin care! Water is
usually sufficient for cleaning the skin.
2. If soap is needed, use a mild one
without fragrance, lotions, or creams,
which would leave a residue!
3. Items NOT recommended for routine
peristomal skin care: creams, lotions,
powders, baby wipes, isopropyl alcohol,
steroidal medications, and ointments
4. Normally, there should not be any sign
of irritation. Abnormal assessment that
requires follow-up includes red, broken,
or irritated skin.
© by Lecturio
Skin Care for Ostomies
1. Less is more for skin care! Water is
usually sufficient for cleaning the skin.
2. If soap is needed, use a mild one
without fragrance, lotions, or creams,
which would leave a residue!
3. Items NOT recommended for routine
peristomal skin care: creams, lotions,
powders, baby wipes, isopropyl alcohol,
steroidal medications, and ointments
4. Normally, there should not be any sign
of irritation. Abnormal assessment that
requires follow-up includes red, broken,
or irritated skin.
© by Lecturio
Nurses and Ostomy Care
Care includes:
• Assessing the stoma
• Skin care
• Emptying the waste
pouch
• Changing the appliance
© by Lecturio
When to Empty an Ostomy Bag
Bag needs emptying NOW!
3/4
Right on the edge
of problems!
1/2
No problem here
1/3
The safest time to empty
© by Lecturio
How to Empty the Ostomy Bag
• At home, clients can sit on the toilet
and empty their pouch directly into
the toilet.
• If the client cannot sit on the
toilet, this can also be done with
assistance on a bed.
© by Lecturio
How to Empty the Ostomy Bag
1. Hold the bottom of the pouch up.
Open the Velcro closures or
remove the clamp and set it aside.
2. Slowly unroll the tail, or spout,
over the basin or graduated
cylinder.
3. Slide your fingers down the pouch
to push out all the stool.
© by Lecturio
How to Empty the Ostomy Bag
1. Hold the bottom of the pouch up.
Open the Velcro closures or
remove the clamp and set it aside.
2. Slowly unroll the tail, or spout,
over the basin or graduated
cylinder.
3. Slide your fingers down the pouch
to push out all the stool.
© by Lecturio
How to Empty the Ostomy Bag
1. Hold the bottom of the pouch up.
Open the Velcro closures or
remove the clamp and set it aside.
2. Slowly unroll the tail, or spout,
over the basin or graduated
cylinder.
3. Slide your fingers down the pouch
to push out all the stool.
© by Lecturio
Ballooning
Gas exiting from the digestive tract through
the stoma can cause the ostomy bag to
inflate.
Why do you burp an ostomy bag?
© by Lecturio
Gas can collect in the pouch even if there is no stool.
To release gas, follow these steps:
1. Hold the tail of the pouch up
slightly and open the Velcro
closures or remove the clamp.
2. Hold the top of the pouch with
one hand.
3. With the other hand, push the
gas out by sliding your thumb
and index finger from the top to
the bottom of the pouch.
© by Lecturio
Gas can collect in the pouch even if there is no stool.
To release gas, follow these steps:
1. Hold the tail of the pouch up
slightly and open the Velcro
closures or remove the clamp.
2. Hold the top of the pouch with Hold the tail
end up so it
one hand.
does not spill
3. With the other hand, push the
gas out by sliding your thumb
and index finger from the top to
the bottom of the pouch.
© by Lecturio
Gas can collect in the pouch even if there is no stool.
To release gas, follow these steps:
1. Hold the tail of the pouch up
slightly and open the Velcro
closures or remove the clamp.
2. Hold the top of the pouch with
one hand.
3. With the other hand, push the
gas out by sliding your thumb
and index finger from the top to
the bottom of the pouch.
© by Lecturio
Gas can collect in the pouch even if there is no stool.
To release gas, follow these steps:
4. Secure the Velcro closures or reclamp the
pouch as described above.
5. Wash your hands when done.
© by Lecturio
Gas can collect in the pouch even if there is no stool.
To release gas, follow these steps:
4. Secure the Velcro closures or reclamp the
pouch as described above.
5. Wash your hands when done.
How to Clean the Pouch
1. Wipe the inside and outside of the tail
with toilet paper to help prevent odor.
2. Check both sides of the pouch for tears
or holes. If you find any, put on a new
pouch.
3. If the pouch closes with a clamp,
rinse the clamp if there is stool on it.
© by Lecturio
How to Clean the Pouch
1. Wipe the inside and outside of the tail
with toilet paper to help prevent odor.
2. Check both sides of the pouch for tears
or holes. If you find any, put on a new
pouch.
3. If the pouch closes with a clamp,
rinse the clamp if there is stool on it.
© by Lecturio
How to Clean the Pouch
1. Wipe the inside and outside of the tail
with toilet paper to help prevent odor.
2. Check both sides of the pouch for tears
or holes. If you find any, put on a new
pouch.
3. If the pouch closes with a clamp,
rinse the clamp if there is stool on it.
© by Lecturio
Most clients empty the bag anywhere
from 4 to 10 times in a 24-hour period.
How many times a day do clients with ostomies empty the bag?
© by Lecturio
Nurses and Ostomy Care
Care includes:
• Assessing the stoma
• Skin care
• Emptying the waste
pouch
• Changing the appliance
© by Lecturio
Skill
Changing an Ostomy Pouch
What Will You Need?
Pouching Gauze Stoma-measuring Stoma
system guide paste
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Pre-procedure
1. Perform hand hygiene.
2. Provide privacy.
3. Explain the procedure.
4. Raise the bed to an appropriate height.
5. Assist the client to the correct position.
6. Perform hand hygiene, again.
7. Put on gloves.
8. Remove the old or soiled ostomy.
© by Lecturio
Procedure
1. Measure the stoma using the stoma-
measuring guide.
2. For a one-piece pouch, select the size
that matches the stoma. For a two-piece
pouch, cut a hole slightly bigger than
the stoma size into the adhesive back.
3. Gently wipe the stoma and wash the
peristoma skin with wet gauze and allow
it to dry.
4. Apply the stoma paste.
© by Lecturio
Procedure
1. Measure the stoma using the stoma-
measuring guide.
2. For a one-piece pouch, select the size
that matches the stoma. For a two-piece
pouch, cut a hole slightly bigger than
the stoma size into the adhesive back.
3. Gently wipe the stoma and wash the
peristoma skin with wet gauze and allow Two-piece
it to dry. pouch
4. Apply the stoma paste.
One-piece
pouch
© by Lecturio
Procedure
1. Measure the stoma using the stoma-
measuring guide.
2. For a one-piece pouch, select the size
that matches the stoma. For a two-piece
pouch, cut a hole slightly bigger than
the stoma size into the adhesive back.
3. Gently wipe the stoma and wash the
peristoma skin with wet gauze and allow
it to dry.
4. Apply the stoma paste.
© by Lecturio
Procedure
1. Measure the stoma using the stoma-
measuring guide.
2. For a one-piece pouch, select the size
that matches the stoma. For a two-piece
pouch, cut a hole slightly bigger than
the stoma size into the adhesive back.
3. Gently wipe the stoma and wash the
peristoma skin with wet gauze and allow
it to dry.
4. Apply the stoma paste.
Pro-tip: Make sure the adhesive is dry before
placement of the appliance.
© by Lecturio
Procedure
5. Apply the one-piece ostomy pouch
system, or apply the adhesive back of
the two-piece system followed by
application of the pouch to the adhesive
back.
6. Ensure the ostomy closure clamp is
applied.
7. Have the client rest in position for about
5 minutes.
© by Lecturio
Procedure
5. Apply the one-piece ostomy pouch
system, or apply the adhesive back of
the two-piece system followed by
application of the pouch to the adhesive
back.
6. Ensure the ostomy closure clamp is
applied.
7. Have the client rest in position for about
5 minutes.
© by Lecturio
Procedure
5. Apply the one-piece ostomy pouch
system, or apply the adhesive back of
the two-piece system followed by
application of the pouch to the adhesive
back.
6. Ensure the ostomy closure clamp is
applied.
7. Have the client rest in position for about
5 minutes.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Post-procedure
1. Assist the client to a comfortable
position.
2. Lower the bed to its lowest level.
3. Dispose off all used supplies.
4. Remove gloves.
5. Perform hand hygiene.
6. Document the procedure.
© by Lecturio
Documentation for Ostomy
1100 Two-piece Hollister ostomy
1 Type of ostomy
2 changed. Stoma color appears normal
without signs of erythema or dermatitis.
3 The skin integrity is intact with no signs
4
of ulceration or lesions. Texture of the
stoma is moist with normal, soft turgor.
5
© by Lecturio
Documentation for Ostomy
1100 Two-piece Hollister ostomy
1
2 Stoma color changed. Stoma color appears normal
without signs of erythema or dermatitis.
3 The skin integrity is intact with no signs
4
of ulceration or lesions. Texture of the
stoma is moist with normal, soft turgor.
5
© by Lecturio
Documentation for Ostomy
1100 Two-piece Hollister ostomy
1
2 changed. Stoma color appears normal
without signs of erythema or dermatitis.
3 Integrity The skin integrity is intact with no signs
4
of ulceration or lesions. The texture of the
stoma is moist with normal, soft turgor.
5
© by Lecturio
Documentation for Ostomy
1100 Two-piece Hollister ostomy
1
2 changed. Stoma color appears normal
without signs of erythema or dermatitis.
3 The skin integrity is intact with no signs
4 Texture
of ulceration or lesions. Texture of the
stoma is moist with normal, soft turgor.
5
© by Lecturio
Documentation for Ostomy
1100 Two-piece Hollister ostomy
1
2 changed. Stoma color appears normal
without signs of erythema or dermatitis.
3 The skin integrity is intact with no signs
4
of ulceration or lesions. Texture of the
stoma is moist with normal, soft turgor.
5 Turgor
© by Lecturio
Special Considerations
Special Considerations
Odor Bloating
Body image Clothing
Sexual relationships Keep extra supplies
and intimacy on hand at all times
Odor and Filters
• Filters allow for the
digestive gas to be
released without odor.
• Prevent the filter from
getting wet by covering
the filter with medical
tape when showering.
© by Lecturio
Bloating: Dietary Tips for Ostomies
• Encourage the client to keep a food diary
to track specific foods that cause them to
have increased gas.
• Foods that tend to cause more gas than
others include beans, certain fruits (apples
and pears), certain veggies (asparagus,
broccoli, cauliflower, and carrots), dairy,
grains, nuts, and carbonated beverages.
• Encourage the client to eat slowly in order
to swallow less air.
Bloating: Dietary Tips for Ostomies
All of these will cause extra air to be swallowed, resulting in gas formation.
Drinking through
Smoking
a straw
Drinking carbonated
Chewing gum
beverages
Body Image, Clothing, and Intimacy
• Encourage clients to wear clothes
they feel comfortable in special
underwear or wraps to hold their
ostomy
• Sexual relationships and intimacy can
be resumed with an ostomy.
© by Lecturio
Living with an Ostomy: Extra Supplies
• Keep extra supplies on hand
at all times.
• Encourage independence with
individual ostomy care.
• Encourage enrolling in support
groups.
© by Lecturio
