Mary Dominie M.

Sutingco 03/31/2021

BSN 2-A

Colostomy Care Scenario

Good morning I am Mary Sutingco and I will be stating the following on how to implement the
changing of bowel diversion ostomy appliance. This procedure is done for people who had
undergone colostomy, ileostomy, gastrostomy, jejunostomy which is made by making an
opening or stoma for gastrointestinal onto the skin to divert and drain fecal material. The purpose
of this procedure is to assess and care for peritoneal skin, to collect stool for the assessment of
the amount and type of amount and to minimize odors for the client’s comfort and self-esteem.
In doing the procedure we must always consider and note the stoma color, their condition (e.g if
they have hernia, specific bowel obstructions etc), their history as it may include relevant data to
make our implementation better, the need for an appliance change of stool, assess and ask them
if there is any discomfort around the stoma, the appropriate time to change whereas avoidance to
change close to meal or visiting hours, and their diet to help them educate in appropriate diet to
prevent some flatulence, abdominal irritation and odor for self-esteem.

In preparation we should note the materials needed:

-clean gloves

-bedpan

-moisture proof bag (for disposable pouches)

-cleaning materials (warm water, mild soap optional)

-wash cloth and 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

Then we must consider the need for an appliance change of stool, assess and ask them if there is
any discomfort around the stoma, the appropriate time to change whereas avoidance to change
close to meal or visiting hours. We should establish rapport to the client in doing this. So facing
the patient I will again introduce myself, verify client’s identity, explain to them the rationale of
procedure, the procedure itself, and discuss how results will be used in planning further care or
treatments.

Now I will wash my hands, apply clean gloves and observe appropriate infection control
measures to practice aseptic technique. Next is provide client privacy preferably in bathroom
where clients can learn to deal with ostomy especially if they practice this in home. Then I will
now assist the client to a comfortable sitting (if in bathroom) or lying position if in bed as this
facilitate smoother pouch application and avoid wrinkles. I will unfasten the belt if the client is
wearing one.

I will then empty the pouch and remove the ostomy skin barrier. To do this I must empty the
contents of a drainable pouch through the bottom opening into a bedpan or toilet. The rationale
behind this is it will prevent the spillage of stool onto the client’s skin. In case if the pouches
uses clamp, I will not throw it as it can be reused. In this time we can assess the consistency,
color and amount of stool. Now peel the skin barrier off slowly, beginning at the top and
working downward, while holding the client’s skin taut. Holding the skin will lessen the
discomfort and lessening the chance of skin abrasion. I will now discard the disposable pouch in
a moisture-proof bag.

Now I will clean and dry the peristomal skin and stoma by using toilet tissue first to remove
excess stool. In cleaning the stoma the warm water is used and wash cloth to clean the stoma.
However, mild soap is optional due to it sometimes can irritate the skin. If it will be allowed,
then usage of deodorant will be avoided because it may interfere with adhesives of skin barrier.
Then pat dry the area using the towel because forceful rubbing can abrade the skin. Then assess
the stoma for color (which should be red or similar in color of mucosal linings of inner cheek),
size, shape, (size and shape include that stoma should be slightly protrude 1.5 to 2.5 in. and
appear moist and swollen) and bleeding (which should be slight bleed when being touched). If
bluish discoloration is seen in the stoma may indicate poor or impaired blood circulation which
should be notified to doctor immediately. Assess also the peristomal skin for any redness,
ulceration or irritation. Transient redness after the removal of adhesive may indicate normal.

I will place a piece of tissue or gauze over the stoma and change it as needed. This is to absorb
any seepage from stoma while the ostomy appliance is being changed. Then, I will prepare and
apply the skin barrier. In order to do this, use stoma measuring guide to determine the size of
stoma. On the backing of skin barrier, trace a circle the same size using pen or pencil as the
stomal opening, then cut out the traced stoma pattern to make an opening in the skin barrier. This
opening is not ore than 1/8 to ¼ inch larger than the stoma to allow space for the stoma to slighty
expand when functioning as it minimizes the risk for stool contacting the peristomal skin. Now,
remove the backing to expose the sticky adhesive side

If the used pouching system is one-piece pouching system, center the one piece skin barrier and
pouch over the stoma the press gently into client’s skin for 30 seconds to ensure it will adhere to
client’s clothing. Remove the tissue over the stoma before applying the pouch and snap the
pouch onto the flange of skin barrier wafer. For drainable pouches, close the pouch in
accordance to the manufacter’s directions. Then wash the hands again and dispose all the waste
in appropriate receptacle.

Before leaving the client, I will reassess her again if there were any discomforts then provide her
a comfortable position and environment. Then I will document the procedure using forms or
checklists supplemented by narrative notes when appropriate. I will report if there are any
increase in stoma size, changes in color of stoma (e.g. bluish discoloration), peristomal skin
appearance and if there are any redness in it, and if there is any presence of skin irritation or
erosion. Also the client’s respond during the performance of procedure should be noted, their
experience with ostomy and the skills they learned especially in client education for procedures.