Nursing & Healthcare Programs

Performing Ostomy Care

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

Residents who have had a portion of their intestines removed due to illness or trauma may have a temporary or permanent ostomy, which is an opening in the abdomen that is created for the elimination of urine or feces. The portion of the intestine that is connected to the abdominal wall and is visible is called the stoma. A pouch is placed over the stoma to collect feces. The pouch should only be changed every 3 to 7 days or when leakage occurs to prevent skin irritation.

Ostomy Care

  1. Gather your supplies:
    • Gloves
    • New ostomy pouch, skin barrier, clamp, and pouch deodorant
    • Skin paste
    • Gauze pads
    • Wash cloths or bath wipes
    • Towel
    • Adhesive remover
    • Scissors
    • Trash can
    • Absorbent pad
  2. Provide the resident privacy by closing the door or curtain.
  3. Perform hand hygiene and don gloves.
  4. Raise the bed to a comfortable working height and lower the bed rail closest to you.
  5. Place an absorbent pad under the resident to catch any leakage or spillage from the stoma or pouch.
  6. Gently lift up on the pouch and barrier in one hand while pushing the skin down. Use adhesive remover pads if necessary.
  7. Place the used pouch and barrier in the trash.
  8. Clean the stoma and the area around it with a gauze pad, wash cloth, and/or a bath wipe.
    • Be gentle with this step. Do no rubbing or scrubbing, as that can irritate the skin and/or stoma.
  9. Carefully pat the area dry with a towel or gauze pad.
  10. Examine the area for skin breakdown. Immediately report breakdown to the nurse.
  11. Check the size of the opening of the new barrier. The opening may need to be trimmed with scissors to accommodate the stoma.
  12. Remove the backing from the barrier, and then apply a thin layer of skin paste per the manufacturer’s instructions.
  13. Using one hand, gently pull the skin around the stoma so that it is wrinkle-free.
  14. Position the hole in the barrier over the stoma. The pouch should be hanging downward from the stoma.
  15. Press the barrier and pouch so that an air-tight seal is formed with the skin. No part of the stoma should be between the barrier and skin. The edges of the hole in the barrier should not touch the stoma. Continue applying pressure to the barrier per the manufacturer’s instructions.
  16. Pull carefully on the pouch to ensure that it is fully attached.
  17. Add deodorant to the pouch and secure the bottom opening with the clamp.
  18. Remove the absorbent pad from under the resident.
  19. See to the resident’s comfort. Replace clothing/linens as necessary.
  20. Discard the used supplies.
  21. Remove gloves and perform hand hygiene.
  22. Document the procedure, waste, and skin and stoma condition per institutional policy. Report any difficulties or changes in the skin or waste to the nurse per unit policy.

References

S. A. Sorrentino, & L. N. Remmert. (2012). Bowel elimination. In Mosby’s textbook for nursing assistants (8th ed., pp 421-423). St. Louis, MO: Elsevier Mosby.

More Resources

Removing Personal Protective Equipment

It is important to follow the correct procedure while removing personal protective equipment to avoid contaminating your skin or clothing. The most common source of contamination in this process stems from improper removal of gloves. Gloves are often the most soiled piece of equipment. To avoid contaminating your skin or the other equipment worn, gloves should always be removed first. Then remove the goggles, gown, and mask, in that order.

Partial Bed Bath

Bathing is an important part of a patient’s health routine. A partial bed bath focuses on bathing sensitive areas that cause discomfort if not cleansed frequently, such as the face, hands, axillae, back, and perineum. Though patients receiving a bed bath are typically confined to the bed, some are able to wash themselves and should be encouraged to do so to promote independence.

Perineal Care of the Female Resident

Perineal care should be performed during a bath, after using the bedpan, and/or after incontinence. Proper technique is important for maintaining hygiene, preventing infection, and avoiding skin breakdown. Because of the close proximity between a woman’s urethra, vagina, and anus, it is essential to only wipe in a front to back motion. Wiping in the opposite direction is associated with a greater risk for developing a urinary tract infection.

Measuring Blood Pressure

Many factors can interfere with obtaining an accurate blood pressure. The most common mistakes that lead to inaccurate blood pressures are a result of improper technique, including: not supporting the patient’s arm, using the wrong sized cuff, positioning the cuff too low on the patient’s arm, improper positioning of the cuff’s artery marker, and attempting to measure blood pressure through clothing.

Performing the Heimlich Maneuver

The Heimlich Maneuver, also known as abdominal thrusts, is used to remove an object that is blocking a resident’s airway and preventing air from reaching the lungs. It only takes four to six minutes for brain damage to occur from lack of oxygen, so prompt action is vital.

Measuring the Apical Pulse

The apical pulse rate is the most accurate non-invasive measurement of heart rate because it is measured directly over the apex of the heart. Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).