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

Logrolling the Resident

Logrolling is a technique used to roll a resident onto their side without the resident helping, and while keeping the resident’s spine in a straight line. This is especially important for residents who have had spinal surgery or injury.

Offering the Bedpan

When a resident is bed-bound, they must use a bedpan to urinate and defecate. This can be embarrassing for the resident, so it should be done with sensitivity to the resident’s privacy and dignity. There are two types of bedpans. A regular bedpan is the deeper and more rounded of the two. A fracture pan has a relatively flat upper end with a trough at the lower end. Fracture pans are used for residents who have difficulty, or restrictions against, moving their hips and/or backs.

Moving the Resident to the Side of the Bed

Residents are usually kept in the center of the bed for safety reasons. However, moving a resident to the side of the bed is an important step to take before turning a resident onto his or her side. Performing this action allows the resident to end up side lying in the center of the bed and not smashed up against the side rail.

Passive Range of Motion Exercises

Range of motion exercises are used to help prevent or decrease contractures, improve flexibility of joints, and improve strength [1]. Bedridden patients as well as those with reduced mobility may greatly benefit from passive range of motion exercises. However, do not perform these exercises without an order to do so, as it may be contraindicated in certain situations.

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.

Feeding the Patient

Not all patients will need help feeding themselves. Some patients will only need assistance opening cartons or cutting their food. To promote independence, always let the patient do as much as he or she can before assisting. It is vitally important that the nurse’s aide verifies that the patient receives the correct meal tray. Patients may have special diets that play a critical role in their health (i.e., pureed diet, gluten-free diet, food allergies, etc.). Feeding the wrong food to the wrong patient could result in serious complications.