Far Eastern University

Institute of Nursing

STUDENT PERFORMANCE EVALUATION TOOL

COLOSTOMY CARE

Name:_____________________________ Sec/Group No:________________ Date:________________

Area:______________________________ Faculty:__________________ Concept:___________________
DIRECTION: Rate the learner based on the competencies listed below
KEY:
3 – Very Good Performs expected competencies in a very consistent manner.
2 – Satisfactory Performs expected competencies in a moderately consistent manner.
1 – Needs Improvement Performs expected competencies in a rarely consistent manner.
0 – Poor Does not perform expected competencies.
CRITERIA
A. ATTENDANCE AND ATTITUDE
1. Report on time and attend to activities punctually
2. Display proper grooming and wears complete uniform
3. Behaves appropriately towards teachers, classmates and
clients
4. Accepts constructive criticism
B. PROCEDURE
1. Assist the client to a comfortable sitting or lying position and expose only the stoma area.

- Provide privacy.
- Gather the equipment.
a. Measuring guide of ostomy
b. Colostomy bag
c. Clip
d. Towel (1 pc)
e. Soap
f. Adhesive paste (to be placed around the stoma to avoid leaking)
g. Incontinence sheet (to be placed behind the patient’s back)
- Check the color, size, drainage, surrounding (irritation)
2. Don Gloves
3. Empty the pouch when 1/3 to ½ full & assess for the consistency & amount of effluent
4. Remove the appliance and discard.
5. Using warm water and mild soap, clean the peristomal skin and the stoma (inner to outer)
6. Dry the area thoroughly by patting with a towel or cotton swabs
7. Assess the stoma & peristomal skin. Place a piece of tissue or gauze pad over the stoma, and change
it as needed
8. Measure the size of the stoma by tracing a circle on the backing of the skin barrier the same size as
the stomal opening. Cut out the traced stoma pattern to make an opening in the skin barrier. Remove
the backing to expose the sticky adhesive side.
9. Remove the tissue or gauze pad on the stoma
10. Center the skin barrier over the stoma & gently press it onto the skin, smoothing out any wrinkles
or bubbles
11. Remove the air from the pouch

Documentation:
- Date and time
- Presence or appearance of the stoma
- Any discharges
- Reaction of the patient
- Amount and consistency
TOTAL SCORE =
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Signature of Student Signature of Faculty