Lesson (12): Stoma Care

Lesson (12): Stoma Care

Learning Objectives:
After successful completion of this lesson, the students must be able to:
1) Define Stoma.
2) List purpose of ostomy pouching.
3) Write Characteristics of a stoma.
4) Identify the types of stoma.
5) Implement care of stoma to children
Definition of ostomy pouching:
Ostomy pouching is an external pouch for collection of stool or urine
through a stoma at the skin level. Stoma may be temporary or permanent.

Purposes of ostomy pouching are:

1. Protection of the skin.
2. Control of odor.
3. Promotion of the child's mobility.
4. Containment of drainage.
5. Facilitation of accurate measurement of effluent.
Characteristics of a stoma:
 The bowel is highly vascularized and red.
 The stoma has no nerve sensors for pain.
 The stoma may be edematous after surgical
creation and decreases in size during the next
6 to 8 weeks.
 Stoma color changes, such as becoming pale
or dusky, may represent poor perfusion to the
stoma and must be reported to the practitioner.

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 Lesson (12): Stoma care

Types of stoma and expected effluent:

 Colostomy :
a) Ascending: Stool has higher liquid content, may contain semisolid
particles.
b) Transverse: Stool is thick, semisolid.
c) Descending or sigmoid: Stool is thicker, more formed.
 Ileostomy: Watery stools; large amount of effluent; may become slightly
thicker as diet is advanced; output contains proteolytic digestive enzymes
and is caustic to the skin.
 Jejunostomy: Constant watery output; highly acidic effluent; high volume.
 Urostomy : Urine output; constant drainage of effluent
 Mucous fistula: Often accompanies colostomy or ileostomy; may be
pouched with the fecal ostomy or separated and covered with non-
adherent dressing.

Types of colostomy

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 Lesson (12): Stoma care

Equipment:
 Adhesive remover (optional)
 Measuring template
 Appropriate size pouch and flange for fecal or urinary stoma
 Gloves
 Paste (optional) and syringe (for infants and toddlers)
 Pectin-based powder or antifungal powder (as needed)
 Pen
 Scissors
 Skin barrier ring or strips (as needed)
 Skin preparation sealant (optional)
 Tail closure: flexible for infant pouches; rigid for toddler, school-
age child, and adolescent pouches.
 Washcloths (two) or disposable cloths and towel (one).
Procedure: For Stoma care
1. Perform hand hygiene before patient contact.
2. Verify the correct child using two identifiers.
3. Review the child's history for allergies.
4. Review the products currently used to pouch the child's stoma.
5. Select the appropriate pouch after determining the type of stoma, stoma age,
stoma size, and the child's and family's preferences for one-piece versus two-
piece appliances. For a child with a high-output stoma, it may be helpful to
use a urostomy pouch connected to a urinary drainage bag.
6. Perform hand hygiene and don gloves.
7. Assess the appearance of the stoma, surrounding skin, and stoma output.
8. Cut the skin barrier to size by cutting a hole in the center slightly larger than
the stoma, using stoma guide.

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 Lesson (12): Stoma care

9. Apply skin barrier.

10. Remove the covering from the adhesive backing on the pouch.
11. Center the pouch over the stoma and press gently, moving from the inner
stoma edge to out.
12. Praise the child for helping.
13. Remove soiled gloves.
14. Wash hands.
15. Record type of pouch, skin barrier, amount, appearance of feces,
condition of stoma and skin around it.

Emptying the pouch:

1. Determine the optimum time to change ostomy pouch is one- third filled
with stool, half an hour before meals, and when leakage present. Open
the lower end of the pouch over the toilet or another container and let the
stool drain out.
2. Rinse the inside of the pouch each day with a squeeze bottle of cool
water to remove the entire stool. Fill the pouch with a small amount of
clear water and swish it around thoroughly clean pouch. Then empty
pouch over the toilet or a diaper.
3. Make a wick from toilet tissue to dry the inside lower 1 inch of the
pouch. Wipe off the outside and reattach the clamp or rubber band.
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 Lesson (12): Stoma care

4. Praise the child for helping.

5. Wash your hand as above.

Warning signs:
1. Bleeding from the stoma.
2. Bleeding from the skin around the stoma.
3. Change in bowel pattern.
4. Change in the stoma’s size.
5. Increase in body temperature above 38c.
Complications:
1. Leakage.
2. Prolepses.
3. Obstruction.
4. Stoma becomes edematous and enlarged.

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