Stoma

Care

Prepared by
Raghda Hashem
Under Supervision
 Overall Aim
• At the end of this presentation, every student will be able
to apply stoma care completely, accurately and safely.
 Objectives
By the end of this session the student will be able to:
• Define ostomy , stoma and effluent.

• Identify the types and classification of ostomy.

• List indications of colostomy.

• Identify the complications of ostomy.
• Differentiate between the healthy and unhealthy stoma.
• Mention purpose of colostomy care
• Discuss nursing care of patient having colostomy
• Apply colostomy care
Outlines
• Introduction
• Definitions
• Purpose of ostomy care
• Types of ostomy
• Indications of colostomy
• Differentiate between normal &abnormal
stoma
• Facts about normal stoma
• Complications of ostomy
• Nursing care plan
• Health education
• Stoma irrigation
• Summary
 Introduction
The journey of patients who undergo ostomy surgery can be life-changing,
and proper care is essential to ensure their comfort, health, and overall
well-being.
A stoma is an artificial opening created surgically to allow waste
elimination from the body due to medical conditions such .Caring for a
stoma requires a comprehensive approach that includes not only proper
hygiene and maintenance but also addressing nutritional needs,
psychological adaptation, and potential complications.
Patients and caregivers must be well-informed about the different types of
stomas, best practices for daily care. In this presentation, we will explore
the key aspects of stoma care, including the different types of ostomy
procedures, essential daily care routines, common complications and how to
prevent them, dietary recommendations, and the emotional and social
impact of living with a stoma. We will also provide practical tips for
healthcare professionals and caregivers to ensure the highest quality of
 Definitions

Ostomy:
It is a surgical procedure for
creating an artificial opening
(stoma). from the urinary tract
or intestines.
Stoma:
It is an artificial opening made by
surgical procedure in an organ of
the body. It protrudes above the
skin.
Effluent:

Terminology used to
describe the discharge, output
from a stoma.
 Purposes of ostomy care
• Skin protection and care

• prevent infection.

• Enhance patient acceptance

and support patient

independence in self care.

 Types of ostomy
There are Four
types of stoma
are:

• Colostomy
• Ileostomy
• Urostomy
• Tracheostomy
Ileostomy
An opening into the ileum, the last part of the
small intestine, from the outside of the body.

Urostomy
An operation to create an opening from inside
the body to the outside, making a new way to
pass urine. It re-directs urine away from a
bladder that's diseased, has been injured, or
isn't working.
Colostomy

An opening into the colon from the

outside of the body.
the incision made in the colon (the large
intestine) in cases of obstruction, fistula,
cancer or ulceration of the rectum.
Stools moving through the intestine
drain through the stoma into a bag
attached to the skin of the abdomen.
1: Type of colostomy according to
site:
A- Ascending C-Descending
colostomy:
This colostomy has a stoma
(opening) colostomy:
that is located on the right side This colostomy has a stoma that
of the abdomen. is located on the lower left side of
The output (stool) that drains the abdomen. The output that
from this stoma is in liquid drains from this stoma is firm .
form.

B-Transverse colostomy: D-Sigmoid

This colostomy has a stoma
that is located in the upper
colostomy:
abdomen It is made just a few inches
towards the middle or right side. lower than a descending
The output that drains from this colostomy, in the sigmoid colon.
stoma may be loose or soft. it Stools from a sigmoid colectomy
produces mal odor. are of normal or formed
consistency.
 2: Classification According to numbers of stoma

Single colostomy:

single stoma

is created, when one end of the bowel is

brought out through an opening on to

the anterior abdominal wall. This is

also called as end or terminal

colostomy.
Loop colostomy:
In loop colostomy, a loop of bowel is brought

out on to the abdominal wall and supported

by a plastic bridge/rod or rubber catheter. A

loop stoma has 2 opening, proximal end,

which is active, and distal end is inactive. It

situated in transverse colon.

Double barrel colostomy:
It resembles like a double barrel
gun. In this type of colostomy, the
proximal and distal loop of bowel are
sutured together, for about 10 cm,
and both ends are bring up on to the
abdominal wall.
3: Classification of colostomy according
the time:
Colostomy can be either temporary or
permanent
Temporary colostomy Permanent colostomy
*It is created for elimination *A permanent it provides a mean
when healing needs to take of elimination when the end
place in the case of trauma or portion of colon , rectum or anus in
inflammatory condition of the nonfunctional and must be totally
bowel. removed.
*It used for few weeks, months *It used for long term and may be
or even years. for long life.
*It will be closed and normal *It will not be closed at any time
bowel continuity is restored.
 Indications of Colostomy

[Link] of colon and rectum

2. Diverticulitis:
• is the inflammation or infection of
diverticula, which are small, bulging
pouches that can form in the lining of
the digestive tract, typically in the colon.
 Indications of colostomy, con.
[Link]’s disease:
• is a chronic inflammatory bowel disease (IBD) that
causes inflammation of the digestive tract, affecting
any part from the mouth to the anus. It most commonly
affects the ileum (small intestine) and the colon. which
is an autoimmune form of inflammatory bowel disease.

[Link] colitis:
• is a chronic inflammatory bowel disease (IBD) that
causes inflammation and ulcers in the lining of the
colon (large intestine) and rectum
 Indications OF COLOSTOMY,
CON.

[Link] and Surgery:

• Abdominal trauma, fistula
formation, surgical
complications, or congenital
anomalies.
A healthy Stoma

is characterized by:
1: pinkish-red in color
2: shiny
3: moist
4: stick out slightly from the skin
5:opening of stoma should be in the
center
6: A stoma does not have nerve
endings; therefore, it should not hurt
7:peristomal skin should be normal
 Differentiate between normal &
abnormal stoma
Normal Stoma Abnormal Stoma
• Red/ pink Shiny • Brown, black: necrosis / Pale: vascular
appearance insufficiency
• Warm • Hot: infection / Cold: vascular

• Moist insufficiency
• Dry
• Rounded
• Irregular edges
• Slightly protrude 2-3 cm
• Retracted
• Intact (not inflamed) • inflamed
 Facts about normal stoma

• There is no voluntary control of gas or stool

expelled through the stoma.
• There is no sensation in the stoma (not painful)
because there are no sensory nerve endings in this
area.
• Stomas are vascular and may bleed slightly when
rubbed or irritated.
 Complications of ostomy

Infection Hemorrhage Necrosis

–.

Retraction Parastomal herniation Stenosi

s
1. ASSESSMENT
• Assess current appliance, condition of appliance, and stoma (if bag is
clear).
• Note length of time the appliance has been in place.
• assess the stoma and the skin surrounding the stoma. the size of the
stoma .
• If an abdominal dressing is in place at the surgical incision, check it
frequently for drainage and bleeding.
• Assess any abdominal scars, if surgery was recent.
• Assess the amount, color, consistency, and odor of stool from the
stoma
NURSING DIAGNOSIS 1: disturbed Body Image : May Be Related To

Alteration in [normal] body function (due to disease, surgery, loss of control of bowel elimi
Alteration in self- perception [altered body structure (presence of stoma)]
[Significance of body part or functioning with regard to age, gender, developmental level]
Possibly Evidenced By
Alteration in body structure and function— ostomy
Verbal or nonverbal response to actual or perceived change in body .
Negative feelings about body, fear of reaction by others
Avoids touching or looking at one’s body [stoma].

Desired Outcomes/Evaluation Criteria— Client Will

Demonstrate beginning acceptance by viewing and touching stoma and participating in se
Verbalize feelings about stoma and illness; begin to deal constructively with situation.
Verbalize acceptance of self in situation, incorporating change into self- concept.
ACTIONS/INTERVENTIONS (Body Image Enhancement )

• Ascertain support and counseling were initiated when the possibility or necessity of ostomy
was first discussed.
• Provides information about client’s level of knowledge and anxiety about individual situation.
• Encourage client to verbalize feelings regarding the ostomy.
• Acknowledge normality of feelings of anger, depression, and grief over loss.
• Helps client realize that feelings are not unusual and that feeling guilty about them is not
necessary or helpful.
• Review reason for surgery and future expectations
• Provide opportunities for client to view and touch stoma, using the moment to point out
positive signs of healing.
• Independence in self- care helps improve self- confidence and acceptance of situation .

• 2- Acute pain
May Be Related To
Physical injury agent— disruption of skin or tissues (incisions, drains, skin irritation/injury)
Biological injury agent— activity of disease pro cess (inflammation, neoplasm, trauma)
[Psychological factors— fear, anxiety]
Possibly Evidenced By
• Self- report of intensity or characteristics of pain; self- focusing
• Guarding and expressive behaviors— restlessness, self- focus/narrow focus, crying
• Changes in physiological parameter (e.g., blood pressure, heart or respiratory rate)
 Desired Outcomes/Evaluation Criteria— Client Will
Verbalize that pain is relieved or controlled.
Appear relaxed and able to sleep or rest appropriately

ACTIONS/INTERVENTIONS
- Assess pain, noting location, characteristics, and intensity.
- Encourage client to verbalize concerns. Active- listen to these concerns, and
provide support.
- remaining with client, and giving appropriate information.
- Reduction of anxiety and fear can promote relaxation and comfort.
- Assist with range- of- motion exercises and encourage early ambulation.
- Reduces muscle and joint stiffness. Ambulation returns organs to normal
position.
- Frequent position changes, reduced sitting time, and walking can help reduce
perianal pressure.
- Investigate and report abdominal muscle rigidity, involuntary guarding, and
rebound tenderness.
- Suggestive of peritoneal inflammation, which requires prompt medical
intervention.
 3- Risk for impaired Skin Integrity
Risk factors may include :Absence of sphincter at stoma Character and flow of effluent and flatus from stoma Reaction
to product or chemicals;
improper fitting or care of appliance/skin Possibly evidenced by (Not applicable; presence of signs and symptoms
establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Client Will Maintain skin integrity around stoma. Identify
individual risk factors. Demonstrate behaviors or techniques to promote healing and/or prevent skin breakdown..

ACTIONS/INTERVENTIONS
1-Inspect stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color).
2-Clean with warm water and pat dry.
3-Apply appropriate skin barrier
4-Empty, rinse, and cleanse ostomy pouch on a routine basis

4- risk for imbalanced nutrition less than body requirement

Possibly Evidenced By Inability to ingest food (prolonged anorexia, altered intake preoperatively)
Inability to digest food/absorb nutrients Hyper metabolic state-preoperative inflammatory disease; healing process
Desired Outcomes/Evaluation Criteria
Client Will Maintain weight gain toward goal with normalization of laboratory values and be free of signs of malnutrition.
Plan diet to meet nutritional needs and limit gastrointestinal (GI) disturbance
ACTIONS/INTERVENTIONS

- Obtain a thorough nutritional assessment, including dietary history, food preferences

-Identifies deficiencies and needs to aid in choice of interventions.
- Auscultate bowel sounds. Return of intestinal function indicates readiness to resume oral intake.
- Resume solid foods slowly. Reduces incidence of abdominal cramps and nausea.
- Recommend client increase use of yogurt, buttermilk, and
- acidophilus preparations, if needed. May help prevent gas and decrease odor formation.
- Suggest client with ileostomy limit foods that may thicken stool (e.g., bananas, rice, peanut butter, pasta);
- also limit foods with no digestible fibrous peels (e.g., apples, corn, dried fruits, nuts, popcorn, foods with large seeds).
- These products increase ileac effluent. High- fiber foods many thicken stool (causing constipation )
- Consult with dietitian and nutrition specialist.

5-Risk for deficient Fluid Volume

Risk factors may include: Excessive losses through normal routes “emesis and diarrhea.
Desired Outcomes/Evaluation Criteria - Client Will Maintain adequate hydration a by moist mucous membranes,
good skin turgor and capillary refill, stable vital signs, and appropriate urinary output.

ACTIONS/INTERVENTIONS
1-Monitor intake and output (I&O) carefully and measure liquid stool. Weigh regularly
2-Evaluate skin turgor, capillary refill, and mucous membranes
3-Monitor vital signs, noting postural hypotension and tachycardia
6-deficient Knowledge regarding condition, prognosis, treatment, self- care, and
discharge need

May Be Related To Insufficient information ,insufficient interest in learning, insufficient knowledge

Possibly Evidenced By
Reports insufficient knowledge ,agitated, apathetic Development of preventable complication
Desired Outcomes/Evaluation Criteria
verbalize understanding of condition, disease process, prognosis, and potential complications.

ACTIONS/INTERVENTIONS
- Review anatomy, physiology, and implications of surgical intervention. Discuss future expectations,
including anticipated changes in character of effluent
- Instruct client in stoma and pouch care. Allot time for return demonstrations and provide positive
feedback for efforts.
- Promotes positive management and reduces risk of improper ostomy care and development of
complications.
 Teaching/Learning

NURSING PRIORITIES
1. Assist client in psychosocial adjustment.
2. Prevent complications.
3. Support in dependence in self- care.
4. Provide information about procedure, prognosis, treatment needs, potential
complications, and community resources.
Discharge Plan
1- Assistance with dietary concerns
2- Management of ostomy
3- Acquisition of supplies
4- Adjusting to perceived or actual changes.
5-Complications prevented or minimized.
6-Self- care needs met by self or with assistance depending on specific situation.
7-Procedure, prognosis, therapeutic regimen, and potential complications understood and
sources of supplies
 Health Education about
•
stoma
A. Cleaning the Stoma
• Wash hands before and after stoma care. Use warm water and mild soap .

• B. Changing the Stoma Bag

• Change the bag every 3-5 days or sooner if there are leaks.

• C. Preventing Skin Irritation

• Ensure the stoma bag fits properly to prevent leaks and skin damage.

• D. Diet and Lifestyle Tips

• the colostomate is started on a light, low-residue diet
• After healing: return to normal habits with cautions to some instructions
• Eat a balanced diet to prevent blockages.
• Drink plenty of fluids to stay hydrated.
• Avoid gas-producing foods like beans, cabbage, and carbonated drinks.
• Exercise with caution—wear supportive garments if needed.

.
 Documentation
• Record condition of stoma and peristomal skin.
• ​Record Color (pink, red, purple…)&Size (dimensions or diameter)&Shape
(round, oval, irregular)
&Protrusion (flush with the skin, protruding, retracted)&Condition of the
surrounding skin (intact, red, irritated…) stoma.​
• Record individual's response
• Record color, consistency, and amount of feces in pouch (small, medium,
large)
• procedure being carried out and why. e.g. pouch emptying – routine
pouch change
 Stoma Irrigation
• Stoma irrigation is a bowel management technique used by some
individuals with a colostomy to regulate bowel movements. It involves
introducing warm water into the colon through the stoma to stimulate
evacuation, helping to establish a predictable schedule for stool passage.
• Use lukewarm water (500–1000 mL) to avoid discomfort
• Irrigation catheter Typically 60–100 cm in length, allowing ease of use,
and Smooth, Rounded Edges for safe insertion.
 Stoma care
Procedure

Immediate
postoperative After healing
Sterile Clean
 SUMMARY
In this presentation, we discussed the essential aspects of Stoma Care,
focusing on the importance of proper management to enhance patients’
quality of life
We explored the different types of ostomies, and the specific care required
for each. Daily stoma care routines were highlighted, covering proper
cleaning, bag changes, and skin protection to prevent infections and
complications
Additionally, we addressed the nutritional needs of stoma patients,
emphasizing the importance of a well-balanced diet
The psychosocial impact of living with a stoma was also discussed, along
with strategies for emotional adaptation and available support systems
Finally, we provided guidelines for healthcare providers and caregivers,
ensuring they are equipped with the necessary knowledge to offer
effective support and care. By implementing best practices in stoma care,
we can help patients lead more comfortable, confident, and healthy lives.
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