Protocol Nursing Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health Center PROTOCOL

L FOR: Ostomy Care

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POLICY: 1. The Wound-Ostomy nurse will be consulted for: a. any patient with a new ostomy b. patient teaching and appropriate appliance selection c. any peristomal irritation d. any established stoma with pouching difficulty 2. Patients will be discharged with appropriate prescriptions for ostomy supplies.

DESIRED PATIENT OUTCOMES:

1. Patient will experience minimal/no complications related to bladder or bowel diversion. 2. Peristomal skin integrity will be maintained. 3. Patients will be adequately prepared for discharge.

CLINICAL ASSESSMENT AND CARE: 1. Assess stoma for: a. color - should be pink/red; b. presence or absence of moisture should be moist; c. protrusion above, at or below skin level; d. edema - may be edematous for several days post-op; edema should begin to decrease during within 5-7 days post-op. 2. Assess and monitor drainage: a. Colostomy/Ileostomy: may only excrete serosanguinous fluid for the first 24-72 hours post-op, then fecal drainage should be present. b. Urostomy/Ileal Conduit: will excrete urine immediately. Attach drainage pouch to foley drainage bag to prevent excessive accumulation/stagnation of urine in pouch. 3. Assess colostomy/ileostomy every 8 hours for gas in pouch and release prn. Gas excretion may precede excretion of fecal material. 4. Assess peristomal skin with each appliance change - skin should be clear and without signs of irritation, such as rash, erythema, ulcerations. a. For irritated skin, apply barrier product to peristomal skin. b. For weeping and excoriated skin, sprinkle a small amount of stoma powder on the affected area and remove any excess powder. Stoma powder helps to improve the adherence of skin barriers when skin is eroded and moist due to irritation. c. For dimpling, creases, or irregular skin surfaces, use stoma paste or barrier rings. Stoma paste or rings serve as a caulking agent under skin barriers to fill in creases or irregular skin surfaces. Remove paste or ring residual prior to application of new appliance.

Protocol Nursing Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health Center PROTOCOL FOR: Ostomy Care 5. Confirm appropriateness of appliance:

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a. Select correct appliance for type of diversion: 1) spigot outflow for urostomy 2). open-ended pouch with closure device for ileostomy or colostomy b. Fit of appliance around stoma c. Effectiveness of collecting drainage and wear time d. Patients sensitivity to product e. Patients ability to manage appliance 6. Assess and evaluate patient response to bowel or bladder diversion and ability to: a. verbalize feelings (positive and negative) about diversion b. participate in ostomy care c. resume personal hygiene/grooming behavior d. describe plans for resuming activities of self-care, vocation and recreation e. describe plans for adapting home environment for stoma care f. verbalize concerns, if any, regarding sexual functioning

7. Consult with Clinical Dietician or WOCN to instruct patient regarding: a. foods which may produce gas, constipation, diarrhea b. foods which may produce malodorous urine c. re-introduction of food groups

REPORTABLE CONDITIONS:

1. Changes in stoma appearance. 2. Unexpected changes in drainage. 3. Patients refusal or inability to participate in ostomy care.

DISCHARGE PLANNING:

1. Provide patient with discharge information regarding available community resources: United Ostomy Association; American Cancer Society; Visiting Nurses Association; Wound, Ostomy, and Continence Nurses Society; medical suppliers.

Protocol Nursing Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health Center PROTOCOL FOR: APPROVAL: EFFECTIVE DATE: REVISION DATES: REVIEWED DATES: Ostomy Care Nursing Standards Committee 12/90 12/97, 9/00, 12/02, 4/06, 6/06, 7/12 7/09

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