Assessing the Stoma and Skin Care (Nursing)

00:04 Now when we're talking about ostomies and nursing care, really there's some really important pieces postoperatively and for established ostomies that we need to be aware of and talk about. So when we're talking about care for an ostomy, we need to assess the stoma, we need to provide really good skin care also how do we empty the waste pouch and also how do we even change that appliance. Now there's quite a bit of pieces for each one of these but I'm going to take you through those now. Let's start first with assessment, as nursing we always go back to assessment right?... so there's quite a bit of points here but let's talk about why these are so important now with a stoma there's a lot of things can arise so let's take a look at these. Now at least once per shift is a nurse, you should be assessing that stoma and here's some things we're going to look for- so we need to look for skin irritation, so if you take a look at that upper stoma with that red ring around it, really if you think about it any stool or feces or urine that gets on the patient skin can cause really bad redness and irritation. You can imagine just like your hands in the winter if there's dry cracking redness it's really painful and not good for the integrity of the patient's skin also leakage can occur, same sort of thing here to where if stool or feces gets on the patient's skin and it leaks around that can cause issues. Now sometimes that may be happened because the way the stoma was created surgically or maybe the appliance that we use to catch the feces is not fitted very well so that's something that we can prevent. Now let's take a look at this picture here you see that black picture, okay, this is not what we want guys, this is a really big issue here so we need to make sure we alert the surgeon or the physician about this. This is called necrosis, now if you remember in nursing when you see anything that turns black, this is a big no-no what that means is there's no good blood flow going to this part of the intestine that's on the outside of the abdominal wall and that's a serious issue so if we see a dark and black stoma that is a serious issue. So let's take a minute what should the stoma look like? Let's just refresh if you remember seeing those pictures earlier, it should be pinkish or red nice and round and it shouldn't look like any of these pictures right! Now the other thing that can happen with a stoma, man, I know there's a lot right? We're almost halfway through so there can be some blockage here and that's an issue because your patient's going to feel increased pain maybe a lot of nausea and vomiting. The stoma itself could start getting really swollen or edematous, if you see this you want to alert your doctor, the other thing that can occur is stoma prolapse. Okay, this is a little scary looking I know as a nurse if you take a look here at this picture see how that stoma is long that piece of the intestines protruding out, okay yes this could happen, now you may think okay well how on earth is that going to happen? Well anytime there's maybe really increased abdominal pressure maybe the patient tries to lift something heavy, kind of think of like a herniation or a hernia or if maybe the opening around the stoma is too large, this could all happen and we call this a stoma prolapse. Now this is particularly, this actually comes up quite a bit with pediatric patients because they kind of have a weak abdominal muscle tone. Now lastly, stoma retraction can also occur and what do we mean by this so anytime you hear the word retract right we kind of think of it maybe it back up so what you're going to see here is the stoma because there may be a lot of tension on that stoma maybe because of how it's surgically created the stoma can maybe recede inside the abdominal wall and this is also an issue. This could be because of obesity or maybe lack of blood flow and so guys I know that was a long list, there's a lot of complications unfortunately that can come up with assessing the stoma and there's even more but the good news is some of these can be conservative conservatively treated now if conservative treatment fails then they may have to get surgery again to correct this. Now let's talk about skin care, this is oh so important when we're talking about care for an ostomy, kind of like we talked about earlier we don't want that irritation that goes around the stoma because this can be really painful for the client. Now when you're thinking about skin care, just think of with ostomy, guys less is more, think about it like taking a bath something like that, we're usually going to use really mild things here, so less is more here and water is really actually usually sufficient for cleansing the skin. However, sometimes if feces gets on the patient's skin for example we may need to use a mild soap, now when I say mild, I really mean mild. We don't want something with a lot of lotions or fragrances or anything like that even though we may think okay well wouldn't that be good for the patient's skin, that actually could cause more irritation and issues so again mild soap is great. Now again things we don't want you to use around what we call peristomal skin or skin around the stoma are things like creams, lotions, powders are a no-no, alcohol pads like we like to use for cleaning for nursing because it can dry out the skin, any sort of like steroidal ointments or creams that's all a no-no in ostomy care because the reason why this is a problem this can affect how the actual appliance that catches the urine or the feces adheres to the skin of the stomach and lastly, when we're talking about skin care there should not be any signs of irritation like you recall from earlier so really frequent assessment is key and now anytime that you see remember that red or broken or irritated skin make sure you alert your doctor or make sure you follow up.