Changing an Ostomy Pouch: Post-Procedure and Special Considerations (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Now before you leave the room again make sure that patient's in a comfortable position and lower that bed to its lowest level for safety, don't forget those side rails make sure those are up, dispose of any of the use supplies and especially that old ostomy. Now we can remove our gloves, perform our hand hygiene and we can document our procedure. So when we're talking about documentation for an ostomy, there's five key points we want to talk about so first, what kind of ostomy is it. So here's a great example if you follow along with me on this image, so at 1100 there's a two-piece hollister ostomy appliance with two and a fourth flange and pouch changed, now we want to talk about that stoma color if you remember, what's a bad stoma color? Remember that necrosis we want to make sure this appears normal so here's a great documentation piece for that. Stoma color appears normal without signs of erythema or dermatitis and again remember that skin integrity with care, the skin integrity is intact with no signs of ulcerations or lesions and again think about that stoma remember that assessment of that is key so see here how they've documented the texture of the stoma is moist. Okay so let's pause here for a minute, so you hear that you hear that they're saying the stoma is moist that should be the case with your stoma, anytime you're assessing it I want to bring that home again that it should be red, reddish pink, pinkish and moist and that's normal and that's what we want to see and lastly, don't forget about skin turner, we should have normal soft skin sugar here. So we've talked about a lot of things in regards to the ostomy but I have a few more takeaway points for you in regards to that so let's look at some special considerations, so let's take a look at this slide you see there's six things to think about so we talked about maintenance of it but what about the patient itself so let's really dive into a couple of these. So let's talk about odors first, so this is a really big topic for a patient as you can imagine. A patient can have an ostomy for a while so if the patient's out and about their day really having an odor, that may affect them or someone else could smell, could be really embarrassing for the patient, so again we talked about earlier there's some appliances that have these great filters on it to allow that digestive gas to be released so that ballooning doesn't occur without odor so this is really helpful for the patient. Now if they do have a filter, we want to. prevent that filter from getting wet so instruct the patient if they shower they may want to just put a piece of medical tape for example over that to keep that from being damaged. Now when we're talking about bloating, this can be really uncomfortable for a client so it's a great idea to talk about some dietary tips for them so encourage that patient to keep a food diary so anytime they eat something they may notice okay well this is going to make me feel really bloated, there's a lot of gas which foods are those, so it's important for the patient to be able to identify this themselves. Now which food? Now if you guys remember beans is one, that's definitely going to cost some gas for your patients, fruits, some veggies for example really dairy can do it as well especially grains, nuts and also those really bubbly carbonated beverages and lastly, it's a good idea to teach your patient to eat slowly in order to swallow less air, you may think what are you talking about? So here's a great example, like if a patient goes through a straw they're gulping a lot of air and as you know that can help increase the amount of gas maybe that they feel and also contribute to bloating, also have them slow, too slowly, so their brain will trigger when they're full. Now here's a couple of tips like we were talking about so we don't absorb too much extra air or swallow too much extra air like drinking through a straw like we just talked about also chewing gum is another one, now don't forget smoking, so we know as nurses this contributes to a lot of issues but it will also contribute to bloating and gas for your patient and again this one may be a hard one for your patient but trying to reduce the amount of carbonated beverages so we all like our certain colas for sure but this can definitely contribute to gas for your patient. Now let's take a moment and pause on body image, this is something as a nurse we get in a hurry, we may not really think about this but if you guys remember there were so many new ostomies each year that occur for patients this is definitely going to affect someone's feeling of their body image and this is important for us as nurses to be aware of, so here's a couple of things for them to consider, the good thing about an ostomy a lot of the time, a lot of the times they can actually wear this under their regular clothing, however, there's some great things out there like some special underwear that comes up high, there's also wraps for example to where when the patient puts on their clothing, you can't even tell it's there so just be aware of this that body image really is something that we need to be aware of that this could affect our patient emotionally and psychologically. And next, when we're talking about body image, as a human sexual relationship and intimacy is part of that, if you remember that Maslow's hierarchy of needs, it's a basic need of a patient and this can be resumed with an ostomy, but this is important as the nurse to have an open dialogue with your patient here and lastly, living with an ostomy. Let's talk about just about three things that are important to wrap this up about things they need to consider, so having extra supplies on hand at all times, you may think okay really? You just never know though sometimes maybe the bag, the bag may peel off, maybe you lose the clamp so it's really important for the patient and teach them to be prepared at all times and we've touched on this but encourage independents with individual ostomy care. I'll tell you a lot of the times I've had patients in the hospital that I've taken care of and they really did all of their care for the most part because they just knew their body and were able to take care of this themselves and it really helps promote independence and again as nurses we should allow this and lastly, don't forget about support groups, again living with an ostomy, this may be temporary, it may be longer term we also talked about sexual intimacy and body image earlier. This can be something that's a big life-changing event for a client so make sure you refer them to those as well. Thanks for watching.

    About the Lecture

    The lecture Changing an Ostomy Pouch: Post-Procedure and Special Considerations (Nursing) by Samantha Rhea, MSN, RN is from the course Ostomy Pouching Systems (Nursing).

    Included Quiz Questions

    1. Appearance of stoma
    2. Type of ostomy
    3. Skin integrity around the stoma
    4. Contents coming out of the stoma
    5. Pain assessment
    1. Cover the ostomy filter with tape while showering.
    2. Cut out cauliflower and broccoli to reduce gas.
    3. Wear comfortable clothing that covers the ostomy.
    4. Sexual intimacy cannot occur while an ostomy is present.
    5. Chewing gum will reduce swallowing air and decrease gas.
    1. Attend support groups.
    2. Keep extra supplies at all times.
    3. Be independent with ostomy care.
    4. Allow a family member to do ostomy care.
    5. Avoid talking about the ostomy.

    Author of lecture Changing an Ostomy Pouch: Post-Procedure and Special Considerations (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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