A client on the surgical unit requires a routine change of a two-piece colostomy pouching system. The licensed practical/vocational nurse is preparing to perform the procedure. In what order should the nurse perform the following actions? Arrange the steps in the correct chronological sequence from first to last.
- 1Gently peel the soiled skin barrier away from the abdomen while pressing down on the adjacent skin.
- 2Cleanse the stoma and the surrounding peristomal tissue gently using warm tap water.
- 3Pat the peristomal skin completely dry using a soft cloth or gauze pad.
- 4Determine the exact size and shape of the stoma using a designated measuring guide.
- 5Cut the center opening of the new adhesive skin barrier exactly 1/8 inch larger than the stoma measurement.
- 6Center the new skin barrier over the stoma and press it firmly onto the abdomen.
Answer
The correct sequence for changing an ostomy pouching system is to first remove the old appliance, cleanse the area with warm water, thoroughly dry the skin, measure the stoma, cut the new skin barrier 1/8 inch larger than the stoma, and finally apply the new barrier.
Changing an ostomy pouch requires a methodical approach to maintain skin integrity and ensure a secure seal. The nurse must first safely remove the soiled appliance by supporting the skin to prevent epidermal stripping. Next, gentle cleansing with warm tap water removes effluent without leaving chemical residues. Drying is critical because adhesives fail on moist skin. Once dry, measuring the stoma ensures an accurate fit, as stomas can shrink or swell over time. Cutting the barrier 1/8 inch larger prevents strangulation of the stoma tissue while protecting the skin. Finally, the prepared barrier is applied securely.
Step-by-Step Solution
Key Concept
Ostomy Care Sequencing and Peristomal Skin Management