A nurse is preparing to change a two-piece ostomy appliance for a client with a newly established descending colostomy. In which order should the nurse perform the following actions? Arrange the steps from first to last.
- 1Remove the soiled ostomy pouch and skin barrier by gently pushing the skin away from the adhesive.
- 2Cleanse the stoma and surrounding peristomal skin with warm water and gently pat completely dry.
- 3Measure the stoma using a measuring guide and trace the correct size onto the back of the new skin barrier.
- 4Cut the opening on the skin barrier approximately 1/8 inch (0.3 cm) larger than the traced stoma measurement.
- 5Apply the skin barrier firmly to the peristomal skin and snap the new pouch into place.
Answer
The correct sequence for changing an ostomy appliance is: removing the old appliance, cleaning and drying the skin, measuring the stoma, cutting the barrier to the appropriate size, and applying the new barrier and pouch.
The procedure for changing an ostomy pouch requires a logical progression focused on skin integrity and maintaining a proper seal. The nurse must first gently remove the old equipment by pushing the skin away from the adhesive to prevent epidermal stripping. Next, the skin is cleaned with warm water (avoiding soaps that leave residue) and thoroughly dried. Because the stoma size fluctuates, especially in the postoperative period, the nurse must measure it accurately after cleaning and drying the area. The wafer is then carefully cut approximately 1/8 inch larger than the stoma to ensure it does not compress the stomal tissue while still protecting the surrounding skin from effluent. Finally, the newly cut barrier and pouch are applied.
Step-by-Step Solution
Key Concept
Ostomy Care and Peristomal Skin Management