SDE: Clinical Guidelines Ch7S

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
7
Specialized Health Care Procedures

S. Ostomy Management and Care

Definition

An ostomy is a surgically created opening through the skin to the intestine or urinary tract to provide for elimination of bodily wastes. Urinary stomas and colostomies usually drain into a bag (National Library of Medicine, 2011).

Purpose

To maintain continence; to keep the stoma and the surrounding skin in good condition. To encourage self-care as much as developmentally and physically possible; to facilitate acceptance of the student in school; to replace a bag that is leaking.

Equipment

Gloves, scissors; stoma wafer; disposable washcloth; gauze; ostomy bag; skin protectant or barrier

Procedure

Management (emptying bag)

  1. Empty or assist student to empty contents of bag into toilet.
  2. Inspect skin around stoma for redness, rash, blistering, lesions, or bleeding.
  3. Notify parent if there is any redness, rash, blistering, lesions, or bleeding.
  4. Remind student to wash hands when procedure completed.

Care (changing appliance)

  1. Carefully remove the used bag and skin barrier by pushing the skin away from the bag, instead of pulling the bag off the skin.
  2. Inspect skin for redness, rash, blistering, lesions, or bleeding and notify parent if observed.
  3. Cut skin barrier to fit stoma.
  4. Pat stoma dry with disposable washcloth, cover the stoma with moistened gauze while awaiting placement of bag.
  5. Pat skin dry with disposable washcloth.
  6. Apply skin protectant or barrier to skin around stoma.
  7. Peel off backing from adhesive.
  8. Center the new bag directly over the stoma.
  9. Firmly press the bag to the skin barrier so there are no leaks or wrinkles.
  10. Remind student to wash hands when procedure completed.

Delegation Considerations

Management may be performed by an RN, LPN, OT, PT, teacher, paraprofessional.

Care of stoma or changing appliance may be performed by a RN, LPN, OT, PT, CNA, or trained paraprofessional.

Select Nursing Considerations

  • Health care provider order and parent/guardian authorization is required.
  • Developmental and physical limitations of student.
  • If unfamiliar, training, and consultation for school nurses, RNs and LPNs may be provided by an ostomy-care nurse specialist.
  • Training received by the student and/or family.
  • Irritation at or around the stoma, skin breakdown, increased or decreased ostomy output, vomiting, or pain should be reported for treatment.

Reference

National Library of Medicine. (2011). Ostomy. Retrieved January 19, 2012.

 




Content Last Modified on 7/23/2014 1:31:25 PM