Gather the supplies a nurse need to pouch an ostomy (upload pictures of each)

 Give examples of peri-stomal skin care supplies a nurse will use (upload pictures)

 Describe the  normal stoma finding a nurse should expect to see.

 List and describe three unexpected findings (complications) of a stoma and one nursing intervention for each

Gather the supplies a nurse need to pouch an ostomy (upload pictures of each)

*Note: See explanation area for the attached photos of the supplies needed by the nurse to pouch an ostomy*

The needed supplies the nurse would require to pouch an ostomy would be:

• Alcohol-Based Hand Rubs to prevent cross-contamination of infection.
• Non-Sterile/Clean Gloves, also used to prevent cross-contamination of infection.
• Stethoscope, used to assess the bowel sounds of the patient surrounding the stoma.
• Waterproof pads, used to prevent the spillings of effluent on the patient and bedsheets.
• Adhesive Remover for the Skin, used to safely remove the previous ostomy pouch and flange from the body.
• Stoma Measuring Guide, used to ensure the proper fit and measurement of the stoma and prevent problems associated with it (swelling for too tight measurement, while leakages for too loose/large measurement).
• Pen or Marker, used to trace the diameter of the measuring guide to the flange/wafer.
• Scissors, used to cut the outside of the pen markings based on the acquired measurements.
• Stomahesive Paste/Powder, used to create a skin sealant to adhere pouching system to skin to prevent leaking.
• Flange/Wafer, used to protect the skin from the stomal output and allows the ostomy pouch to connect to the body.
• Ostomy bag and clip, used to collect waste from the body.
• Skin Prep, used to prevent the flange from adhering to the skin.
• Wet Cloth, used to clean the peristomal skin (with or without mild soap), then dry with another clean cloth to prevent irritation of the surrounding skin.

Give examples of peri-stomal skin care supplies a nurse will use (upload pictures)

*Note: See explanation area for the attached photos of the peristomal skin care supplies*

Peristomal skin care refers to the care of the skin surrounding the stoma. Usually, when the nurse pouches an ostomy, peristomal skin care is already part of the process, thus, peristomal skin care supplies are similar to the ostomy pouching supplies.

The skin around the stoma should appear the same as the skin anywhere else on the abdomen. However, in some cases, ostomy output can irritate the peristomal skin. Nursing procedures that entail the care of this skin are (American Cancer Society, 2020):

• Utilizing the right-sized pouch and skin barrier opening to prevent swelling (if too small or too tight) and prevent leakage and irritation (if too large). This is through using the stoma measuring guide, proper-sized flange/wafer, and ostomy pouch.
• Adhesive remover for Skin should be used to prevent skin injuries brought about by pulling the pouching system away from the skin. This should be done gently and through pulling the skin away from the barrier rather than pulling the barrier itself from the skin.
• Clean or sterile water could also be additionally used to clean the skin around the stoma. A clean towel/cloth can be used to dry the skin completely prior placing the skin barrier. If soap is needed, only mild, organic soap should be used with NO LOTIONS, CREAMS, OILS, ALCOHOL, STEROIDAL MEDICATIONS, or OINTMENTS. These may leave residue or film on the skin which may result not only to irritation, but possible effects (e.g. infection).
• Prior putting on accessories such as adhesive, skin barriers, paste, tape, or the pouch itself, the nurse should monitor the patient for sensitivities or allergies to the products to prevent irritation of the peristomal area.

Describe the  normal stoma finding a nurse should expect to see.

The following are the normal findings the nurse should expect to see in a normal stoma (Doyle & McCutcheon, 2015):

• Pinkish or reddish in color, slightly moist, and with little mucus secretions.
• Bleeds easily when rubbed or bumped (when washing). The minor bleeding should resolve rapidly.
• The perisomal area (or the skin surrounding the stoma) should be intact, without irritation, or redness.
• No leaks should also be noted.

List and describe three unexpected findings (complications) of a stoma and one nursing intervention for each answer with reference

The following are the three unexpected findings (complications) of a stoma:

• Peristomal skin irritation. Skin irritation may be itchy, blistered, or open and weeping caused by product used for ostomy pouching system or due to discharge/leakage. Nursing interventions may include changing to a pouching system without a tape (e.g. where skin barrier may be used instead of tape), application of stoma powder every during ostomy care, changing the pouch regularly before it leaks, ensuring that the pouch fits well to the stoma to avoid leakage, and use of accessories such as convex skin barrier, paste, or barrier rings to aid prevention of leakage as well (Doyle & McCutcheon, 2015).
• Ischemia and Necrosis. A stoma that is becoming ischemic (and gradually becomes necrotic) appears edematous with bluish discoloration, until it progresses to necrosis. This is attributed to inadequate arterial blood supply due to the damage to or an inappropriately divided vascular arcade supplying the left colon. The tissue within this area dies (Hersh, 2019). An important nursing intervention is early detection and assessment of possible stomal necrosis or ischemia. Once detected, this should be immediately reported to the physician for medical management such as reoperative surgery or possible other interventions (Vera, 2019).
• Stomal Retraction. The stoma may move inward due to several factors such as weight gain, scar tissue, and/or inappropriate placement. Due to this, the attachment to appliance becomes difficult and may result to leakage and irritation. A helpful nursing intervention to prevent this is the constant monitoring of the appearance of the stoma and utilization of accessory products. Peristomal skin care should also be performed to prevent irritation of the surrounding skin due to anticipated leakage. In severe cases, retraction may require surgery as well, so reporting to the patient's physician is necessary (Hersh, 2019).