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1. Assessment

   • Assess stoma for color, drainage, or excoriation
   • Determine indication for stoma care
   • Assess for adhesive allergies
   • Assess for latex allergies
   • Ensure to have proper applience

2. Risks

   • Infection
   • Impaired skin integrity
   • Injury from insertion or removal of applience

3. Ostomy Supplies

   • Bedpan and toilet access
   • Clean gloves
   • Washcloth, towel, waterproof pad
   • washbasin with warm water
   • Gauze, skin barrier cream
   • Ostomy appliance and bag
   • Clamp, trash bag
   • Stoma measuring guide

4. Documentation

   • Date and Time of precedure
   • the cause of procedure
   • size of stoma
   • characteristics of stoma
     • Color
     • Drainage
     • redness
     • excoriation
     • odor
   • Characteristics of Feces
     • Amount
     • color
     • odor
   • The client's toleration of the procedure

5. Patient Teaching

   • Explain procedure
   • Explain the stoma should be juicy red color not pale
   • maintaing privacy
   • Encourage self care

6. Procedure

   • Confirm HCP order, obtain consent
     • Confirm client (ID and DOB)
       • Provide privacy and introduce self
         • perform hand hygiene
           • Place graduated cylincer under bag for measurement
             • remove clamp, uncuff the bag and empty the contents in measuring device
               • Discard the appliance unless reusable
                 • Gently clean the surrounding skin with a washcloth and warm water
                   • Pat skin dry and apply barrier cream no closer than 2 in. from the stoma
                     • Let dry completely and assess the stoma
                       • Cut a hole in the appliance to 1/8 inch larger than the stoma
                         • Carefully lay the appliance over the stoma
                           • Smooth out air and hold even pressure for 5 minutes
                             • Apply the clamp to the bottom of the new pouch
                               • wash hands and Document