Elimination. Basic Principles Wash Hands & Wear Gloves Infection control, your protection & your client’s protection Privacy Embarrassing Positions

EliminationElimination

Basic Principles Basic Principles

Wash Hands & Wear GlovesWash Hands & Wear Gloves Infection control, your protection & your Infection control, your protection & your

client’s protectionclient’s protection PrivacyPrivacy

Embarrassing Embarrassing Positions for urinationPositions for urination

IndependenceIndependence

Functions of Urinary Functions of Urinary SystemSystem

Remove wastes from blood to form urineRemove wastes from blood to form urine Remove nitrogenous waste products of Remove nitrogenous waste products of

cellular metabolismcellular metabolism Regulates fluid and electrolyte balanceRegulates fluid and electrolyte balance

The nephron = functional unit of the The nephron = functional unit of the kidney and forms the urinekidney and forms the urine

Goal of Urinary SystemGoal of Urinary System

To maintain chemical homeostasis of the To maintain chemical homeostasis of the blood. blood. Filtration by the NephronsFiltration by the Nephrons

H2O, glucose, amino acids, urea, creatinine, H2O, glucose, amino acids, urea, creatinine, major electrolytesmajor electrolytes

Not normally large proteins or blood cellsNot normally large proteins or blood cells Proteinuria is a sign of glomerular injuryProteinuria is a sign of glomerular injury

Normal adult 24hr output = 1500-1600ml. Normal adult 24hr output = 1500-1600ml.

Overview of Urinary Overview of Urinary SystemSystem

KidneysKidneys Bean shaped organsBean shaped organs Either side of vertebral columns T12 – L3Either side of vertebral columns T12 – L3 Right kidney lower due to liverRight kidney lower due to liver Urine produced with filtration of blood Urine produced with filtration of blood

through nephronsthrough nephrons Major role in fluid & electrolyte balance Major role in fluid & electrolyte balance

UretersUreters Connect kidneys to bladderConnect kidneys to bladder 10 -12 in length, ½ in diameter in adult10 -12 in length, ½ in diameter in adult Peristaltic wavesPeristaltic waves

Renal colicRenal colic

MicturitionMicturition

BladderBladder Distensible, muscular sacDistensible, muscular sac Reservoir for urine ( approx. capacity = Reservoir for urine ( approx. capacity =

600mls )600mls ) Organ of excretion ( norm. voiding= 300mls)Organ of excretion ( norm. voiding= 300mls) Lies in pelvic cavity behind symphysis pubisLies in pelvic cavity behind symphysis pubis

UrethraUrethra Short, muscular tubeShort, muscular tube Urine from bladder to meatus and from the Urine from bladder to meatus and from the

bodybody Female 4-6.5cm (1 ½ - 2 ½ in.) lengthFemale 4-6.5cm (1 ½ - 2 ½ in.) length Male 20cms ( 8 in.)Male 20cms ( 8 in.)

Urinary and reproductive systemsUrinary and reproductive systems

MeatusMeatus External opening of the urethra, male & External opening of the urethra, male &

femalefemale

The need to void is a conscious The need to void is a conscious awarenessawareness

Life Cycle Changes Life Cycle Changes

Infants & childrenInfants & children Unable to concentrate urine b/c kidneys are Unable to concentrate urine b/c kidneys are

immatureimmature Urine is light yellowUrine is light yellow Void frequentlyVoid frequently Voluntary control @ 24mos. when Voluntary control @ 24mos. when

neuromuscular structures develop neuromuscular structures develop

AdultAdult 1500 – 1600 mls urine/24hrs1500 – 1600 mls urine/24hrs Concentrates urine – normal is amber Concentrates urine – normal is amber

coloredcolored NocturiaNocturia

Not usuallyNot usually Decreased renal blood flow during restDecreased renal blood flow during rest Ability to concentrate urineAbility to concentrate urine

ElderlyElderly Micturition impairedMicturition impaired mobility mobility Diseases, alzheimer’s, CVADiseases, alzheimer’s, CVA Physiological age related changesPhysiological age related changes

Bladder loses muscle tone and capacityBladder loses muscle tone and capacity Kidneys lose ability to concentrate urineKidneys lose ability to concentrate urine Bladder loses muscle strength Bladder loses muscle strength

Common ProblemsCommon Problems

Urinary RetentionUrinary Retention Accumulation of urine in the bladderAccumulation of urine in the bladder Inability to emptyInability to empty Pressure, discomfort and tendernessPressure, discomfort and tenderness

Residual Urine = urine retained in the Residual Urine = urine retained in the bladder after voidingbladder after voiding

IncontinenceIncontinence Loss of voluntary control to voidLoss of voluntary control to void

Infection, nerve damage to bladder or brain, spinal cord Infection, nerve damage to bladder or brain, spinal cord injury, or aging processinjury, or aging process

Total incontinence = no controlTotal incontinence = no control Stress incontinence = sm. amts. Urine excreted Stress incontinence = sm. amts. Urine excreted

involuntarily with coughing or laughinginvoluntarily with coughing or laughing

At risk for skin breakdown related to acid urine At risk for skin breakdown related to acid urine next to skin. next to skin.

Adult Diapers or AttendsAdult Diapers or Attends

Frequency & UrgencyFrequency & Urgency NocturiaNocturia Enuresis – involuntary discharge of urineEnuresis – involuntary discharge of urine Nocturnal Enuresis Nocturnal Enuresis

During sleepDuring sleep Bed-wetting children 5yrs and olderBed-wetting children 5yrs and older

OliguriaOliguria 30mls/hr or 720 mls/24hrs30mls/hr or 720 mls/24hrs

Renal anuriaRenal anuria cessation of urine production 100mls/24h cessation of urine production 100mls/24h

Promoting Healthy Promoting Healthy Urinary EliminationUrinary Elimination

Urinate as soon as the urge is feltUrinate as soon as the urge is felt Avoids stasis and distentionAvoids stasis and distention Prevents urgency, infection, and Prevents urgency, infection, and

incontinenceincontinence

Drink about 2liters fluid/dayDrink about 2liters fluid/day Limit Na, caffeine, and alcoholLimit Na, caffeine, and alcohol

For people with NocturiaFor people with Nocturia fld. Intake in the p.m.fld. Intake in the p.m. caffiene and alcoholcaffiene and alcohol Void before bedtimeVoid before bedtime

For Women For Women Wipe perineum front to backWipe perineum front to back Void soon after intercourseVoid soon after intercourse Wash handsWash hands Pelvic – floor strengthening exercises (Kegel Pelvic – floor strengthening exercises (Kegel

Exercises)Exercises)

Client EducationClient Education

S & S of infectionS & S of infection Fluid intake ( if no restrictions 2-5 L/day )Fluid intake ( if no restrictions 2-5 L/day ) Perineal hygienePerineal hygiene Meds. & side effects on urination, color, Meds. & side effects on urination, color,

and volumeand volume

Facilitating MicturitionFacilitating Micturition

Nursing Measures to promote voiding in Nursing Measures to promote voiding in people who are having difficulty:people who are having difficulty:

1.1. Privacy and natural positionPrivacy and natural position

2.2. Providing commode or bathroomProviding commode or bathroom

3.3. Running waterRunning water

4.4. Warm water to dangle fingersWarm water to dangle fingers

5.5. Warm water over perineum ( measure if on Warm water over perineum ( measure if on In/Out )In/Out )

6.6. Gently stroking inner thighs or pressure Gently stroking inner thighs or pressure to symphysis pubisto symphysis pubis

7.7. Pain reliefPain reliefWarmth to the bladder & perineum relaxes Warmth to the bladder & perineum relaxes

muscles & facilitates voiding. ( Sitz bath muscles & facilitates voiding. ( Sitz bath or warm tub )or warm tub )

If unsuccessful- If unsuccessful- urinary catheterization urinary catheterization may be indicatedmay be indicated

Promoting complete bladder emptyingPromoting complete bladder emptying Prevention of infectionPrevention of infection

Good perineal hygieneGood perineal hygiene Adequate fld. IntakeAdequate fld. Intake

Dilutes urine & flushes urethraDilutes urine & flushes urethra

Acidifying urine ( inhibits microorganisms)Acidifying urine ( inhibits microorganisms) Cranberry juice, whole grain breads, meats, Cranberry juice, whole grain breads, meats,

eggs, prunes and plums.eggs, prunes and plums.

Indwelling Catheter CareIndwelling Catheter Care

GoalGoal- prevent infection & maintain - prevent infection & maintain unobstructed flow of urine. Monitor unobstructed flow of urine. Monitor for problems.for problems.

Perineal hygiene @ least 2x/day and Perineal hygiene @ least 2x/day and prnprn

Do not advance catheter further into Do not advance catheter further into urethra during perineal careurethra during perineal care

Catheter CareCatheter Care

Fld intake (3L/day )Fld intake (3L/day ) Handwashing and GlovesHandwashing and Gloves Positioning Positioning

Urine bagUrine bag Tubing Tubing

Bowel EliminationBowel Elimination

FunctionFunction- excrete/eliminate waste - excrete/eliminate waste products of digestion.products of digestion.

Maintaining normal bowel elimination is Maintaining normal bowel elimination is essential to health and efficient body essential to health and efficient body functions.functions.

GI SystemGI System

Small IntestineSmall Intestine Absorption nutrients & electrolytesAbsorption nutrients & electrolytes 20 ft length, 1 in. diameter20 ft length, 1 in. diameter 3 sections3 sections

DuodenumDuodenum JejunumJejunum Ileum Ileum

GIGI

Large IntestineLarge Intestine Absorbs H2O and electrolytesAbsorbs H2O and electrolytes Temporarily stores waste productsTemporarily stores waste products Main function is eliminationMain function is elimination 5 – 6 ft. length, 6 – 7 cm. diameter5 – 6 ft. length, 6 – 7 cm. diameter

CecumCecum Ascending colon ( Right side )Ascending colon ( Right side ) Transverse colonTransverse colon Descending colonDescending colon

Patterns through life Patterns through life cyclecycle

Babies: 3 – 6 BM’s/dayBabies: 3 – 6 BM’s/day Children: Children:

Neuromuscular structures not developed Neuromuscular structures not developed until 15 – 18 mos.until 15 – 18 mos.

Voluntary control 2 – 3 yrs.Voluntary control 2 – 3 yrs. Pregnant women prone to constipationPregnant women prone to constipation

Pressure on abd. OrgansPressure on abd. Organs Iron supplementsIron supplements

Elderly prone to constipationElderly prone to constipation Slowing of peristalsis Slowing of peristalsis

Determinants affecting Determinants affecting eliminationelimination

Dietary patterns & fld. IntakeDietary patterns & fld. Intake 6 – 8 glasses H2O/day ( 1400- 2000mls )6 – 8 glasses H2O/day ( 1400- 2000mls )

fld. Liquifies stoolfld. Liquifies stool Dietary fiber stimulates peristalsisDietary fiber stimulates peristalsis Soft stoolSoft stool

Factors affecting Factors affecting eliminationelimination

Fiber ( undigestible residue ) provides Fiber ( undigestible residue ) provides bulkbulk Absorbs fluidAbsorbs fluid Increases stool massIncreases stool mass Bowel wall stretchesBowel wall stretches Peristalsis stimulatedPeristalsis stimulated Defecation results Defecation results


Personal habitsPersonal habits Busy schedule, postpone BM, constipationBusy schedule, postpone BM, constipation

Activity & exerciseActivity & exercise Immobile activity in colonImmobile activity in colon

Medications Medications Laxatives Laxatives Narcotics with codieneNarcotics with codiene


EmotionsEmotions Anxiety peristalsis & diarrheaAnxiety peristalsis & diarrhea DepressionDepression

PainPain Surgery Surgery

Anaesthetic causes temporary cessation of Anaesthetic causes temporary cessation of peristalsisperistalsis

Direct manipulation of the bowel stops Direct manipulation of the bowel stops peristalsisperistalsis


1.1. Constipation – difficult passage of hard, Constipation – difficult passage of hard, dry stool; infrequent movementsdry stool; infrequent movements

2.2. Fecal Impaction – unrelieved Fecal Impaction – unrelieved constipation, feces wedged in rectum, constipation, feces wedged in rectum, no BM usually 3days, oozing of no BM usually 3days, oozing of diarrheal stool developsdiarrheal stool develops

3.3. Diarrhea- # liquid stoolDiarrhea- # liquid stool4.4. Flatulence – abd. Distention & painFlatulence – abd. Distention & pain


Incontinence – inability to control Incontinence – inability to control passage of stoolpassage of stool

HemorrhoidsHemorrhoids Dilated engorged veinsDilated engorged veins Increased pressure when strainingIncreased pressure when straining Internal / externalInternal / external Bleeding Bleeding

Daily BM Not essential.Daily BM Not essential. 2 / week a concern2 / week a concern Defecation patternDefecation pattern BM, Stool, Feces, Defecate – all mean BM, Stool, Feces, Defecate – all mean

waste products expelled via the bowelwaste products expelled via the bowel

Promoting Healthy Bowel Promoting Healthy Bowel EliminationElimination

PrivacyPrivacySquatting positionSquatting positionBedpan positionBedpan positionCathartics & laxativesCathartics & laxativesAnti- diarrheal agentsAnti- diarrheal agentsEnemasEnemasdisimpactiondisimpaction

Bowel routineBowel routineDaily time clockDaily time clockHot drinksHot drinksStool softenersStool softenersPrivavyPrivavyPosition and abdominal pressurePosition and abdominal pressureBearing downBearing down

Assissting with Assissting with Elimination Elimination

Embarrassing & stressfulEmbarrassing & stressful Usually urge to defecate 1hr. PcUsually urge to defecate 1hr. Pc

Bedpans Bedpans Metal or plasticMetal or plastic Regular or fracture panRegular or fracture pan Cleanliness Cleanliness

Urinals Urinals CommodeCommode

ProcedureProcedure

Privacy- close door, Privacy- close door, Side rail as neededSide rail as needed Recumbent with HOB Recumbent with HOB Tissue Tissue Call bellCall bell Leave alone if possibleLeave alone if possible GlovesGloves Clean genitalsClean genitals

ProcedureProcedure

Remove pan and coverRemove pan and cover In & OutIn & Out Specimens Specimens Clean panClean pan Wash hands yours and client’sWash hands yours and client’s Lower bed Lower bed Client comfortClient comfort

Peri - CarePeri - Care

Cleaning of genitals , routine part of Cleaning of genitals , routine part of complete/ partial bed bathcomplete/ partial bed bath

Incontinence Incontinence

Procedure for Peri CareProcedure for Peri Care

Regular patientRegular patient Simple explanation- layman’s termsSimple explanation- layman’s terms PrivacyPrivacy GlovesGloves Dorsal recumbent positionDorsal recumbent position Incontinent pad under buttocksIncontinent pad under buttocks Warm soap and waterWarm soap and water Female – separate labiaFemale – separate labia


Male – begin penile head move down Male – begin penile head move down along shaft, retract foreskin, rinse and along shaft, retract foreskin, rinse and dry.dry.


Catheter – Catheter – Q 8 hrs.Q 8 hrs. Clean perineum & 2in. Of catheterClean perineum & 2in. Of catheter

No powders / lotionsNo powders / lotions Avoid advancing catheter Avoid advancing catheter Keep urine drainage bag off floor but below Keep urine drainage bag off floor but below

level of bladderlevel of bladder Empty bag Q8 – 12hrs or when bag is full, Empty bag Q8 – 12hrs or when bag is full,

remember to mark amt. Emptied on In/Out remember to mark amt. Emptied on In/Out sheetsheet

Avoid use of baby powder/ cornstarchAvoid use of baby powder/ cornstarch No medicinal purpose No medicinal purpose Can form clumps or will cake in creasesCan form clumps or will cake in creases Use vaseline/ zincoxide as skin barrier for Use vaseline/ zincoxide as skin barrier for

incontinent clients incontinent clients

Suppository Suppository AdministrationAdministration

Check physician’s order, protocolCheck physician’s order, protocol Left Lateral positionLeft Lateral position Gloves Gloves LubicationLubication Hold with thumb and index fingerHold with thumb and index finger Insert with index finger (3 – 4”) never Insert with index finger (3 – 4”) never

forceforce Deep breath = relaxes anal sphincterDeep breath = relaxes anal sphincter

CautionCaution Vagus nerve stimulation can cause heart Vagus nerve stimulation can cause heart

rate to slow – avoid excess manipulationrate to slow – avoid excess manipulation

Enema AdministrationEnema Administration

Main purposeMain purpose Promotion of defecation, stimulate peristalsisPromotion of defecation, stimulate peristalsis The fluid breaks up fecal mass, stretches the The fluid breaks up fecal mass, stretches the

rectal wall & initiates the defecation reflexrectal wall & initiates the defecation reflex

Types of EnemasTypes of Enemas

Cleansing EnemasCleansing Enemas

Tap WaterTap Water HypotonicHypotonic Used only onceUsed only once Electrolyte imbalance Electrolyte imbalance

Water toxicityWater toxicity Circulatory overload ( concentration gradient)Circulatory overload ( concentration gradient)

Normal SalineNormal Saline Used when more than one enema is Used when more than one enema is

neededneeded SafestSafest IsotonicIsotonic Large volume to distend bowelLarge volume to distend bowel

Hypertonic SolutionHypertonic Solution Smaller volume of fluidSmaller volume of fluid Draws from surrounding tissue into bowel to Draws from surrounding tissue into bowel to

soften stool and stimulate peristalsissoften stool and stimulate peristalsis Fleets – sodium phosphateFleets – sodium phosphate

Low volume, concentrated solutionLow volume, concentrated solution

Soap sudsSoap suds Less common Less common Soap irritates the bowelSoap irritates the bowel 5 – 15 mls. Castile soap in 1000mls warm 5 – 15 mls. Castile soap in 1000mls warm

waterwater

Oil RetentionOil Retention Oil based solutionOil based solution Lubricates the rectum and colonLubricates the rectum and colon Softens stool, easier to passSoftens stool, easier to pass Retain 1 –2 hrs if possibleRetain 1 –2 hrs if possible Follow with cleansing enemaFollow with cleansing enema

MedicatedMedicated Instill meds.Instill meds. Rectal mucosa absorptionRectal mucosa absorption Ex. – Kayexalate to K (potassium). Ex. – Kayexalate to K (potassium).

Absorbs K from the intestinal tractAbsorbs K from the intestinal tract

Volumes for EnemasVolumes for Enemas

Large VolumeLarge Volume 500 – 1000mls. 500 – 1000mls. Container 12 – 18 in. above the bowelContainer 12 – 18 in. above the bowel Lg. Volume stimulates & causes evacuation Lg. Volume stimulates & causes evacuation

of stoolof stool

Small VolumeSmall Volume 500 mls.500 mls. Container 12 in.above bowelContainer 12 in.above bowel

Volumes for EnemasVolumes for Enemas

Pre packagedPre packaged Fleet 150mlsFleet 150mls Microlax 5mlsMicrolax 5mls Hypertonic solution Hypertonic solution User friendlyUser friendly Hold for 5min.Hold for 5min.

Oral FleetOral Fleet

Prepackaged used more than large Prepackaged used more than large volume because:volume because: Works Works Less risk for electrolyte imbalanceLess risk for electrolyte imbalance Rapid administrationRapid administration Less discomfort and distentionLess discomfort and distention Convenient and quickConvenient and quick

Physician’s order reads “ enemas to Physician’s order reads “ enemas to clear”clear” No more than 3 total givenNo more than 3 total given Return solution will be highly colored but no Return solution will be highly colored but no

solid stoolsolid stool Isotonic solution (normal saline)Isotonic solution (normal saline)

Excess enema use seriously depletes fluid Excess enema use seriously depletes fluid and electrolytesand electrolytes

Procedure for Enema Procedure for Enema AdministrationAdministration

Confirm Dr’s order, prepare client, verbal Confirm Dr’s order, prepare client, verbal consent, equipment, privacyconsent, equipment, privacy Left lateral position ( fld. Flows by gravity)Left lateral position ( fld. Flows by gravity) Drape, pad under buttocksDrape, pad under buttocks Warm solution- stimulates peristalsisWarm solution- stimulates peristalsis

Hot sol’n burns mucosaHot sol’n burns mucosa Cold sol’n causes crampingCold sol’n causes cramping


Prime tubePrime tube Lubricate tipLubricate tip Glove Glove Insert 7 – 10 cm.(3-4in) adultInsert 7 – 10 cm.(3-4in) adult

Do not forceDo not force Deep breathDeep breath Guide toward umbilicusGuide toward umbilicus


Container at appropriate heightContainer at appropriate height Lg. = 12 – 18inLg. = 12 – 18in Sm. = 12inSm. = 12in 1000mls takes ~ 10 min to instill1000mls takes ~ 10 min to instill Higher the bag – greater the pressureHigher the bag – greater the pressure

C/O discomfort, lower bag, slow infusion, C/O discomfort, lower bag, slow infusion, stop, then start againstop, then start again

Remain side lying to retain 5 – 10 min. or Remain side lying to retain 5 – 10 min. or as long as possibleas long as possible


Assist to bathroom or give bedpanAssist to bathroom or give bedpan Evaluate resultsEvaluate results DocumentDocument

Type & volume of enemaType & volume of enema Color, amount, consistency of fecal returnColor, amount, consistency of fecal return Hygienic measures for clientHygienic measures for client

Wash HandsWash Hands

Ostomy CareOstomy Care

Certain diseases require surgical Certain diseases require surgical interventions to create an opening into interventions to create an opening into the abdominal wall for fecal and urinary the abdominal wall for fecal and urinary eliminationelimination

Enterostomy – the surgical procedure Enterostomy – the surgical procedure performed to produce the artificial performed to produce the artificial stoma.stoma.

Definitions Definitions

Ostomy = Ostomy = opening made to allow passage of opening made to allow passage of urine or stool urine or stool Piece of intestine is brought out onto the client’s Piece of intestine is brought out onto the client’s

abd. abd. Lacks nerve endingsLacks nerve endings Doesn’t hurt to touch but has other implicationsDoesn’t hurt to touch but has other implications

Stoma = Stoma = mouth like opening in the abdominal mouth like opening in the abdominal wall to drain urine or stoolwall to drain urine or stool

Effluent – drainage from stomaEffluent – drainage from stoma Bowel ostomiesBowel ostomies

Cancer ( Ca)Cancer ( Ca) Drain fecal materialDrain fecal material Consistency depends on locationConsistency depends on location

Higher up = more liquidHigher up = more liquid Greater risk skin irritation b/c concentration Greater risk skin irritation b/c concentration

of digestive enzymesof digestive enzymes

Ileostomy Ileostomy End of small intestine End of small intestine By passes lg. Intestine = freq. Liquid stoolsBy passes lg. Intestine = freq. Liquid stools

Colostomy Colostomy Large intestineLarge intestine More solid stoolMore solid stool

Ostomies may be permanent Ostomies may be permanent More commonMore common

temporarytemporary Rest the bowelRest the bowel Crohn’sCrohn’s

Urinary OstomiesUrinary Ostomies

Provide drainage of urine that bypasses Provide drainage of urine that bypasses the bladder = Urinary Diversionthe bladder = Urinary Diversion

UreterostomyUreterostomy Ureter to abd. WallUreter to abd. Wall Lt., Rt., BilateralLt., Rt., Bilateral

Ileal ConduitIleal Conduit

6 – 8 in. ileum6 – 8 in. ileum 1 end for external opening1 end for external opening Other end closed offOther end closed off Ureters implanted into this piece of bowelUreters implanted into this piece of bowel Pouch Pouch Urine will have shred of mucus b/c bowel Urine will have shred of mucus b/c bowel

still produces samestill produces same

ConcernsConcerns

Infection Infection Sterile ureters provide opening into systemSterile ureters provide opening into system

Skin BreakdownSkin Breakdown Continuous drainageContinuous drainage Moisture on skinMoisture on skin

Replace urinary pouch q 2-3 daysReplace urinary pouch q 2-3 days

Pouching an EnterostomyPouching an Enterostomy

Effluent ( drainage ) may begin immediatelyEffluent ( drainage ) may begin immediately Collects all effluentCollects all effluent Protects the skinProtects the skin Stoma should be moist and reddish pink (same Stoma should be moist and reddish pink (same

as other mucus membranes)as other mucus membranes) Flush to skin or bud-like protrusionFlush to skin or bud-like protrusion Black, purple, dry = inadequate circulationBlack, purple, dry = inadequate circulation

Pouch with Skin BarrierPouch with Skin Barrier

Comfortable fitComfortable fit Cover skin surrounding stomaCover skin surrounding stoma Good sealGood seal Post-op pouch should allow for visibility Post-op pouch should allow for visibility

of stomaof stoma

Types of pouches and Types of pouches and skin barriersskin barriers

One Piece Pouching SystemOne Piece Pouching System Skin barriers preattached, precut, custom fitSkin barriers preattached, precut, custom fit

Two Piece SystemTwo Piece System Skin barrier with flange ( plastic ring)Skin barrier with flange ( plastic ring) Corresponding size pouchCorresponding size pouch

Assess stomaAssess stoma Measure correct size Measure correct size Change q 3-7 daysChange q 3-7 days Empty 1/3 to ½ full, expel flatus prnEmpty 1/3 to ½ full, expel flatus prn

Steps to Care for Steps to Care for OstomiesOstomies

Supine positionSupine position Wash hands, gloveWash hands, glove Remove pouch & skin barrier, push skin Remove pouch & skin barrier, push skin

away from barrieraway from barrier Cleanse peristomal skin gently with warm Cleanse peristomal skin gently with warm

tap water and clean clothtap water and clean cloth Do not scrub, Avoid soap ( residue- pouch Do not scrub, Avoid soap ( residue- pouch

won’t adher)won’t adher)


Correct sizingCorrect sizing Cut opening 1/16 – 1/8 larger than stomaCut opening 1/16 – 1/8 larger than stoma Remove backingRemove backing Ileostomy- apply thin circle barrier paste Ileostomy- apply thin circle barrier paste

around opening of pouch and allow to dry around opening of pouch and allow to dry (if creases or bumps use barrier paste to (if creases or bumps use barrier paste to even surface for pouch application) even surface for pouch application)


Pouch should point to client’s kneesPouch should point to client’s knees Maintain gentle finger pressure around Maintain gentle finger pressure around

barrier for 1-2 min. barrier for 1-2 min. Picture frame flange with non allergic Picture frame flange with non allergic

paper tapepaper tape Ostomy deodorant for pouchOstomy deodorant for pouch Tub bath or shower Tub bath or shower


Normal stoma oozes blood if rubbedNormal stoma oozes blood if rubbed Actual bleeding into pouch is abnormalActual bleeding into pouch is abnormal Pouch covers are availablePouch covers are available The client will be watching the nurse The client will be watching the nurse

during ostomy care to gage reaction.during ostomy care to gage reaction. Be conscious of facial expression & Be conscious of facial expression &

nonverbal cuesnonverbal cues


EducationEducation Counseling Counseling

Body imageBody image Self careSelf care Fear of rejectionFear of rejection Sexual functionSexual function Powerlessness over bowel regulationPowerlessness over bowel regulation

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Elimination. Basic Principles Wash Hands & Wear Gloves Infection control, your protection & your client’s protection Privacy Embarrassing Positions