Types
Colostomy: sigmoid (formed stool), transverse (semi-formed). Ileostomy: liquid, high output risk. Urostomy: urine. Loop vs end. Temporary vs permanent. Preoperative stoma site marking by ET nurse critical.
Stoma Assessment
Normal: red/pink, moist, protruding 1-2 cm, edema for 6 weeks. Abnormal: pale (anemia), dusky/dark (ischemia — urgent), necrotic (emergency), retracted. Peristomal skin intact. Ileostomy output 500-1000 mL/day.
Patient Education
Pouch change every 3-7 days or if leaking. Clean with warm water (no alcohol). Stoma powder for weepy skin. Ileostomy: high output >1000 mL/day causes dehydration. Diet: introduce gradually, avoid gas foods, chew thoroughly.
Important Notes
- A dark, dusky, or black stoma indicates ischemia — notify surgeon immediately.
- Ileostomy output >1000-1500 mL/day requires urgent management to prevent dehydration and AKI.
Clinical Tips
- Healthy stoma is beefy red and moist.
- Wait 6-8 weeks post-surgery before using convex pouching system — stoma shrinks.
Summary
Ostomy care requires stoma assessment for viability, proper pouching, skin protection, and comprehensive patient education.
