When planning care for a patient who has a colostomy, which intervention is important for the nurse to perform when pouching the colostomy?
a. Leave an intact skin barrier in place for 3 to 7 days.
b. Use soap and water to cleanse the peristomal skin.
c. Empty the pouch when it is two-thirds full.
d. Use tape to secure pouches that have minor leaks.
A
Observe the existing skin barrier and pouch for leakage and length of time in place. The pouch should be changed every 3 to 7 days, not daily. To minimize skin irritation, avoid unnecessary changing of the entire pouching system, but if the effluent is leaking under the wafer, change it, because skin damage from the effluent will cause more skin trauma than will be caused by early removal of the wafer. Cleanse the peristomal skin gently with warm tap water using a washcloth; do not scrub the skin. Pat the skin dry. Avoid soap; it leaves residue on the skin, which interferes with pouch adhesion. Pouches must be emptied when they are one-third to one-half full, because the weight of the pouch may disrupt the seal of the adhesive on the skin. If the ostomy pouch is leaking, change it. Taping or patching it to contain effluent leaves the skin exposed to chemical or enzymatic irritation.
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