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    Colostomy Checklist

    Uploaded by

    Lyssa Marie Ege
    _________________________________ Name & Signature

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Colostomy Checklist

    Uploaded by

    Lyssa Marie Ege
    102 views1 page
    _________________________________ Name & Signature

    Original Description:

    For educational purposes only

    Original Title

    colostomy-checklist

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    _________________________________ Name & Signature

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    102 views1 page

    Colostomy Checklist

    Uploaded by

    Lyssa Marie Ege
    _________________________________ Name & Signature

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Mountain View College

    College of Nursing - Annex

    COLOSTOMY CARE PERFORMANCE CHECKLIST


    Name:________________________________________________________ Date:____________

    1. Inform the patient about the procedure


    2. Gather materials needed and wash hand.
    3. Provide privacy and position the patient comfortably.
    4. Wear gloves and remove current ostomy appliance after emptying the pouch. Dispose the
    appliance appropriately.
    5. Assess the stoma and condition of the skin surrounding the stoma.
    6. Wash hands and don gloves.
    7. Cleanse the stoma and skin with warm tap water using clean wash cloth or gauze pads (do
    not scrub) and pat dry completely.
    8. Measure stoma at base for correct size of pouching system. Use the measuring guide to cut
    opening on the pouch 1/16 inch larger than stoma.

    9. Place the gauze pad over the stoma and prepare the new wafer and pouch.

    10. Trace the pattern on paper backing of wafer. Cut wafer as traced.
    11. Apply skin barrier if needed. Attach clean pouch to wafer. Be sure that the port is closed.
    Fold bottom of drainable open pouches or use closure device like clamp.

    12. Gently remove the gauze pad from orifice of the stoma.
    13. Remove the paper backing from wafer and gently place it on skin with stoma centered in
    cutout opening of wafer.
    14. Using hypoallergenic tape, secure the edges of the wafer.
    15. Dispose the old pouch and soiled materials properly. Consider spraying deodorant in the
    room if needed.
    16. Remove gloves and perform hand hygiene.
    17. Ask client if there is discomfort around the stoma.
    18. Document the procedure done. Report and record pertinent assessments and
    interventions. (change in stoma color, size, protrusion, stoma effluent, skin irritation and
    tenderness)
    Total
    Scale: 4 – Exemplary (Competent and Independent)
    3 – Proficient (Requires minimum guidance)
    2 – Satisfactory (Requires frequent guidance)
    1 – Developing (Requires close guidance)

    Clnical Instructor:______________________________
    Name & Signature

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