# 45

Discuss nursing care of the client who has a colostomy
- empty ostomy frequently to keep free of odors.
-keep stoma site clean and dry. for ileostomies, special care must be taken to prevent skin breakdown.
-apply a barrier such as karaya gum over skin around the stoma to prevent contact with any excretions.
-assess the pouch for correct fit if there is any skin irritation or leakage around the stoma.
-measure clients intake and output while hospitalized.
-disposable appliances can be kept on for up to seven days. they must be changed when they begin to leak.
-if feces leak onto the peristomal skin, the appliance should be removed and good asking care given to the peristomal area before applying a new appliance
-if irritation persists at the stoma or on the surrounding skin, the appliance should be replaced every 24-48 hrs. good skin care and any prescribed treatments are priorities until the irritation subsides.
-control odors because odor control is essential to clients self-esteem.
-teach clients to include dark green vegetables in the diet ( chlorophyll helps deordorize feces) . Bismuth subgallates also help lessen fecal odor. A deodorizer can be placed in the pouck and some appliances have a charcoal filter disk.
-teach self-care dietary considerations. initallly clients should avoid high fiber foods and gas producing foods
-teach client to avoid heavy lifting and contact sports.
-address self-esteem and sexuality issues.
-instruct client to avoid laxatives and enemas because they may cause severe fluid and electrolyte imbalances.