This is the process of caring for a child with a stoma created at the anterior abdominal wall making the skin exposed to effluent. This is as a result of birth defect, injury or diseases related to the colon. It is necessary for a paediatric nurse to provide basic physical and psychological care to child and caregiver.
Aims
· Prevent excoriation around the stoma
· Provide psychological support
· Ensure stoma is intact
· Ensure effective elimination
· Promote personal hygiene
Requirements
a. Colostomy bag
b. Sterile gauze
c. Examination gloves
d. Normal saline
e. Topical medication/hypoallergenic/skin barrier cream
f. Diaper
g. Stoma measuring guide
h. Plastic bag
i. Water
j. Mackintosh cape with towel
k. Bedpan
l. Antimicrobial solution (savlon)
Steps
1. Establish rapport (Refer to steps)
2. Explain procedure to patient in simple plain language (refer to steps) and use illustrations if possible
3. Provide privacy
4. Perform five moments of hand hygiene
5. Nurse child in a desirable bed/cot
6. Check and record baseline vital signs (temperature, pulse, respiration, blood pressure, pain, SPO2)
7. Prepare items and send to bedside
8. Pour normal saline into a receiver for cleaning
9. Wear examination gloves
10. Expose dressing on stoma to initiate stoma care
11. Clean in and around stoma till effluent appears clean
12. Inspect stoma for colour, prolapse, collapse, and oedema
13. Assess skin around stoma for redness, breakdown or dry skin
14. Apply topical ointment to prevent skin excoriation
15. Measure size of stoma and cut stoma bag hole 1/8 inch wider than measured (if necessary)
16. Fix stoma bag on stoma depending on how mobile the child is
17. Allow base of colostomy bag face down or side if child is mobile or unconscious respectively
18. Monitor intake and output in ileostomy
19. Encourage the mother of the child with ileostomy to feed frequently to prevent dehydration
20. Allow child to wear one piece loose waist undergarment and outfit to prevent child from pulling off and exerting pressure on the pouch
21. Occupy child with toys during pouch change
22. Start toilet training for bladder control at appropriate time as for any other child
23. Encourage caregiver to change pouch always when halfway full
24. Inform caregiver to provide child with adequate nutrition and avoid feeds likely to cause diarrhoea
25. Involve child and caregiver completely in stoma care
26. Teach caregiver home management of stoma
27. Encourage caregiver to report if bleeding, prolapse, oedema of stoma is detected
28. Provide child and caregiver continuous psychological support
29. Express appreciation to child and caregiver
30. Dispose off, decontaminate and clean used items
31. Remove examination gloves
32. Document findings manually/electronically
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