{"id":1686,"date":"2024-09-26T18:30:16","date_gmt":"2024-09-26T22:30:16","guid":{"rendered":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/chapter\/ostomies-2\/"},"modified":"2024-10-07T14:55:36","modified_gmt":"2024-10-07T18:55:36","slug":"ostomies","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/chapter\/ostomies\/","title":{"raw":"7.5 Ostomies","rendered":"7.5 Ostomies"},"content":{"raw":"<p style=\"text-align: left;\">An [pb_glossary id=\"482\"]ostomy[\/pb_glossary] is a surgical procedure that creates an opening ([pb_glossary id=\"1488\"]stoma[\/pb_glossary]) from an area inside the body to the outside of the body. In ostomies related to elimination, a stoma is an opening on the abdomen that is connected to the gastrointestinal or urinary system to allow waste (urine or feces) to be collected in a pouch. See Figure 7.5.1 for an image of a stoma. A stoma can be permanent, such as when an organ is removed, or temporary, such as when an organ requires time to heal. Ostomies are created for clients with conditions such as cancer of the bowel or bladder, inflammatory bowel diseases, or perforation of the colon.<\/p>\r\n\r\n\r\n[caption id=\"attachment_1670\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-1666 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-300x237.jpg\" alt=\"\" width=\"300\" height=\"237\" \/> <strong>Figure 7.5.1<\/strong> Stoma[\/caption]\r\n<p style=\"text-align: left;\">There are several different kinds of ostomies related to elimination. Common types of ostomies include the following:<\/p>\r\n\r\n<ul style=\"text-align: left;\">\r\n \t<li><strong>Ileostomy: <\/strong>The lower end of the small intestine (ileum) is attached to a stoma to bypass the colon,\u00a0rectum, and anus.<\/li>\r\n \t<li><strong>Colostomy:\u00a0<\/strong>The colon is attached to a stoma to bypass the rectum and the anus.<\/li>\r\n \t<li><strong>Urostomy: <\/strong>The ureters (tubes that carry urine from the kidney to the bladder) are attached to a stoma to bypass the bladder.<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left;\">Figures 7.5.2 and 7.5.3 show the anatomical locations of [pb_glossary id=\"485\"]ileostomies[\/pb_glossary] and various sites of [pb_glossary id=\"483\"]colostomies[\/pb_glossary]. It is important to understand the site of a client\u2019s colostomy because the site impacts the characteristics of the waste. For example, due to the natural digestive process of the colon and absorption of water, waste from an ileostomy or a colostomy placed in the anterior ascending colon will be watery compared to waste from an ostomy placed in the descending colon.<\/p>\r\n\r\n<table class=\"grid\" style=\"border-collapse: collapse; width: 100%;\" border=\"0\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 50%; border-color: white;\">\r\n\r\n[caption id=\"attachment_1667\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-1667 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\" \/> <strong>Figure 7.5.2<\/strong> Location of an ileostomy compared to colostomies[\/caption]<\/td>\r\n<td style=\"width: 50%; border-color: white;\">\r\n\r\n[caption id=\"attachment_192\" align=\"aligncenter\" width=\"293\"]<img class=\"wp-image-192\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy.jpg\" alt=\"\" width=\"293\" height=\"293\" \/> <strong>Figure 7.5.3<\/strong> Colostomy types[\/caption]<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p style=\"text-align: left;\">The tissue of a stoma is very delicate. Immediately after surgery, a stoma is swollen, but it will shrink in size over several weeks. A healthy, healed stoma appears moist and dark red or pink in colour. Stomas that are swollen; dry; have malodorous discharge; or are bluish, purple, black, or pale should be reported to the provider. The skin surrounding a stoma can easily become irritated from the pouch adhesive or leakage of fluid from the stoma, so the nurse must perform interventions to prevent skin breakdown. Any identified signs of skin breakdown should be reported to the provider.<\/p>\r\n<p style=\"text-align: left;\">Stoma appliances are supplied as a one- or two-piece set. A two-piece set consists of an ostomy barrier (also called a wafer) and a pouch. The ostomy barrier is the part of the appliance that sticks to the skin with a hole that is fitted around the stoma. The pouch collects the waste and must be emptied regularly. It attaches to the ostomy barrier in a clicking motion to secure the two parts, similar to how a plastic storage container cover snaps to a container to create a seal. The pouching system must be completely sealed to prevent the leaking of the waste and to protect the surrounding peristomal skin. The pouch has an end with an opening where the waste is drained and is closed using a plastic clip o<span style=\"background-color: #ffffff;\">r Velcro strip.<\/span><\/p>\r\n<p style=\"text-align: left;\">In a one-piece stoma appliance set, the ostomy barrier and the pouch are one piece. See Figure 7.5.4 for an image of a stoma with an ostomy barrier in place. See Figure 7.5.5 for an image of a client with an ileostomy appliance with a pouch attached. The flange is the adhesive part of the ostomy pouching system that secures it to the body.<\/p>\r\n\r\n\r\n[caption id=\"attachment_1670\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-193 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-and-flange.jpg\" alt=\"\" width=\"300\" height=\"168\" \/> <strong>Figure 7.5.4<\/strong> Ostomy barrier[\/caption]\r\n\r\n[caption id=\"attachment_1670\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-1670 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-300x214.jpg\" alt=\"\" width=\"300\" height=\"214\" \/> <strong>Figure 7.5.5 <\/strong>Ostomy pouch[\/caption]\r\n<p style=\"text-align: left;\">Individuals with colostomies, ileostomies, and urostomies have no sensation and no control over the output of the stoma. Depending on the type of system, the ostomy appliance can last from four to seven days, but the pouch must be changed if there is leaking, odour, excessive skin exposure, or itching or burning under the skin barrier. Clients with pouches can swim and take showers with the pouching system on.<\/p>\r\n\r\n<h1 style=\"text-align: left;\">Changing an Ostomy Appliance (Flange and Pouch)<\/h1>\r\n<div class=\"textbox shaded\"><strong>Some elements of ostomy care involve restricted activities. HCAs must have client-specific delegation from a regulated health professional to perform any restricted activities.\u00a0<\/strong><\/div>\r\n<h2>Safety Considerations<\/h2>\r\n<ul>\r\n \t<li>Pouching system should be changed every 4 to 7 days, depending on the client and type of pouch. Notify supervisor if there is skin breakdown, if there are challenges with flange adhesion, or if there are other concerns related to the pouching system.<\/li>\r\n \t<li>Clients should participate in the care of their ostomy, if able, and health care providers should promote client and family involvement.<\/li>\r\n \t<li>Encourage the client to empty the pouch when it is one-third to one-half full of urine, flatus, or feces as they become heavy and have increased risk of spillage.<\/li>\r\n \t<li>Ostomy product choices may be limited in acute care settings. Other choices are available in community retail settings. Encourage the client\/family to explore other options.<\/li>\r\n \t<li>Observe the centre of the flange for evidence of leaking. Waste on the peristomal skin can cause skin breakdown. Leaking flanges must be changed immediately.<\/li>\r\n \t<li>An ostomy belt may be used to help hold the ostomy pouch in place.<\/li>\r\n \t<li>Factors that affect the pouching system include sweating, high heat, moist or oily skin, and physical exercise.<\/li>\r\n \t<li>Always report minor skin irritations immediately. Skin that is sore, wet, or red is difficult to seal with a flange.<\/li>\r\n \t<li>Change ileostomy appliances <strong>prior<\/strong> to eating to decrease the likelihood that a bowel movement will occur during appliance change.<\/li>\r\n<\/ul>\r\n<table class=\"grid\" style=\"width: 100%;\"><caption>Table 7.5.1 Procedure:\u00a0Changing an Ostomy Appliance[footnote](Data source: BCIT, 2015; Berman &amp; Snyder, 2016; Convatec, 2018; Perry, et al., 2018; United Ostomy Association of America, 2017)[\/footnote]<\/caption>\r\n<thead>\r\n<tr>\r\n<th scope=\"col\">STEP<\/th>\r\n<th scope=\"col\">ACTION<\/th>\r\n<th scope=\"col\">ADDITIONAL INFORMATION<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">1.<\/th>\r\n<td style=\"width: 46.8342%;\">Perform hand hygiene.<\/td>\r\n<td style=\"width: 47.1357%;\">This prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_1671\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-1671 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-300x200.jpg\" alt=\"\" width=\"300\" height=\"200\" \/> <strong>Figure 7.5.6 <\/strong>Hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">2.<\/th>\r\n<td style=\"width: 46.8342%;\">Gather supplies, including:\r\n<ul>\r\n \t<li>flange<\/li>\r\n \t<li>ostomy bag and clip<\/li>\r\n \t<li>scissors,<\/li>\r\n \t<li>stoma measuring guide<\/li>\r\n \t<li>waterproof pad<\/li>\r\n \t<li>pen<\/li>\r\n \t<li>adhesive remover for old flange<\/li>\r\n \t<li>stomahesive paste or powder<\/li>\r\n \t<li>warm wet cloth(s) and dry cloth<\/li>\r\n \t<li>non-sterile gloves<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"width: 47.1357%;\">\r\n\r\n[caption id=\"attachment_1672\" align=\"aligncenter\" width=\"199\"]<img class=\"size-medium wp-image-1672\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-199x300.jpg\" alt=\"\" width=\"199\" height=\"300\" \/> <strong>Figure 7.5.7<\/strong> Ostomy Supplies[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">3.<\/th>\r\n<td style=\"width: 46.8342%;\">Identify the client and review the procedure. Encourage the client to participate as much as possible, or observe and assist client as they complete the procedure.<\/td>\r\n<td style=\"height: 30px; width: 47.1357%;\">Proper identification complies with agency policy. Encouraging clients to participate helps them adjust to having an ostomy.<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">4.<\/th>\r\n<td style=\"width: 46.8342%;\">Create privacy. Place waterproof pad under pouch.<\/td>\r\n<td style=\"height: 15px; width: 47.1357%;\">The pad prevents the spilling of effluent on client and bed sheets.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 185px;\">\r\n<th style=\"width: 5.82915%;\" scope=\"row\">5.<\/th>\r\n<td style=\"width: 46.8342%;\">Apply gloves. Remove the ostomy bag, and measure and empty contents. Place the old pouching system in a garbage bag.<\/td>\r\n<td style=\"height: 185px; width: 47.1357%;\">\r\n\r\n[caption id=\"attachment_197\" align=\"aligncenter\" width=\"232\"]<img class=\"wp-image-197 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-ostomy-bag-from-flange-0011.jpg\" alt=\"\" width=\"232\" height=\"182\" \/> <strong>Figure 7.5.8 <\/strong>Removing an ostomy bag[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">6.<\/th>\r\n<td style=\"width: 46.8342%;\">Remove the flange by gently pulling it toward the stoma. Support the skin with your other hand. An adhesive remover may be used.<\/td>\r\n<td style=\"width: 47.1357%;\">Gentle removal helps prevent skin tears. An adhesive remover may be used to decrease skin and hair stripping.\r\n\r\n[caption id=\"attachment_198\" align=\"aligncenter\" width=\"182\"]<img class=\"wp-image-198 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-flange-001.jpg\" alt=\"\" width=\"182\" height=\"198\" \/> <strong>Figure 7.5.9<\/strong> Removing a flange[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">7.<\/th>\r\n<td style=\"width: 46.8342%;\">Clean the stoma gently by wiping with warm water. Do not use soap.<\/td>\r\n<td style=\"width: 47.1357%;\">Aggressive cleaning can cause bleeding. If removing the stomahesive paste from the skin, use a dry cloth first.\r\n\r\nClean the stoma and peristomal skin.\r\n\r\n[caption id=\"attachment_199\" align=\"aligncenter\" width=\"215\"]<img class=\"wp-image-199 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning-stoma-and-peristomal-skin-001.jpg\" alt=\"\" width=\"215\" height=\"150\" \/> <strong>Figure 7.5.10 <\/strong>Cleaning a stoma[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">8.<\/th>\r\n<td style=\"width: 46.8342%;\">Observe the stoma and peristomal skin.<\/td>\r\n<td style=\"width: 47.1357%;\">A stoma should be pink to red in colour, preferrably moist and raised above skin level.\r\n\r\n[caption id=\"attachment_200\" align=\"aligncenter\" width=\"87\"]<img class=\"wp-image-200 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Assess-stoma-001.jpg\" alt=\"\" width=\"87\" height=\"106\" \/> <strong>Figure 7.5.11 <\/strong>Healthy stoma[\/caption]\r\n\r\n<strong>Observe stoma<\/strong>\r\n\r\nSkin surrounding the stoma should be intact and free from wounds, rashes, or skin breakdown. Notify your supervisor if you are concerned about the condition of the peristomal skin.<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">9.<\/th>\r\n<td style=\"width: 46.8342%;\">Measure the stoma diameter using the measuring guide (tracing template) and cut out stoma hole.\r\n\r\nTrace diameter of the measuring guide onto the flange, and cut on the outside of the pen marking.<\/td>\r\n<td style=\"width: 47.1357%;\">The opening should be 2 mm\u00a0larger than the stoma size.\r\n\r\nKeep the measurement guide with the client's supplies for future use. Trace template.\r\n\r\n[caption id=\"attachment_1678\" align=\"aligncenter\" width=\"242\"]<img class=\"wp-image-201 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Tracing-stoma-size-from-tracing-template-001.jpg\" alt=\"\" width=\"242\" height=\"197\" \/> <strong>Figure 7.5.12 <\/strong>Measuring stoma size[\/caption]\r\n\r\nOnce the size is traced onto back of flange, cut out the size to fit the stoma.\r\n\r\n[caption id=\"attachment_1678\" align=\"aligncenter\" width=\"300\"]<img class=\"wp-image-1678 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" \/> <strong>Figure 7.5.13 <\/strong>Cutting flange to size[\/caption]\r\n\r\nCheck the flange to ensure a proper fit to the stoma.\r\n\r\n[caption id=\"attachment_1678\" align=\"aligncenter\" width=\"250\"]<img class=\"wp-image-203 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Assess-if-flange-is-the-correct-size-for-stoma-001.jpg\" alt=\"\" width=\"250\" height=\"192\" \/> <strong>Figure 7.5.14 <\/strong>Fitting flange to stoma[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">10.<\/th>\r\n<td style=\"width: 46.8342%;\">Prepare skin and apply accessory products as required or according to agency policy.<\/td>\r\n<td style=\"width: 47.1357%;\">Peristomal skin prep.\r\n\r\nAccessory products may include stomahesive paste, stomahesive powder, or products used to create a skin sealant to adhere pouching system to skin to prevent leaking.\r\n\r\nWet skin will prevent the flange from adhering to the skin.\r\n\r\n[caption id=\"attachment_205\" align=\"aligncenter\" width=\"159\"]<img class=\"wp-image-204 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Prepare-peristomal-skin-for-flnage-001-e1442766619416.jpg\" alt=\"\" width=\"159\" height=\"281\" \/> <strong>Figure 7.5.15 <\/strong>Prepping peristomal skin[\/caption]\r\n\r\nApply stomahesive paste.\r\n\r\n[caption id=\"attachment_205\" align=\"aligncenter\" width=\"208\"]<img class=\"wp-image-205 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Applying-stomahersive-paste-001.jpg\" alt=\"\" width=\"208\" height=\"147\" \/> <strong>Figure 7.5.16 <\/strong>Applying stomahesive paste[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">11.<\/th>\r\n<td style=\"width: 46.8342%;\">Remove the inner backing on the flange and apply flange over stoma. Leave the border tape on. Apply pressure. Hold in place for 1 minute to warm the flange to meld to the client\u2019s body. Then remove outer border backing and press gently to create seal.<\/td>\r\n<td style=\"width: 47.1357%;\">The warmth of the hand can help the appliance adhere to the skin and prevent leakage.\r\n\r\nRemove backing from flange.\r\n\r\n[caption id=\"attachment_207\" align=\"aligncenter\" width=\"223\"]<img class=\"wp-image-206 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Remove-backing-from-flange-001.jpg\" alt=\"\" width=\"223\" height=\"194\" \/> <strong>Figure 7.5.17 <\/strong>Preparing flange[\/caption]\r\n\r\nApply flange around stoma.\r\n\r\n[caption id=\"attachment_207\" align=\"aligncenter\" width=\"182\"]<img class=\"wp-image-198 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-flange-001.jpg\" alt=\"\" width=\"182\" height=\"198\" \/> <strong>Figure 7.5.18 <\/strong>Applying flange[\/caption]\r\n\r\nPress gently to create seal.\r\n\r\n[caption id=\"attachment_207\" align=\"aligncenter\" width=\"220\"]<img class=\"wp-image-207 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Stoma-A-001.jpg\" alt=\"\" width=\"220\" height=\"197\" \/> <strong>Figure 7.5.19 <\/strong>Sealing flange[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">12.<\/th>\r\n<td style=\"width: 46.8342%;\">Apply the ostomy bag. Attach the clip to the bottom of the bag.<\/td>\r\n<td style=\"width: 47.1357%;\">Apply ostomy pouch. This step prevents the effluent from soiling the client or bed.\r\n\r\n[caption id=\"attachment_1685\" align=\"aligncenter\" width=\"232\"]<img class=\"wp-image-208 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-ostomy-bag-from-flange-001.jpg\" alt=\"\" width=\"232\" height=\"182\" \/> <strong>Figure 7.5.20 <\/strong>Applying ostomy pouch[\/caption]\r\n\r\nAttach clip to bottom of bag.\r\n\r\n[caption id=\"attachment_1685\" align=\"aligncenter\" width=\"199\"]<img class=\"wp-image-1685 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-199x300.jpg\" alt=\"\" width=\"199\" height=\"300\" \/> <strong>Figure 7.5.21 <\/strong>Closing ostomy pouch[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">13.<\/th>\r\n<td style=\"width: 46.8342%;\">Hold palm of hand over ostomy pouch for 2 minutes to assist with appliance adhering to skin.<\/td>\r\n<td style=\"height: 30px; width: 47.1357%;\">Some flanges are heat activated and adhere better when warmth is applied.<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">14.<\/th>\r\n<td style=\"width: 46.8342%;\">Clean up supplies, and place the client in a comfortable position. Remove garbage from the client\u2019s room.<\/td>\r\n<td style=\"height: 30px; width: 47.1357%;\">Removing garbage helps decrease odour.<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">15.<\/th>\r\n<td style=\"width: 46.8342%;\">Perform hand hygiene.<\/td>\r\n<td style=\"height: 15px; width: 47.1357%;\">This minimizes the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 5.82915%;\" scope=\"row\">16.<\/th>\r\n<td style=\"width: 46.8342%;\">Document procedure.<\/td>\r\n<td style=\"width: 47.1357%;\">Follow agency policy for documentation. Document the appearance of the stoma and peristomal skin, products used, and the client\u2019s ability to tolerate procedure and assistance with procedure.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Watch the video\uff1a<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=h8CtsPAaa5Y\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=h8CtsPAaa5Y\"><em>Ostomy Bag Pouch Change | Ostomy Care Nursing | Colostomy, Ileostomy Bag Change<\/em><\/a> by RegisteredNurseRN (2017).\r\n\r\n<\/div>\r\n<\/div>\r\n<h2>Procedure Video<\/h2>\r\nThe following video provides the best demonstration of the skills for\u00a0how to empty and change an ostomy flange and bag.\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Watch the video:<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Some elements of ostomy care involve restricted activities. HCAs must have client-specific delegation from a regulated health professional to perform any restricted activities.\u00a0<\/strong>\r\n\r\n&nbsp;\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=FXKM1r5L8U8\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=FXKM1r5L8U8\"><em>How To Empty &amp; Change An Ostomy Bag<\/em><\/a> by CareChannel (2019)\r\n\r\n<\/div>\r\n<\/div>\r\n<h1>Stool Specimen Collection<\/h1>\r\n<p style=\"text-align: left;\">Stool samples are collected from clients to test for cancer, parasites, or occult blood (i.e., hidden blood). Follow specific instructions from the facility\/agency where you are working for collecting the sample.<\/p>\r\nTo collect a sample, perform the following steps:\r\n<ul>\r\n \t<li>Explain the procedure to the client. Instruct them to flush the toilet before defecating to remove any potential chemicals and to not place toilet paper in the toilet after defecating. Request they notify you when they have had a bowel movement.<\/li>\r\n \t<li>Review the manufacturer\u2019s instructions because different test kits may have different instructions.<\/li>\r\n \t<li>Contact the laboratory with any questions.<\/li>\r\n \t<li>Label the card with the patient\u2019s name and medical information as per agency policy. Open the flap of the guaiac test card.<\/li>\r\n \t<li>Apply non-sterile gloves. Use the applicator stick to apply a thin smear of the stool specimen to\u00a0one of the squares of filter paper on the card. Obtain a second specimen from a different part of\u00a0the stool and apply it to the second square of filter paper on the card. (Occult blood isn\u2019t typically\u00a0equally dispersed throughout the stool.)<\/li>\r\n \t<li>Place the labelled test card in a transport bag and send it to the laboratory for analysis.<\/li>\r\n \t<li>If you are working in an agency where nurses apply the guaiac developer solution to the card, allow the specimen to dry for 3\u20135 minutes. Open the reverse side of the card and apply two drops of guaiac developer solution to each square. A blue reaction will occur within 60 seconds if the test is positive. The absence of a blue colour after 60 seconds is considered a negative test.<\/li>\r\n \t<li>Document the date and time of the test and any unusual characteristics of the stool sample.<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Summary<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nHelping to ensure your clients maintain health urinary and bowel elimination are essential medical and psychosocial aspects of providing quality care. The HCA can help clients maintain regular and healthy elimination and prevent complications such constipation, infections, and incontinence.\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox\"><header class=\"textbox__header\">Review Questions<\/header>\r\n<div class=\"h5p\">[h5p id=\"5\"]<\/div>\r\n<div class=\"pdf\">\r\n<ol>\r\n \t<li>Which term describes the process of emptying urine from the bladder? (Select one or more)\r\n<ol type=\"a\">\r\n \t<li>Voiding<\/li>\r\n \t<li>Defecation<\/li>\r\n \t<li>Urination<\/li>\r\n \t<li>Micturition<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Urine should be observed for colour, clarity, odour, amount, and particles\r\n<ol type=\"a\">\r\n \t<li>False<\/li>\r\n \t<li>True<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Which of the following is your responsibility when supporting Mrs. Daliwal who has an indwelling catheter?\r\n<ol type=\"a\">\r\n \t<li>Keep the drainage bag below the level of her bladder.<\/li>\r\n \t<li>Hide the tubing by placing it underneath the client.<\/li>\r\n \t<li>Hook the drainage bag to the bed rail.<\/li>\r\n \t<li>Try to comfort her by saying that her urge to void is all in her head.<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The prolonged retention and accumulation of feces in the rectum is called:\r\n<ol type=\"a\">\r\n \t<li>Fecal incontinence<\/li>\r\n \t<li>Fecal impaction<\/li>\r\n \t<li>Constipation<\/li>\r\n \t<li>Diarrhea<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Which statement about ostomies is true?\r\n<ol type=\"a\">\r\n \t<li>Good skin care around the stoma is essential.<\/li>\r\n \t<li>The client does not need to wear a pouch.<\/li>\r\n \t<li>Feces are always liquid.<\/li>\r\n \t<li>Deodorants cannot control odours.<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Which position should the client be in when the HCA gives an enema?\r\n<ol type=\"a\">\r\n \t<li>Right position<\/li>\r\n \t<li>Prone position<\/li>\r\n \t<li>Sims\u2019 position<\/li>\r\n \t<li>Semi-Fowler\u2019s position<\/li>\r\n<\/ol>\r\n<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<h1>Chapter 7 Attributions and References<\/h1>\r\n<h2>Unit 7.2 Image Attributions<\/h2>\r\n<ul>\r\n \t<li><strong>Figure 7.2.1<\/strong> <a href=\"http:\/\/commons.wikimedia.org\/wiki\/File:Urine_Hydration_chart.svg\">Urine Hydration Chart<\/a> by Aishik Rehman, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.2.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Home_Care_Bedpans_%26_Urinals.png\">Home Care Bedpans &amp; Urinals<\/a>\u00a0by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.2.3<\/strong> <a href=\"http:\/\/commons.wikimedia.org\/wiki\/File:Condom_Catheter.png\">Condom Catheter<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n \t<li><span style=\"color: #339966; background-color: #ffffff;\"><span style=\"color: #000000;\"><strong>Figure 7.2.4<\/strong> Urinary Drainage Bag <span class=\"ui-provider gz b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">by Kim Morris, HCA Program\/ Thompson Rivers University,\u00a0is used under a <a class=\"fui-Link ___1qmgydl f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh ftqa4ok f2hkw1w fhgqx19 f1olyrje f1p93eir f1h8hb77 f1x7u7e9 f10aw75t fsle3fq\" title=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link CC BY 2.0\">CC BY 2.0<\/a> licence.\u00a0<\/span><\/span><\/span><\/li>\r\n \t<li><strong>Figure 7.2.5<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Closed_Urinary_Drainage.png\">Drainage Bag Position<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.2.6<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Empty_the_Urinary_Drainage_Bag.png\">Empty the Drainage Bag<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.2.7<\/strong><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:IncontinenceProduct.jpg\"> Incontinence product<\/a> by Hadifn, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\r\n<\/ul>\r\n<h2>Unit 7.3 Image Attributions<\/h2>\r\n<ul>\r\n \t<li><strong>Figure 7.3.1<\/strong> <a href=\"https:\/\/www.flickr.com\/photos\/johnbullas\/1448820757\">Bristol Stool Chart<\/a> by John C Bullas, via Flickr, is licsensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\">CC BY-NC-ND 2.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.3.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hospital_worker_putting_on_sterile_gloves.tiff\">Gl<\/a><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hospital_worker_putting_on_sterile_gloves.tiff\">oves<\/a> by CDC, via Wikimedia Commons, is in the <a class=\"extiw\" title=\"w:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a>.<\/li>\r\n \t<li><strong>Figure 7.3.3<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Enema_prepared,_disposable.jpg\">Disposable Enema<\/a> by Helena4780, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.3.4<\/strong> Lubricate tip of suppository or enema from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><span style=\"color: #000000;\"><strong>Figure 7.3.5<\/strong> Dispose of gloves <\/span>from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.3.6<\/strong> <a href=\"https:\/\/unsplash.com\/photos\/WIYtZU3PxsI\">Using an ABHR<\/a> by Kelly Sikkema on Unsplash, is used under the <a href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a>.<\/li>\r\n \t<li><strong>Figure 7.3.7<\/strong> Ensure call bell is available to client <span style=\"color: #339966; background-color: #ffffff;\"><span style=\"color: #000000;\"><span class=\"ui-provider gz b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">by Kim Morris, HCA Program\/ Thompson Rivers University,\u00a0is used under a <a class=\"fui-Link ___1qmgydl f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh ftqa4ok f2hkw1w fhgqx19 f1olyrje f1p93eir f1h8hb77 f1x7u7e9 f10aw75t fsle3fq\" title=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link CC BY 2.0\">CC BY 2.0<\/a> licence.\u00a0<\/span><\/span><\/span><\/li>\r\n<\/ul>\r\n<h2>Unit 7.4 Image Attributions<\/h2>\r\n<ul>\r\n \t<li><strong>Figure 7.4.1<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Urine_sample.JPG\">Urine Specimen<\/a> by Turbotorque, via Wikimedia Commons, is in the <a class=\"extiw\" title=\"w:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a>.<\/li>\r\n<\/ul>\r\n<h2>Unit 7.5 Image Attributions<\/h2>\r\n<ul>\r\n \t<li><strong>Figure 7.5.1<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_2017-02-20_5351.jpg\">Stoma<\/a> by Salicyna, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy.png\">Location of Ileostomy<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.3<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0247_Colostomy.png\">Colostomy Types<\/a> by BruceBlaus, via Wikimedia Commons, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\">CC BY 3.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.5.4<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ostomy_wafer_being_worn_by_an_ileostomy_patient.jpg\">Ostomy Barrier<\/a> by Eric Polsinelli, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.5<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_2016-09-09_4158.jpg\">Ostomy Pouch<\/a>\u00a0by Salicyna, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.6<\/strong> <a href=\"https:\/\/www.flickr.com\/photos\/arlingtonva\/4314530838\">Hand Hygiene<\/a> by Arlington County, via Flickr, is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/deed.en\">CC BY-SA 2.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.7<\/strong> Ostomy Supplies from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.5.8 <\/strong>Removing an Ostomy Bag, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.9\u00a0<\/strong>Removing a Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.5.10 <\/strong>Cleaning a Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.11 <\/strong>Healthy Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.12\u00a0<\/strong>Measuring Stoma Size, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.13\u00a0<\/strong>Cutting Flange to Size, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.14\u00a0<\/strong>Fitting Flange to Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.15\u00a0<\/strong>Prepping Peristomal Skin, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.16\u00a0<\/strong>Applying Stomahesive Paste, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.17\u00a0<\/strong>Preparing Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.5.18 <\/strong>Applying Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.19\u00a0<\/strong>Applying Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\r\n \t<li><strong>Figure 7.5.20 <\/strong>Applying Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n \t<li><strong>Figure 7.5.21\u00a0<\/strong>Closing Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\r\n<\/ul>\r\n<h2>Videos<\/h2>\r\n<ul>\r\n \t<li><a href=\"https:\/\/youtu.be\/NAT40dWPlWs\"><em>What Your Urine Colour Says About Your Health | Urinary System Breakdown | #DeepDives<\/em><\/a> by Health (2021) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=lY2bZjggc08\"><em>Urinary Tract Infections, Animation<\/em><\/a> by Alila Medical Media (2016) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><em><a href=\"https:\/\/youtu.be\/kD8ChQSZIxs\">How to use a Bedpan - Tips for Caregivers<\/a>\u00a0<\/em>by CareChannel (2019) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><a href=\"https:\/\/youtu.be\/YBI3QjJ6Y1I\"><em>Assisting with a Urinal<\/em><\/a> by Ashraf Z Qotmosh (2020) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><em><a href=\"https:\/\/youtu.be\/0cOv3k2JRZU\">How to Apply a Condom Catheter<\/a>,<\/em> by University of Manitoba Nursing Skills (2018) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><a href=\"https:\/\/youtu.be\/kVMfKVJN5J0\"><em>How to Perform Perineal Care with an Indwelling Catheter<\/em><\/a>, by University of Manitoba Nursing Skills (2018) is licensed under a Standard YouTube License.<\/li>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=WbVW_R7XIBY\"><em>Empty Urinary Drainage Bag CNA Skill NEW,<\/em><\/a> by 4yourCNA (2016) is licensed under a Standard YouTube License.<\/li>\r\n<\/ul>\r\n<h2>References<\/h2>\r\n<p class=\"hanging-indent\">Anderson, R., Doyle, G. R., &amp; McCutcheon, J. A. (2018).\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/\"><em>Clinical Procedures for Safer Patient Care \u2013 Thompson Rivers University Edition<\/em><\/a>. Thompson Rivers University. https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/\/<\/p>\r\n<p class=\"hanging-indent\">Berman, A. J., &amp; Snyder S. (2016).\u00a0<em>Skills in clinical nursing<\/em> (8th ed.). Pearson.<\/p>\r\n<p class=\"hanging-indent\">British Columbia Institute of Technology (BCIT). (2015b). Clinical techniques. In <em>NURS 2020<\/em>. BCIT. https:\/\/circuit.bcit.ca\/islandora\/object\/coutlines%3A400<\/p>\r\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. <em>Wikijournal of Medicine, 1<\/em>(2). <cite>DOI:10.15347\/wjm\/2014.010.\u00a0ISSN\u00a02002-4436.<\/cite><\/p>\r\n<p class=\"hanging-indent\">Convatech. (2018).\u00a0<em>Ostomy care video library<\/em>. https:\/\/www.convatec.com\/videos\/ostomy-videos\/.<\/p>\r\n<p class=\"hanging-indent\">Lilley, L., Rainforth Collins, S., Snyder, J., &amp; Swart, B. (2016).\u00a0<em>Pharmacology for Canadian health care practice<\/em> (3rd Canadian ed.). Elsevier.<\/p>\r\n<p class=\"hanging-indent\">Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2018).\u00a0<em>Clinical nursing skills and techniques<\/em> (9th ed.). Elsevier-Mosby.<\/p>\r\n<p class=\"hanging-indent\">United Ostomy Association of America. (2017).\u00a0<em>Ileostomy guide<\/em>. http:\/\/www.ostomy.org\/uploaded\/files\/ostomy_info\/IleostomyGuide.pdf?direct=1.<\/p>","rendered":"<p style=\"text-align: left;\">An <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_1686_482\">ostomy<\/a> is a surgical procedure that creates an opening (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_1686_1488\">stoma<\/a>) from an area inside the body to the outside of the body. In ostomies related to elimination, a stoma is an opening on the abdomen that is connected to the gastrointestinal or urinary system to allow waste (urine or feces) to be collected in a pouch. See Figure 7.5.1 for an image of a stoma. A stoma can be permanent, such as when an organ is removed, or temporary, such as when an organ requires time to heal. Ostomies are created for clients with conditions such as cancer of the bowel or bladder, inflammatory bowel diseases, or perforation of the colon.<\/p>\n<figure id=\"attachment_1670\" aria-describedby=\"caption-attachment-1670\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1666 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-300x237.jpg\" alt=\"\" width=\"300\" height=\"237\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-300x237.jpg 300w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-768x607.jpg 768w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-65x51.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-225x178.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma-350x276.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-stoma.jpg 1023w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1670\" class=\"wp-caption-text\"><strong>Figure 7.5.1<\/strong> Stoma<\/figcaption><\/figure>\n<p style=\"text-align: left;\">There are several different kinds of ostomies related to elimination. Common types of ostomies include the following:<\/p>\n<ul style=\"text-align: left;\">\n<li><strong>Ileostomy: <\/strong>The lower end of the small intestine (ileum) is attached to a stoma to bypass the colon,\u00a0rectum, and anus.<\/li>\n<li><strong>Colostomy:\u00a0<\/strong>The colon is attached to a stoma to bypass the rectum and the anus.<\/li>\n<li><strong>Urostomy: <\/strong>The ureters (tubes that carry urine from the kidney to the bladder) are attached to a stoma to bypass the bladder.<\/li>\n<\/ul>\n<p style=\"text-align: left;\">Figures 7.5.2 and 7.5.3 show the anatomical locations of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_1686_485\">ileostomies<\/a> and various sites of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_1686_483\">colostomies<\/a>. It is important to understand the site of a client\u2019s colostomy because the site impacts the characteristics of the waste. For example, due to the natural digestive process of the colon and absorption of water, waste from an ileostomy or a colostomy placed in the anterior ascending colon will be watery compared to waste from an ostomy placed in the descending colon.<\/p>\n<table class=\"grid\" style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 50%; border-color: white;\">\n<figure id=\"attachment_1667\" aria-describedby=\"caption-attachment-1667\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1667 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-300x300.jpg 300w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-150x150.jpg 150w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-65x65.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-225x225.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram-350x350.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ileostomy-diagram.jpg 416w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1667\" class=\"wp-caption-text\"><strong>Figure 7.5.2<\/strong> Location of an ileostomy compared to colostomies<\/figcaption><\/figure>\n<\/td>\n<td style=\"width: 50%; border-color: white;\">\n<figure id=\"attachment_192\" aria-describedby=\"caption-attachment-192\" style=\"width: 293px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-192\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy.jpg\" alt=\"\" width=\"293\" height=\"293\" \/><figcaption id=\"caption-attachment-192\" class=\"wp-caption-text\"><strong>Figure 7.5.3<\/strong> Colostomy types<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: left;\">The tissue of a stoma is very delicate. Immediately after surgery, a stoma is swollen, but it will shrink in size over several weeks. A healthy, healed stoma appears moist and dark red or pink in colour. Stomas that are swollen; dry; have malodorous discharge; or are bluish, purple, black, or pale should be reported to the provider. The skin surrounding a stoma can easily become irritated from the pouch adhesive or leakage of fluid from the stoma, so the nurse must perform interventions to prevent skin breakdown. Any identified signs of skin breakdown should be reported to the provider.<\/p>\n<p style=\"text-align: left;\">Stoma appliances are supplied as a one- or two-piece set. A two-piece set consists of an ostomy barrier (also called a wafer) and a pouch. The ostomy barrier is the part of the appliance that sticks to the skin with a hole that is fitted around the stoma. The pouch collects the waste and must be emptied regularly. It attaches to the ostomy barrier in a clicking motion to secure the two parts, similar to how a plastic storage container cover snaps to a container to create a seal. The pouching system must be completely sealed to prevent the leaking of the waste and to protect the surrounding peristomal skin. The pouch has an end with an opening where the waste is drained and is closed using a plastic clip o<span style=\"background-color: #ffffff;\">r Velcro strip.<\/span><\/p>\n<p style=\"text-align: left;\">In a one-piece stoma appliance set, the ostomy barrier and the pouch are one piece. See Figure 7.5.4 for an image of a stoma with an ostomy barrier in place. See Figure 7.5.5 for an image of a client with an ileostomy appliance with a pouch attached. The flange is the adhesive part of the ostomy pouching system that secures it to the body.<\/p>\n<figure id=\"attachment_1670\" aria-describedby=\"caption-attachment-1670\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-193 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-and-flange.jpg\" alt=\"\" width=\"300\" height=\"168\" \/><figcaption id=\"caption-attachment-1670\" class=\"wp-caption-text\"><strong>Figure 7.5.4<\/strong> Ostomy barrier<\/figcaption><\/figure>\n<figure id=\"attachment_1670\" aria-describedby=\"caption-attachment-1670\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1670 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-300x214.jpg\" alt=\"\" width=\"300\" height=\"214\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-300x214.jpg 300w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-768x547.jpg 768w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-65x46.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-225x160.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158-350x249.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Ileostomy_2016-09-09_4158.jpg 800w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1670\" class=\"wp-caption-text\"><strong>Figure 7.5.5 <\/strong>Ostomy pouch<\/figcaption><\/figure>\n<p style=\"text-align: left;\">Individuals with colostomies, ileostomies, and urostomies have no sensation and no control over the output of the stoma. Depending on the type of system, the ostomy appliance can last from four to seven days, but the pouch must be changed if there is leaking, odour, excessive skin exposure, or itching or burning under the skin barrier. Clients with pouches can swim and take showers with the pouching system on.<\/p>\n<h1 style=\"text-align: left;\">Changing an Ostomy Appliance (Flange and Pouch)<\/h1>\n<div class=\"textbox shaded\"><strong>Some elements of ostomy care involve restricted activities. HCAs must have client-specific delegation from a regulated health professional to perform any restricted activities.\u00a0<\/strong><\/div>\n<h2>Safety Considerations<\/h2>\n<ul>\n<li>Pouching system should be changed every 4 to 7 days, depending on the client and type of pouch. Notify supervisor if there is skin breakdown, if there are challenges with flange adhesion, or if there are other concerns related to the pouching system.<\/li>\n<li>Clients should participate in the care of their ostomy, if able, and health care providers should promote client and family involvement.<\/li>\n<li>Encourage the client to empty the pouch when it is one-third to one-half full of urine, flatus, or feces as they become heavy and have increased risk of spillage.<\/li>\n<li>Ostomy product choices may be limited in acute care settings. Other choices are available in community retail settings. Encourage the client\/family to explore other options.<\/li>\n<li>Observe the centre of the flange for evidence of leaking. Waste on the peristomal skin can cause skin breakdown. Leaking flanges must be changed immediately.<\/li>\n<li>An ostomy belt may be used to help hold the ostomy pouch in place.<\/li>\n<li>Factors that affect the pouching system include sweating, high heat, moist or oily skin, and physical exercise.<\/li>\n<li>Always report minor skin irritations immediately. Skin that is sore, wet, or red is difficult to seal with a flange.<\/li>\n<li>Change ileostomy appliances <strong>prior<\/strong> to eating to decrease the likelihood that a bowel movement will occur during appliance change.<\/li>\n<\/ul>\n<table class=\"grid\" style=\"width: 100%;\">\n<caption>Table 7.5.1 Procedure:\u00a0Changing an Ostomy Appliance<a class=\"footnote\" title=\"(Data source: BCIT, 2015; Berman &amp; Snyder, 2016; Convatec, 2018; Perry, et al., 2018; United Ostomy Association of America, 2017)\" id=\"return-footnote-1686-1\" href=\"#footnote-1686-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/caption>\n<thead>\n<tr>\n<th scope=\"col\">STEP<\/th>\n<th scope=\"col\">ACTION<\/th>\n<th scope=\"col\">ADDITIONAL INFORMATION<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">1.<\/th>\n<td style=\"width: 46.8342%;\">Perform hand hygiene.<\/td>\n<td style=\"width: 47.1357%;\">This prevents the spread of microorganisms.<\/p>\n<figure id=\"attachment_1671\" aria-describedby=\"caption-attachment-1671\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1671 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-300x200.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-300x200.jpg 300w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-768x511.jpg 768w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-65x43.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-225x150.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands-350x233.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning_hands.jpg 849w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1671\" class=\"wp-caption-text\"><strong>Figure 7.5.6 <\/strong>Hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">2.<\/th>\n<td style=\"width: 46.8342%;\">Gather supplies, including:<\/p>\n<ul>\n<li>flange<\/li>\n<li>ostomy bag and clip<\/li>\n<li>scissors,<\/li>\n<li>stoma measuring guide<\/li>\n<li>waterproof pad<\/li>\n<li>pen<\/li>\n<li>adhesive remover for old flange<\/li>\n<li>stomahesive paste or powder<\/li>\n<li>warm wet cloth(s) and dry cloth<\/li>\n<li>non-sterile gloves<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 47.1357%;\">\n<figure id=\"attachment_1672\" aria-describedby=\"caption-attachment-1672\" style=\"width: 199px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1672\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-199x300.jpg\" alt=\"\" width=\"199\" height=\"300\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-199x300.jpg 199w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-678x1024.jpg 678w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-768x1159.jpg 768w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-1018x1536.jpg 1018w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-1357x2048.jpg 1357w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-65x98.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-225x340.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1-350x528.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/ostomy-supplies-scaled-1.jpg 1696w\" sizes=\"auto, (max-width: 199px) 100vw, 199px\" \/><figcaption id=\"caption-attachment-1672\" class=\"wp-caption-text\"><strong>Figure 7.5.7<\/strong> Ostomy Supplies<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">3.<\/th>\n<td style=\"width: 46.8342%;\">Identify the client and review the procedure. Encourage the client to participate as much as possible, or observe and assist client as they complete the procedure.<\/td>\n<td style=\"height: 30px; width: 47.1357%;\">Proper identification complies with agency policy. Encouraging clients to participate helps them adjust to having an ostomy.<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">4.<\/th>\n<td style=\"width: 46.8342%;\">Create privacy. Place waterproof pad under pouch.<\/td>\n<td style=\"height: 15px; width: 47.1357%;\">The pad prevents the spilling of effluent on client and bed sheets.<\/td>\n<\/tr>\n<tr style=\"height: 185px;\">\n<th style=\"width: 5.82915%;\" scope=\"row\">5.<\/th>\n<td style=\"width: 46.8342%;\">Apply gloves. Remove the ostomy bag, and measure and empty contents. Place the old pouching system in a garbage bag.<\/td>\n<td style=\"height: 185px; width: 47.1357%;\">\n<figure id=\"attachment_197\" aria-describedby=\"caption-attachment-197\" style=\"width: 232px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-197 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-ostomy-bag-from-flange-0011.jpg\" alt=\"\" width=\"232\" height=\"182\" \/><figcaption id=\"caption-attachment-197\" class=\"wp-caption-text\"><strong>Figure 7.5.8 <\/strong>Removing an ostomy bag<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">6.<\/th>\n<td style=\"width: 46.8342%;\">Remove the flange by gently pulling it toward the stoma. Support the skin with your other hand. An adhesive remover may be used.<\/td>\n<td style=\"width: 47.1357%;\">Gentle removal helps prevent skin tears. An adhesive remover may be used to decrease skin and hair stripping.<\/p>\n<figure id=\"attachment_198\" aria-describedby=\"caption-attachment-198\" style=\"width: 182px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-198 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-flange-001.jpg\" alt=\"\" width=\"182\" height=\"198\" \/><figcaption id=\"caption-attachment-198\" class=\"wp-caption-text\"><strong>Figure 7.5.9<\/strong> Removing a flange<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">7.<\/th>\n<td style=\"width: 46.8342%;\">Clean the stoma gently by wiping with warm water. Do not use soap.<\/td>\n<td style=\"width: 47.1357%;\">Aggressive cleaning can cause bleeding. If removing the stomahesive paste from the skin, use a dry cloth first.<\/p>\n<p>Clean the stoma and peristomal skin.<\/p>\n<figure id=\"attachment_199\" aria-describedby=\"caption-attachment-199\" style=\"width: 215px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-199 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Cleaning-stoma-and-peristomal-skin-001.jpg\" alt=\"\" width=\"215\" height=\"150\" \/><figcaption id=\"caption-attachment-199\" class=\"wp-caption-text\"><strong>Figure 7.5.10 <\/strong>Cleaning a stoma<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">8.<\/th>\n<td style=\"width: 46.8342%;\">Observe the stoma and peristomal skin.<\/td>\n<td style=\"width: 47.1357%;\">A stoma should be pink to red in colour, preferrably moist and raised above skin level.<\/p>\n<figure id=\"attachment_200\" aria-describedby=\"caption-attachment-200\" style=\"width: 87px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-200 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Assess-stoma-001.jpg\" alt=\"\" width=\"87\" height=\"106\" \/><figcaption id=\"caption-attachment-200\" class=\"wp-caption-text\"><strong>Figure 7.5.11 <\/strong>Healthy stoma<\/figcaption><\/figure>\n<p><strong>Observe stoma<\/strong><\/p>\n<p>Skin surrounding the stoma should be intact and free from wounds, rashes, or skin breakdown. Notify your supervisor if you are concerned about the condition of the peristomal skin.<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">9.<\/th>\n<td style=\"width: 46.8342%;\">Measure the stoma diameter using the measuring guide (tracing template) and cut out stoma hole.<\/p>\n<p>Trace diameter of the measuring guide onto the flange, and cut on the outside of the pen marking.<\/td>\n<td style=\"width: 47.1357%;\">The opening should be 2 mm\u00a0larger than the stoma size.<\/p>\n<p>Keep the measurement guide with the client&#8217;s supplies for future use. Trace template.<\/p>\n<figure id=\"attachment_1678\" aria-describedby=\"caption-attachment-1678\" style=\"width: 242px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-201 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Tracing-stoma-size-from-tracing-template-001.jpg\" alt=\"\" width=\"242\" height=\"197\" \/><figcaption id=\"caption-attachment-1678\" class=\"wp-caption-text\"><strong>Figure 7.5.12 <\/strong>Measuring stoma size<\/figcaption><\/figure>\n<p>Once the size is traced onto back of flange, cut out the size to fit the stoma.<\/p>\n<figure id=\"attachment_1678\" aria-describedby=\"caption-attachment-1678\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1678 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-300x199.jpg 300w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-768x509.jpg 768w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-65x43.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-225x149.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring-350x232.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/flange-measuring.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1678\" class=\"wp-caption-text\"><strong>Figure 7.5.13 <\/strong>Cutting flange to size<\/figcaption><\/figure>\n<p>Check the flange to ensure a proper fit to the stoma.<\/p>\n<figure id=\"attachment_1678\" aria-describedby=\"caption-attachment-1678\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-203 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Assess-if-flange-is-the-correct-size-for-stoma-001.jpg\" alt=\"\" width=\"250\" height=\"192\" \/><figcaption id=\"caption-attachment-1678\" class=\"wp-caption-text\"><strong>Figure 7.5.14 <\/strong>Fitting flange to stoma<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">10.<\/th>\n<td style=\"width: 46.8342%;\">Prepare skin and apply accessory products as required or according to agency policy.<\/td>\n<td style=\"width: 47.1357%;\">Peristomal skin prep.<\/p>\n<p>Accessory products may include stomahesive paste, stomahesive powder, or products used to create a skin sealant to adhere pouching system to skin to prevent leaking.<\/p>\n<p>Wet skin will prevent the flange from adhering to the skin.<\/p>\n<figure id=\"attachment_205\" aria-describedby=\"caption-attachment-205\" style=\"width: 159px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-204 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Prepare-peristomal-skin-for-flnage-001-e1442766619416.jpg\" alt=\"\" width=\"159\" height=\"281\" \/><figcaption id=\"caption-attachment-205\" class=\"wp-caption-text\"><strong>Figure 7.5.15 <\/strong>Prepping peristomal skin<\/figcaption><\/figure>\n<p>Apply stomahesive paste.<\/p>\n<figure id=\"attachment_205\" aria-describedby=\"caption-attachment-205\" style=\"width: 208px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-205 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Applying-stomahersive-paste-001.jpg\" alt=\"\" width=\"208\" height=\"147\" \/><figcaption id=\"caption-attachment-205\" class=\"wp-caption-text\"><strong>Figure 7.5.16 <\/strong>Applying stomahesive paste<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">11.<\/th>\n<td style=\"width: 46.8342%;\">Remove the inner backing on the flange and apply flange over stoma. Leave the border tape on. Apply pressure. Hold in place for 1 minute to warm the flange to meld to the client\u2019s body. Then remove outer border backing and press gently to create seal.<\/td>\n<td style=\"width: 47.1357%;\">The warmth of the hand can help the appliance adhere to the skin and prevent leakage.<\/p>\n<p>Remove backing from flange.<\/p>\n<figure id=\"attachment_207\" aria-describedby=\"caption-attachment-207\" style=\"width: 223px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-206 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Remove-backing-from-flange-001.jpg\" alt=\"\" width=\"223\" height=\"194\" \/><figcaption id=\"caption-attachment-207\" class=\"wp-caption-text\"><strong>Figure 7.5.17 <\/strong>Preparing flange<\/figcaption><\/figure>\n<p>Apply flange around stoma.<\/p>\n<figure id=\"attachment_207\" aria-describedby=\"caption-attachment-207\" style=\"width: 182px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-198 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-flange-001.jpg\" alt=\"\" width=\"182\" height=\"198\" \/><figcaption id=\"caption-attachment-207\" class=\"wp-caption-text\"><strong>Figure 7.5.18 <\/strong>Applying flange<\/figcaption><\/figure>\n<p>Press gently to create seal.<\/p>\n<figure id=\"attachment_207\" aria-describedby=\"caption-attachment-207\" style=\"width: 220px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-207 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Stoma-A-001.jpg\" alt=\"\" width=\"220\" height=\"197\" \/><figcaption id=\"caption-attachment-207\" class=\"wp-caption-text\"><strong>Figure 7.5.19 <\/strong>Sealing flange<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">12.<\/th>\n<td style=\"width: 46.8342%;\">Apply the ostomy bag. Attach the clip to the bottom of the bag.<\/td>\n<td style=\"width: 47.1357%;\">Apply ostomy pouch. This step prevents the effluent from soiling the client or bed.<\/p>\n<figure id=\"attachment_1685\" aria-describedby=\"caption-attachment-1685\" style=\"width: 232px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-208 size-full\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/Removing-ostomy-bag-from-flange-001.jpg\" alt=\"\" width=\"232\" height=\"182\" \/><figcaption id=\"caption-attachment-1685\" class=\"wp-caption-text\"><strong>Figure 7.5.20 <\/strong>Applying ostomy pouch<\/figcaption><\/figure>\n<p>Attach clip to bottom of bag.<\/p>\n<figure id=\"attachment_1685\" aria-describedby=\"caption-attachment-1685\" style=\"width: 199px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1685 size-medium\" src=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-199x300.jpg\" alt=\"\" width=\"199\" height=\"300\" srcset=\"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-199x300.jpg 199w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-65x98.jpg 65w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-225x340.jpg 225w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag-350x529.jpg 350w, https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-content\/uploads\/sites\/430\/2024\/09\/attach-clip-to-bag.jpg 678w\" sizes=\"auto, (max-width: 199px) 100vw, 199px\" \/><figcaption id=\"caption-attachment-1685\" class=\"wp-caption-text\"><strong>Figure 7.5.21 <\/strong>Closing ostomy pouch<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">13.<\/th>\n<td style=\"width: 46.8342%;\">Hold palm of hand over ostomy pouch for 2 minutes to assist with appliance adhering to skin.<\/td>\n<td style=\"height: 30px; width: 47.1357%;\">Some flanges are heat activated and adhere better when warmth is applied.<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">14.<\/th>\n<td style=\"width: 46.8342%;\">Clean up supplies, and place the client in a comfortable position. Remove garbage from the client\u2019s room.<\/td>\n<td style=\"height: 30px; width: 47.1357%;\">Removing garbage helps decrease odour.<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">15.<\/th>\n<td style=\"width: 46.8342%;\">Perform hand hygiene.<\/td>\n<td style=\"height: 15px; width: 47.1357%;\">This minimizes the transmission of microorganisms.<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 5.82915%;\" scope=\"row\">16.<\/th>\n<td style=\"width: 46.8342%;\">Document procedure.<\/td>\n<td style=\"width: 47.1357%;\">Follow agency policy for documentation. Document the appearance of the stoma and peristomal skin, products used, and the client\u2019s ability to tolerate procedure and assistance with procedure.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Watch the video\uff1a<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Ostomy Bag Pouch Change | Ostomy Care Nursing | Colostomy, Ileostomy Bag  Change\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/h8CtsPAaa5Y?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=h8CtsPAaa5Y\"><em>Ostomy Bag Pouch Change | Ostomy Care Nursing | Colostomy, Ileostomy Bag Change<\/em><\/a> by RegisteredNurseRN (2017).<\/p>\n<\/div>\n<\/div>\n<h2>Procedure Video<\/h2>\n<p>The following video provides the best demonstration of the skills for\u00a0how to empty and change an ostomy flange and bag.<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Watch the video:<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Some elements of ostomy care involve restricted activities. HCAs must have client-specific delegation from a regulated health professional to perform any restricted activities.\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"How To Empty &amp; Change An Ostomy Bag\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/FXKM1r5L8U8?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=FXKM1r5L8U8\"><em>How To Empty &amp; Change An Ostomy Bag<\/em><\/a> by CareChannel (2019)<\/p>\n<\/div>\n<\/div>\n<h1>Stool Specimen Collection<\/h1>\n<p style=\"text-align: left;\">Stool samples are collected from clients to test for cancer, parasites, or occult blood (i.e., hidden blood). Follow specific instructions from the facility\/agency where you are working for collecting the sample.<\/p>\n<p>To collect a sample, perform the following steps:<\/p>\n<ul>\n<li>Explain the procedure to the client. Instruct them to flush the toilet before defecating to remove any potential chemicals and to not place toilet paper in the toilet after defecating. Request they notify you when they have had a bowel movement.<\/li>\n<li>Review the manufacturer\u2019s instructions because different test kits may have different instructions.<\/li>\n<li>Contact the laboratory with any questions.<\/li>\n<li>Label the card with the patient\u2019s name and medical information as per agency policy. Open the flap of the guaiac test card.<\/li>\n<li>Apply non-sterile gloves. Use the applicator stick to apply a thin smear of the stool specimen to\u00a0one of the squares of filter paper on the card. Obtain a second specimen from a different part of\u00a0the stool and apply it to the second square of filter paper on the card. (Occult blood isn\u2019t typically\u00a0equally dispersed throughout the stool.)<\/li>\n<li>Place the labelled test card in a transport bag and send it to the laboratory for analysis.<\/li>\n<li>If you are working in an agency where nurses apply the guaiac developer solution to the card, allow the specimen to dry for 3\u20135 minutes. Open the reverse side of the card and apply two drops of guaiac developer solution to each square. A blue reaction will occur within 60 seconds if the test is positive. The absence of a blue colour after 60 seconds is considered a negative test.<\/li>\n<li>Document the date and time of the test and any unusual characteristics of the stool sample.<\/li>\n<\/ul>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Summary<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Helping to ensure your clients maintain health urinary and bowel elimination are essential medical and psychosocial aspects of providing quality care. The HCA can help clients maintain regular and healthy elimination and prevent complications such constipation, infections, and incontinence.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox\">\n<header class=\"textbox__header\">Review Questions<\/header>\n<div class=\"h5p\">\n<div id=\"h5p-5\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-5\" class=\"h5p-iframe\" data-content-id=\"5\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Chapter 7 Review Questions\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"pdf\">\n<ol>\n<li>Which term describes the process of emptying urine from the bladder? (Select one or more)\n<ol type=\"a\">\n<li>Voiding<\/li>\n<li>Defecation<\/li>\n<li>Urination<\/li>\n<li>Micturition<\/li>\n<\/ol>\n<\/li>\n<li>Urine should be observed for colour, clarity, odour, amount, and particles\n<ol type=\"a\">\n<li>False<\/li>\n<li>True<\/li>\n<\/ol>\n<\/li>\n<li>Which of the following is your responsibility when supporting Mrs. Daliwal who has an indwelling catheter?\n<ol type=\"a\">\n<li>Keep the drainage bag below the level of her bladder.<\/li>\n<li>Hide the tubing by placing it underneath the client.<\/li>\n<li>Hook the drainage bag to the bed rail.<\/li>\n<li>Try to comfort her by saying that her urge to void is all in her head.<\/li>\n<\/ol>\n<\/li>\n<li>The prolonged retention and accumulation of feces in the rectum is called:\n<ol type=\"a\">\n<li>Fecal incontinence<\/li>\n<li>Fecal impaction<\/li>\n<li>Constipation<\/li>\n<li>Diarrhea<\/li>\n<\/ol>\n<\/li>\n<li>Which statement about ostomies is true?\n<ol type=\"a\">\n<li>Good skin care around the stoma is essential.<\/li>\n<li>The client does not need to wear a pouch.<\/li>\n<li>Feces are always liquid.<\/li>\n<li>Deodorants cannot control odours.<\/li>\n<\/ol>\n<\/li>\n<li>Which position should the client be in when the HCA gives an enema?\n<ol type=\"a\">\n<li>Right position<\/li>\n<li>Prone position<\/li>\n<li>Sims\u2019 position<\/li>\n<li>Semi-Fowler\u2019s position<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<h1>Chapter 7 Attributions and References<\/h1>\n<h2>Unit 7.2 Image Attributions<\/h2>\n<ul>\n<li><strong>Figure 7.2.1<\/strong> <a href=\"http:\/\/commons.wikimedia.org\/wiki\/File:Urine_Hydration_chart.svg\">Urine Hydration Chart<\/a> by Aishik Rehman, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.2.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Home_Care_Bedpans_%26_Urinals.png\">Home Care Bedpans &amp; Urinals<\/a>\u00a0by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.2.3<\/strong> <a href=\"http:\/\/commons.wikimedia.org\/wiki\/File:Condom_Catheter.png\">Condom Catheter<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<li><span style=\"color: #339966; background-color: #ffffff;\"><span style=\"color: #000000;\"><strong>Figure 7.2.4<\/strong> Urinary Drainage Bag <span class=\"ui-provider gz b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">by Kim Morris, HCA Program\/ Thompson Rivers University,\u00a0is used under a <a class=\"fui-Link ___1qmgydl f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh ftqa4ok f2hkw1w fhgqx19 f1olyrje f1p93eir f1h8hb77 f1x7u7e9 f10aw75t fsle3fq\" title=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link CC BY 2.0\">CC BY 2.0<\/a> licence.\u00a0<\/span><\/span><\/span><\/li>\n<li><strong>Figure 7.2.5<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Closed_Urinary_Drainage.png\">Drainage Bag Position<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.2.6<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Empty_the_Urinary_Drainage_Bag.png\">Empty the Drainage Bag<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.2.7<\/strong><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:IncontinenceProduct.jpg\"> Incontinence product<\/a> by Hadifn, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA 4.0<\/a> licence.<\/li>\n<\/ul>\n<h2>Unit 7.3 Image Attributions<\/h2>\n<ul>\n<li><strong>Figure 7.3.1<\/strong> <a href=\"https:\/\/www.flickr.com\/photos\/johnbullas\/1448820757\">Bristol Stool Chart<\/a> by John C Bullas, via Flickr, is licsensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\">CC BY-NC-ND 2.0<\/a> licence.<\/li>\n<li><strong>Figure 7.3.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hospital_worker_putting_on_sterile_gloves.tiff\">Gl<\/a><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hospital_worker_putting_on_sterile_gloves.tiff\">oves<\/a> by CDC, via Wikimedia Commons, is in the <a class=\"extiw\" title=\"w:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a>.<\/li>\n<li><strong>Figure 7.3.3<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Enema_prepared,_disposable.jpg\">Disposable Enema<\/a> by Helena4780, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.3.4<\/strong> Lubricate tip of suppository or enema from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><span style=\"color: #000000;\"><strong>Figure 7.3.5<\/strong> Dispose of gloves <\/span>from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.3.6<\/strong> <a href=\"https:\/\/unsplash.com\/photos\/WIYtZU3PxsI\">Using an ABHR<\/a> by Kelly Sikkema on Unsplash, is used under the <a href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a>.<\/li>\n<li><strong>Figure 7.3.7<\/strong> Ensure call bell is available to client <span style=\"color: #339966; background-color: #ffffff;\"><span style=\"color: #000000;\"><span class=\"ui-provider gz b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">by Kim Morris, HCA Program\/ Thompson Rivers University,\u00a0is used under a <a class=\"fui-Link ___1qmgydl f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh ftqa4ok f2hkw1w fhgqx19 f1olyrje f1p93eir f1h8hb77 f1x7u7e9 f10aw75t fsle3fq\" title=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link CC BY 2.0\">CC BY 2.0<\/a> licence.\u00a0<\/span><\/span><\/span><\/li>\n<\/ul>\n<h2>Unit 7.4 Image Attributions<\/h2>\n<ul>\n<li><strong>Figure 7.4.1<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Urine_sample.JPG\">Urine Specimen<\/a> by Turbotorque, via Wikimedia Commons, is in the <a class=\"extiw\" title=\"w:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a>.<\/li>\n<\/ul>\n<h2>Unit 7.5 Image Attributions<\/h2>\n<ul>\n<li><strong>Figure 7.5.1<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_2017-02-20_5351.jpg\">Stoma<\/a> by Salicyna, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.2<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy.png\">Location of Ileostomy<\/a> by BruceBlaus, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.3<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0247_Colostomy.png\">Colostomy Types<\/a> by BruceBlaus, via Wikimedia Commons, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\">CC BY 3.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.5.4<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ostomy_wafer_being_worn_by_an_ileostomy_patient.jpg\">Ostomy Barrier<\/a> by Eric Polsinelli, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.5<\/strong> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_2016-09-09_4158.jpg\">Ostomy Pouch<\/a>\u00a0by Salicyna, via Wikimedia Commons, is licensed under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">CC BY-SA-4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.6<\/strong> <a href=\"https:\/\/www.flickr.com\/photos\/arlingtonva\/4314530838\">Hand Hygiene<\/a> by Arlington County, via Flickr, is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/deed.en\">CC BY-SA 2.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.7<\/strong> Ostomy Supplies from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.5.8 <\/strong>Removing an Ostomy Bag, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.9\u00a0<\/strong>Removing a Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.5.10 <\/strong>Cleaning a Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.11 <\/strong>Healthy Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.12\u00a0<\/strong>Measuring Stoma Size, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.13\u00a0<\/strong>Cutting Flange to Size, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.14\u00a0<\/strong>Fitting Flange to Stoma, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.15\u00a0<\/strong>Prepping Peristomal Skin, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.16\u00a0<\/strong>Applying Stomahesive Paste, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.17\u00a0<\/strong>Preparing Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.5.18 <\/strong>Applying Flange, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.19\u00a0<\/strong>Applying Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\u00a0licence.<\/li>\n<li><strong>Figure 7.5.20 <\/strong>Applying Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<li><strong>Figure 7.5.21\u00a0<\/strong>Closing Ostomy Pouch, from Anderson, Doyle &amp; McCutcheon (2018), via BCcampus, is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a> licence.<\/li>\n<\/ul>\n<h2>Videos<\/h2>\n<ul>\n<li><a href=\"https:\/\/youtu.be\/NAT40dWPlWs\"><em>What Your Urine Colour Says About Your Health | Urinary System Breakdown | #DeepDives<\/em><\/a> by Health (2021) is licensed under a Standard YouTube License.<\/li>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=lY2bZjggc08\"><em>Urinary Tract Infections, Animation<\/em><\/a> by Alila Medical Media (2016) is licensed under a Standard YouTube License.<\/li>\n<li><em><a href=\"https:\/\/youtu.be\/kD8ChQSZIxs\">How to use a Bedpan &#8211; Tips for Caregivers<\/a>\u00a0<\/em>by CareChannel (2019) is licensed under a Standard YouTube License.<\/li>\n<li><a href=\"https:\/\/youtu.be\/YBI3QjJ6Y1I\"><em>Assisting with a Urinal<\/em><\/a> by Ashraf Z Qotmosh (2020) is licensed under a Standard YouTube License.<\/li>\n<li><em><a href=\"https:\/\/youtu.be\/0cOv3k2JRZU\">How to Apply a Condom Catheter<\/a>,<\/em> by University of Manitoba Nursing Skills (2018) is licensed under a Standard YouTube License.<\/li>\n<li><a href=\"https:\/\/youtu.be\/kVMfKVJN5J0\"><em>How to Perform Perineal Care with an Indwelling Catheter<\/em><\/a>, by University of Manitoba Nursing Skills (2018) is licensed under a Standard YouTube License.<\/li>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=WbVW_R7XIBY\"><em>Empty Urinary Drainage Bag CNA Skill NEW,<\/em><\/a> by 4yourCNA (2016) is licensed under a Standard YouTube License.<\/li>\n<\/ul>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Anderson, R., Doyle, G. R., &amp; McCutcheon, J. A. (2018).\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/\"><em>Clinical Procedures for Safer Patient Care \u2013 Thompson Rivers University Edition<\/em><\/a>. Thompson Rivers University. https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/\/<\/p>\n<p class=\"hanging-indent\">Berman, A. J., &amp; Snyder S. (2016).\u00a0<em>Skills in clinical nursing<\/em> (8th ed.). Pearson.<\/p>\n<p class=\"hanging-indent\">British Columbia Institute of Technology (BCIT). (2015b). Clinical techniques. In <em>NURS 2020<\/em>. BCIT. https:\/\/circuit.bcit.ca\/islandora\/object\/coutlines%3A400<\/p>\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. <em>Wikijournal of Medicine, 1<\/em>(2). <cite>DOI:10.15347\/wjm\/2014.010.\u00a0ISSN\u00a02002-4436.<\/cite><\/p>\n<p class=\"hanging-indent\">Convatech. (2018).\u00a0<em>Ostomy care video library<\/em>. https:\/\/www.convatec.com\/videos\/ostomy-videos\/.<\/p>\n<p class=\"hanging-indent\">Lilley, L., Rainforth Collins, S., Snyder, J., &amp; Swart, B. (2016).\u00a0<em>Pharmacology for Canadian health care practice<\/em> (3rd Canadian ed.). Elsevier.<\/p>\n<p class=\"hanging-indent\">Perry, A. G., Potter, P. A., &amp; Ostendorf, W. R. (2018).\u00a0<em>Clinical nursing skills and techniques<\/em> (9th ed.). Elsevier-Mosby.<\/p>\n<p class=\"hanging-indent\">United Ostomy Association of America. (2017).\u00a0<em>Ileostomy guide<\/em>. http:\/\/www.ostomy.org\/uploaded\/files\/ostomy_info\/IleostomyGuide.pdf?direct=1.<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1686-1\">(Data source: BCIT, 2015; Berman &amp; Snyder, 2016; Convatec, 2018; Perry, et al., 2018; United Ostomy Association of America, 2017) <a href=\"#return-footnote-1686-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_1686_482\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_1686_482\"><div tabindex=\"-1\"><p>A surgically created artificial opening in the abdomen for elimination of feces or urine.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_1686_1488\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_1686_1488\"><div tabindex=\"-1\"><p>A surgically created opening on the surface of the skin that allows the passage of bodily waste out of the body. It is often used when a portion of the digestive or urinary system needs to be bypassed, as in cases of colostomy, ileostomy, or urostomy.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_1686_485\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_1686_485\"><div tabindex=\"-1\"><p>A surgically created artificial opening between the ileum (final section of the small intestine) and the abdominal wall.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_1686_483\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_1686_483\"><div tabindex=\"-1\"><p>A surgically created artificial opening between the colon and the abdominal wall.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":123,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-1686","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":153,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapters\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/wp\/v2\/users\/123"}],"version-history":[{"count":3,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapters\/1686\/revisions"}],"predecessor-version":[{"id":2015,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapters\/1686\/revisions\/2015"}],"part":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/parts\/153"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapters\/1686\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/wp\/v2\/media?parent=1686"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/pressbooks\/v2\/chapter-type?post=1686"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/wp\/v2\/contributor?post=1686"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/wp-json\/wp\/v2\/license?post=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}