Policy Manual sample

MDT Home Health Care Agency, Inc. UROSTOMY CARE POLICY Policy: To better understand care of patient with urostomy, including patient/family education. Urostomy is an opening in the abdomen created by a surgical procedure (radical cystectomy) to allow urine to flow to the outside of the body. This may be needed when a diseased or damaged bladder has to be removed. Part of the ureters may also be removed. A small segment of the small or large intestine is used to create the channel (a urinary diversion). Wound, ostomy, and continence nurses are available in our Agency to help our patients and families to learn how to care for their ostomy. Caring for the ostomy Our nurse will help to keep patients quality of life, and understanding how to care for their ostomy that will help them live comfortably with it. The Patient’s Physician must confirm the ostomy caring order/procedure bellow. When the patients have an ostomy, urine leaves their body through the stoma instead of the urethra. Since there is no muscle around the stoma, the patients are not able to control when urine passes out of their body. An odor-proof plastic pouch (ostomy pouch) surrounds the stoma to collect the urine and is held to their skin with an adhesive. Pouching systems may be one-piece or two-piece. Pouching systems In a two-piece system, the pouch and barrier (sometimes called a flange or wafer) are separate. The pouch contains a closing ring that attaches it to the barrier. This is generally a snap ring, similar to those found on food storage containers. The barrier fits around the stoma and sticks to patient’s skin. In a one-piece system, the pouch and barrier are a single unit. Both two-piece and one-piece pouches can be either drainable or closed. These systems also contain a special valve or spout that adapts either to a leg bag or to a night drain tube connected to a special drainable bag or bottle. Drainable pouch. Place toilet paper in the bowl to prevent splashing. Patient must sit down with the pouch between their legs. The pouch is usually held shut with a clip system. Simply unclip it and allow its contents to fall into the toilet. Clean the end of the pouch with toilet paper and reclip it. (Teach patient the procedure) Closed pouch. Unsnap the pouch from the barrier and dispose of it. Do not flush it down the toilet. Putting the pouch in a Ziploc bag reduces odor. You then need to attach a new pouch. (Teach patient the procedure) Replacing ostomy pouch If the patient has a drainable pouch, usually is needed to replace it every 4 to 7 days (as ordered) or whenever there is a leak in the pouch or itching or burning under the barrier. If has a closed pouch, replace it when it is one-third to one-half full. Prepare the new pouch and barrier. Cut an opening in the new barrier slightly larger than the stoma. You may also have a precut barrier. If the patient has a two-piece system, snap the pouch to the barrier. Remove the paper backing from the barrier so that the adhesive is Home Health Agency Nursing Care & Procedures K-197