W4 · Difficulty caring for a stoma
Actual Wounds and skin
Definition
The person or carer struggles to manage a stoma and its appliance.- New ostomy
- low confidence
- skin problems
- poor appliance fit
- Leaks
- skin irritation
- fear
- poor technique
📋 Scenario
A new colostomy patient cannot change the bag.
Subjective (S): "I don't know how to change the bag."
Objective (O): New colostomy; leaks; skin irritation; afraid.
Assessment tools for this scenario: CP-SKIN Skin & Wound Score
Validated scales to consider: Braden Scale, TIME wound chart
**CarePath diagnosis:** Difficulty caring for a stoma related to new ostomy, as evidenced by leaks and skin irritation.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Teach and practice. | Showing the steps and letting her practice with guidance builds skill and confidence and prepares her for care at home. |
| Check skin. | Checking the skin around the stoma finds irritation early so it can be treated before it breaks down. |
| Use a skin barrier. | A skin barrier protects the skin from stool and adhesive, which reduces irritation and helps the appliance seal. |
| Support emotionally. | Fear and shame are common with a new stoma, and emotional support helps her accept it and take part in care. |
| Refer to a stoma nurse. | A stoma nurse has specialist knowledge to check fit, solve leaks and give ongoing advice. |
**Expected outcomes**
- Within 1 week: changes the bag correctly, skin intact, says she feels confident.
**Linking the data to the diagnosis**
The patient says, 'I don't know how to change the bag.' She has a new colostomy, leaks, skin irritation and is afraid. The difficulty is already present and causing skin harm, so this is an actual problem. It rests on the new ostomy, with leaks and skin irritation as evidence. The plan aims, within 1 week, for her to change the bag correctly, keep the skin intact and say she feels confident.
CarePath diagnosis
Difficulty caring for a stoma related to new ostomy, as evidenced by leaks and skin irritation.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Teach and practice. | Showing the steps and letting her practice with guidance builds skill and confidence and prepares her for care at home. |
| 2. Check skin. | Checking the skin around the stoma finds irritation early so it can be treated before it breaks down. |
| 3. Use a skin barrier. | A skin barrier protects the skin from stool and adhesive, which reduces irritation and helps the appliance seal. |
| 4. Support emotionally. | Fear and shame are common with a new stoma, and emotional support helps her accept it and take part in care. |
| 5. Refer to a stoma nurse. | A stoma nurse has specialist knowledge to check fit, solve leaks and give ongoing advice. |
Expected outcomes
- Within 1 week: changes the bag correctly, skin intact, says she feels confident.
Linking the data to the diagnosis
The patient says, 'I don't know how to change the bag.' She has a new colostomy, leaks, skin irritation and is afraid. The difficulty is already present and causing skin harm, so this is an actual problem. It rests on the new ostomy, with leaks and skin irritation as evidence. The plan aims, within 1 week, for her to change the bag correctly, keep the skin intact and say she feels confident.