COCN cheat sheet

A healthy stoma is rose-red to pink and moist; dusky, bluish, or black mucosa signals ischemia or necrosis and requires immediate surgeon notification.

Measure the stoma at its base with a measuring guide and record width and height separately for oval stomas; remeasure at each pouch change for the first 6-8 weeks as edema resolves.

Expected 24-hour output: ileostomy roughly 500-1,200 mL, colostomy roughly 200-600 mL (formed), urostomy urine roughly 1,500-2,000 mL; ileostomy output above 1,500 mL/day is high output.

Effluent character by site: ileostomy is liquid to pasty and enzyme-rich (corrosive to skin); transverse colostomy is semi-formed; descending and sigmoid colostomy effluent is formed.

The Ostomy Skin Tool DET score grades peristomal skin on Discoloration, Erosion/ulceration, and Tissue overgrowth, each 0-5 (total 0-15); 0 = intact healthy skin.

Peristomal candidiasis presents with satellite pustules; pseudoverrucous hyperplasia follows chronic moisture exposure; folliculitis follows hair traction from adhesive removal.

Urostomy urine normally contains mucus strands from the bowel segment; alkaline urine raises risk of skin irritation and encrustation, so hydration and acidification are assessed.

Preoperative assessment covers diagnosis and planned procedure, abdominal contour in supine, sitting, and standing positions, scars, creases, body habitus, vision, manual dexterity, cognition, and support system.

Stoma site marking is done with the patient supine, sitting, and standing; the site sits over the rectus abdominis, away from the waist crease, umbilicus, scars, bony prominences, skin folds, and pannus infold, and within the patient's sight and reach.

Typical sites: ileostomy right lower quadrant; sigmoid colostomy left lower quadrant; transverse colostomy right upper abdomen; ileal conduit urostomy right lower quadrant.

Stoma edema peaks around postoperative day 2-3 and resolves over 6-8 weeks, so the pouching aperture must be recut as the stoma shrinks.

Check stoma color every 4 hours for the first 24 hours postoperatively, then per institutional protocol; dusky or black mucosa is reported immediately.

First stool: ileostomy usually within 1-3 days; colostomy often 3-5 days; delayed return with distension and nausea suggests ileus or obstruction.

Enhanced recovery (ERAS) elements: carbohydrate loading, no routine nasogastric tube, opioid-sparing analgesia, early ambulation, and early oral intake.

A Brooke end ileostomy everts and sutures mucosa to skin, forming a spout; mucocutaneous separation is managed with powder or a cohesive seal and by avoiding firm convexity over the defect.

Postoperative teaching progresses from observing and emptying the pouch, to assisting with changes, to independent self-care, typically by discharge or within 6-8 weeks.

Ureteral stents placed with an ileal conduit are generally removed around postoperative day 7-10; urine may be blood-tinged and contains mucus.

Cut the barrier opening about 2-3 mm (1/8 inch) larger than the stoma base; a larger opening exposes skin to effluent and causes denudation.

Standard-wear barriers suit formed colostomy stool; extended-wear barriers resist erosion longer and suit liquid effluent from ileostomies and urostomies.

Convexity is indicated for flush or retracted stomas, creases, and folds; it is avoided over ischemic or necrotic tissue, mucocutaneous separation, active bleeding, or severely fragile skin.

Barrier paste is a filler that caulks creases and uneven skin; it is not an adhesive and does not substitute for a correctly sized barrier opening.

For weeping denuded skin, dust stoma powder on the moist area, seal with no-sting barrier film, and repeat (crusting technique) before applying the pouching system.

Empty a drainable pouch when it is one-third to one-half full; a full pouch adds weight, pulls the seal loose, and increases leakage risk.

Typical wear time is 3-7 days for a well-fitting system; shorten it when itching, burning, or leakage occurs, because leakage of effluent under the barrier is the leading cause of peristomal skin injury.

Avoid alcohol-based products, oils, and lotions on peristomal skin; use adhesive remover wipes to prevent mechanical stripping during pouch changes.

Irrigation is an option only for descending or sigmoid colostomies with formed stool; it is never used for ileostomies or urostomies.

Closed-end pouches suit formed colostomy output; drainable pouches suit ileostomies; urostomy pouches have a spout and antireflux valve and connect to a night drainage bag.

Teaching is matched to readiness, health literacy, vision, dexterity, and cognition; short sessions with demonstration and teach-back confirm psychomotor competence before discharge.

Psychosocial screening addresses body image, mood, intimacy, social isolation, and work plans; positive findings trigger referral to social work, sexual health counseling, or mental health.

PLISSIT is a tiered model for sexual concerns: Permission, Limited Information, Specific Suggestions, and Intensive Therapy, with referral when needs exceed nursing scope.

Ileostomy diet guidance: chew thoroughly, eat small frequent meals, limit high-fiber and gas-forming foods initially, and drink 2-3 L of fluid daily with added salt to offset sodium loss.

Odor-reducing foods include yogurt, buttermilk, and parsley; odor-increasing foods include fish, eggs, onions, garlic, and asparagus.

Gas-forming sources include carbonated beverages, beer, chewing gum, smoking, and swallowed air from drinking through straws.

Lifting is commonly restricted to about 10-15 pounds for 6-8 weeks postoperatively; a support belt or hernia prevention garment is used with return to heavy activity.

Travel planning: carry at least twice the usual supplies in carry-on luggage, keep a provider letter, and presize barriers in case checked baggage is delayed.

Bathing and swimming are permitted with the pouch in place; change the pouch before swimming and secure edges with waterproof tape.

Community resources include the United Ostomy Associations of America (UOAA), peer support groups, and scheduled ostomy nurse follow-up.