Assessment and Patient Evaluation
What to assess
Begin with the whole patient, then focus. Document stoma type (end, loop, double-barrel), location, shape, diameter measured at the base at rest, height, color, moisture, mucosal integrity, and the mucocutaneous junction. Assess peristomal skin with the DET score (discoloration, erosion, tissue overgrowth) and note moisture, creases, scars, hernias, bony prominences, and the belt line in lying, sitting, and standing positions. Record output: stool or urine, consistency, volume, frequency, gas, odor, and pouch wear time. Evaluate patient factors that determine the plan: dexterity, vision, cognition, mobility, nutrition, medications, comorbidities, BMI, caregiver support, finances, culture, sexuality, quality of life, and readiness to learn.
Traps
Common errors include measuring a contracting stoma or including the mucosa rather than the base; calling peristomal redness “irritation” without DET scoring and treatment; forgetting that a loop stoma has two openings and may produce two streams; missing high-output ileostomy (>1.5 L/day), which raises dehydration and AKI risk; and assessing only the stoma while ignoring the pouching system, skin under the barrier, and the patient’s self-care ability.
Rule of thumb: assess at every pouch change and whenever there is a problem; use good light, a mirror for hard-to-see stomas, and document stoma size plus DET.
Worked example: a patient has a 35-mm ileostomy, a ring of moist denuded skin under the barrier, and 1.8 L/day output. Do not simply upsize the pouch. Measure at the base, cut the opening 2–3 mm larger, treat moisture-associated skin damage with stoma powder sealed by barrier film, and evaluate hydration and antimotility management.