What post-op management would you provide to a patient following surgery and placement of a colostomy or ileostomy? What findings would be abnormal and need to be reported?

In caring for a patient after stoma surgery, the nurse should assess and properly monitor the patient. The following needs are things that needs to be observed and reported, if indicated:

• Stoma size and swelling - stomas are usually edematous postoperatively but is expected to reduce 8 week after surgery. Stoma should be pink or red in color. If the stoma color is dark, the attending physician would need to be informed since this may indicate ischemic change and the tissue may become necrotic.
• Temperature - stoma is touched through the appliance and confirm that the temperature is the same as the rest of the abdomen. Other vital signs such as the pulse, blood pressure, and respiration should also be observed. Any abnormal findings should be reported as this may point to sepsis which risk is increased after a surgery.
• Pain management - postoperative pain is expected and should be managed accordingly. If the patient complains of any pain despite administration of pain medications, then an evaluation is warranted.
• Stoma output - the output of a stoma varies depending on the location. The output should be closely monitored. In colostomy, hemoserous/serous fluid is passed for a few days, changes to flatus or liquid stool. It would be like toothpaste in consistency or slightly firmer. In ileostomy, a bile-stained fluid is seen almost immediately postop. Output sometimes may be high and the patient may become dehydrated. Once carbohydrates are introduced in the diet, it becomes porridge-like in consistency. Any deviation from expected stoma output should be reported to the surgeon.
• Early complications - Postop complications should be watched out for in all patients who have undergone stoma surgery. A common complication is mucocutaneous separation, postop infections, and sepsis. Report immediately if there is any noted abnormal findings during postop assessments.
• Patient education - Patients should be counselled regarding proper stoma care including on how to change stoma appliance, how to clean it, and how to identify abnormalities in the stoma.