Nursing care
Ostomy Care: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Ostomy care nursing management centres on fitting the appliance's opening to the stoma's exact size and shape, then monitoring the surrounding skin for breakdown, the complication patients most often present with. The nurse assesses stoma colour and output, protects periwound skin, and teaches the patient or carer to manage the pouch independently before discharge.
When it is done and why
A stoma is created surgically to divert stool or urine when the normal route is obstructed, diseased, resected, or needs to rest, as after colorectal cancer surgery, inflammatory bowel disease, trauma, or bladder cancer. It may be temporary, planned for reversal once the bowel heals, or permanent when the diverted segment has been removed entirely. Nursing involvement starts before surgery and continues for as long as the patient lives with the stoma.
Ostomy care as a nursing responsibility means keeping the stoma viable, the surrounding skin intact, and the patient able to manage independently. The appliance, pouch and adhesive skin barrier together, is fitted precisely to the stoma opening because a poor fit is the single most common cause of the complications nurses see day to day. Too large an opening exposes skin to stool or urine; too small compresses the stoma itself.
Preparing the patient
Before surgery, ideally, a wound ostomy continence nurse marks the stoma site with the patient sitting, standing and lying, avoiding skin folds, the waistline, bony prominences and old scars so the appliance can seal reliably once healed. Where preoperative siting hasn't happened, postoperative teaching has more ground to cover from a standing start.
Assess the patient's manual dexterity, vision and cognition, all of which affect how they'll manage the appliance themselves, and their emotional response to the stoma, which varies enormously and shapes how much teaching can land in a single session. Explain what a stoma looks and feels like before the first dressing reveal if possible; stool without pain and without voluntary control is a genuinely disorienting change for most patients to process.
The steps that matter for safety
Cutting the appliance's skin barrier to match the stoma is the step that prevents the most problems downstream. Measure the stoma with a sizing guide at each change in the early postoperative period, since a new stoma shrinks as swelling resolves over the first six to eight weeks, and cut the opening no more than an eighth of an inch larger than the stoma itself.
Cleanse the peristomal skin with water alone, no soap residue and no alcohol-based wipes, since both interfere with adhesion and irritate skin already at risk. Dry the skin completely before applying the barrier; moisture under the adhesive is the fastest route to leakage. Apply skin barrier paste or rings to fill any uneven contours around the stoma base so stool can't track under the wafer and sit against skin.
During the procedure — the nurse's role
Assess the stoma itself at every appliance change: it should be pink to red and moist, similar to the inside of the cheek. A pale, dusky, purple or black stoma signals compromised perfusion and needs immediate reporting, it is not something to document and revisit later. Note stoma height and whether it protrudes appropriately or is flush or retracted, since a flush stoma is harder to pouch securely.
Observe output volume, colour and consistency against what's expected for that stoma's location; a new ileostomy putting out over 1500 mL a day risks dehydration and electrolyte loss and needs escalation. Empty the pouch when it's a third to half full rather than waiting for it to be heavy, since a full pouch is more likely to pull away from the skin and leak. Involve the patient in each step as soon as they're able, since the goal is their independence, not the nurse doing the task for them indefinitely.
After: monitoring and complications
Peristomal skin breakdown is the complication patients most often present with, and it is nearly always traceable to leakage under a poorly fitted or poorly sealed appliance. Look for erythema, denuded skin, or a fungal rash with satellite lesions from chronic moisture, and correct the fit or barrier product rather than just treating the skin in isolation, since the skin will keep breaking down if the seal keeps failing.
Other complications to watch for include stomal necrosis, retraction, prolapse where the bowel telescopes outward, and parastomal hernia. Report a stoma that has changed colour, stopped producing output for an unexpected stretch, or that has visibly enlarged or changed shape since the last check. Blockage, common with ileostomies and high-fibre or poorly chewed food, presents as cramping, no output, and a swollen stoma, and needs prompt assessment.
Documentation and teaching
Document stoma colour, size, height, and output characteristics at each assessment, along with periwound skin condition and the appliance product used, so trends are visible to the next clinician rather than buried in narrative notes. Photograph per facility policy when skin changes are significant enough to track.
Before discharge, the patient or carer should be able to empty and change the appliance independently, identify the signs of complications that need a call to the ostomy nurse or provider, and know where to get supplies. Cover dietary adjustments relevant to the stoma type, gas- and odour-producing foods for a colostomy, hydration needs for an ileostomy, and give contact details for a wound ostomy continence nurse for follow-up, since ongoing support materially improves how well patients adapt.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our basic care and comfort practice questions are the closest set to what this page covers.
One question from the basic care and comfort set
A nurse is preparing to feed a client who had a stroke and has mild dysphagia. Which action best reduces the risk of aspiration?
Rationale
Upright at 90 degrees with a chin tuck narrows the airway entrance and directs the bolus toward the esophagus — it is the single highest-yield positioning intervention for dysphagia. Thin liquids and straws move fastest and aspirate most easily, side-lying removes the gravity you want, and large bites overwhelm a swallow that is already impaired.
Answer: B
Common questions
How do I know if an ostomy appliance is cut the right size?
Measure the stoma with a sizing guide and cut the barrier opening no more than about an eighth of an inch larger than the stoma. Too tight compresses the stoma, too loose exposes skin to output; both increase the risk of leakage and breakdown, so remeasure regularly while the stoma is still shrinking after surgery.
What does a healthy stoma look like?
A healthy stoma is pink to red and moist, similar in colour to the inside of the cheek, and may bleed slightly when touched since it's highly vascular. Pale, dusky, purple or black colouring indicates compromised blood supply and needs urgent reporting.
How often should an ostomy pouch be emptied versus changed?
Empty the pouch when it's a third to half full, which for most patients is several times a day. The full appliance, wafer and pouch, is typically changed every three to seven days depending on the product and skin condition, or sooner if leakage occurs.
What causes skin breakdown around a stoma?
Most peristomal skin breakdown comes from stool or urine leaking under a poorly fitted appliance and sitting against the skin. Fixing the underlying fit or seal, not just treating the irritated skin, is what stops it recurring.
When should a patient with a new ileostomy call about output?
High output, generally over 1500 mL in 24 hours, or no output for several hours with cramping and a swollen stoma, both warrant a call. High output risks dehydration and electrolyte imbalance; absent output can signal blockage.